“Disturbing.” “Tragic.” “Extraordinarily troubling.” “Disconcerting.” “Sad.”
Those are just some of the words original architects of the Affordable Care Act used in interviews with The Huffington Post to describe the effort by President Donald Trump and congressional Republicans to speed through a bill to repeal major parts of the law and “replace” it with a more meager set of health care reforms.
It’s easy to see why key figures behind the biggest expansion of the social safety net in decades would be aghast at what’s happening now. On Thursday ― seven years to the day since President Barack Obama signed the Affordable Care Act into law ― the House is tentatively scheduled to advance its repeal measure.
“More people are going to get hurt under the Republican version than under the ACA. They may not like the ACA, but we could certainly work on it and improve it,” said former Sen. Max Baucus (D-Mont.), who chaired the Finance Committee during the period the Affordable Care Act passed Congress. The legislation that emerged from the committee in September 2009 formed the backbone of the eventual law.
“But they’re going to hate the Republican version,” Baucus continued, “because it’s going to give much more benefits to the wealthy at the expense of others, and a lot of people are going to get hurt along the way.”
If House Speaker Paul Ryan (R-Wis.) and the White House succeed in this gambit ― a far from certain prospect, given major schisms among Republican lawmakers about the bill ― the consequences would be significant.
A law that extended coverage to 20 million previously uninsured people and reduced the national share of Americans without health coverage to its lowest-ever percentage would be throttled. Almost $1 trillion in money currently financing health benefits for low- and middle-income households would be diverted for tax cuts on the wealthy and health care companies.
In the process, if the Affordable Care Act does not remain in place, 24 million more people would lack health coverage a decade from now, according to a Congressional Budget Office review of the legislation approved by three House committees this month.
“We Americans have to ask ourselves: Are we in this together or are we not?”
Older Americans, especially those with less income, would exit the health insurance market because they wouldn’t be able to afford policies, the CBO projected. States would lose $880 billion in Medicaid funding, forcing cutbacks to that program. House leaders have made changes to the bill since that analysis, but do not have a new CBO score yet.
“We’re in a very tough spot, and it’s sad. It really is very sad. But what do we do about it? People who care about all this have to just keep presenting the facts,” Baucus said.
And the Democratic Party’s decades-long mission to strengthen the social safety net, dating back to President Franklin Roosevelt’s New Deal, would suffer a major setback.
“It really comes down to an attitude. We Americans have to ask ourselves: Are we in this together or are we not?” asked Baucus, who served six terms in the Senate before becoming Obama’s ambassador to China from 2014 until Trump’s inauguration.
“The Republican bill answers that question by saying, no, we’re not in this together, that insurance is really available for those who can afford it and is not really as available for those who can’t afford it. The sort of underlying basis of the ACA was: We’re in this together, we’re all Americans,” Baucus said.
Kathleen Sebelius, who served as Obama’s secretary of health and human services from 2009 to 2014, is worried about the people she’s encountered who would be worse off under the House Republican bill.
“I am really troubled to my soul and very disturbed about what is going to happen to the people I meet on a still-regular basis who tell me about their family situation, about their stories, about their worries that ― whether it’s themselves or their children or their parents who finally have some health security, who finally have a sense that they can count on affordable health coverage ― now this is going to be swept away,” Sebelius said.
“I find it extraordinarily troubling that individuals are rushing to take away people’s health care, to shift costs onto people who are in difficult medical situations,” Sebelius said. “It’s hard to see who the beneficiaries are.”
Beyond the human cost, those who spent all of 2009 and one-quarter of 2010 writing the Affordable Care Act in Congress see a deep irony in GOP leaders’ rush to pass their repeal and “replace” bill within three months of Trump taking office.
“We spent more time going through the particulars of any bill in all of my years here,” said Rep. Sandy Levin (D-Mich.), who’s serving his 18th term in the House. Levin chaired the Ways and Means Committee during the final months of the Affordable Care Act debate in 2010.
When Baucus and other key lawmakers wrote their legislation, they held dozens of hearings and spent many days marking up and amending the bill in committee. By contrast, two House committees approved the Republican bill without a Congressional Budget Office analysis of its impact.
“I am really troubled to my soul.”
“It makes me very irritated, and it’s sad, because we were open, we Democrats were,” Baucus said. Accusations that Democrats rushed their bill by lawmakers who are now doing just that are adding “insult to injury,” he said.
The Finance Committee approved its version of the Affordable Care Act after eight days of debate, some of which stretched into the night. The Senate Health, Education, Labor and Pensions Committee spent even longer on the bill in June and July 2009.
The Finance Committee action came after Baucus ― with the Obama White House’s support ― spent months courting Republican senators, including Chuck Grassley (Iowa), Mike Enzi (Wyo.) and Olympia Snowe (Maine). In the end, all he got was Snowe’s vote in committee, before she opposed it on the floor two months later.
“As we were starting to put it together, regrettably, it became partisan. You just feel it falling away at the very end,” Baucus said. “Republicans saw a major political opportunity to try to demonize Obama, demonize the Democrats and all vote against it. And they’ve been demonizing the ACA every since.”
Even the lengthy committee work in 2009 understates the groundwork Democrats laid in Congress before Obama took office. “For two years, we worked on this. Worked very hard. Had all kinds of groups and subgroups. It was all nonpartisan. We all worked together,” Baucus said.
In 2007 and 2008, Baucus convened 14 hearings on health reform, plus eight more in 2009. Eight days after Obama won the 2008 presidential election, Baucus released a 98-page white paper laying out options for health care legislation. Before the election was even over, Sen. Edward Kennedy (D-Mass.), dying from a brain tumor, and his staff convened meetings with a wide array of interest groups that would be affected by health care reform.
The contrast with today’s proceedings is stark. At present, the Senate isn’t even planning committee action on the House bill and will take it directly to the floor if it passes the lower chamber.
“There is this sort of beat-the-clock mentality of ‘We have to fulfill campaign promises at any cost’ [that is] is very, very troubling in an area where there are real life and death consequences,” Sebelius said.
Levin is the last person who chaired a committee that passed a version of the Affordable Care Act who’s still in Congress, so he’s seeing all this firsthand. He still serves on the Ways and Means Committee and participated in its markup of the Republican health bill that went until 4:30 a.m.
Levin shares Baucus’ frustration about the alternative history told by Republicans opposed to the Affordable Care Act. As a sitting member of Congress, however, he is “absolutely determined” to use his position to push back, directly and in concert with voters and allied interests. “We’re in battle trim,” he said.
“What we need to do is to battle them here, but to combine resources, to coordinate, to organize,” Levin said. “What we need is just a massive outpouring. The people, I think, will speak and we need to help them speak out, to provide more and more opportunities and to organize.”