Advertisement

Other Voices: How to make sure the Senate's bill doesn't come back to life

WASHINGTON — Pushing off a vote on the horrible Senate health care bill (the Better Care Reconciliation Act) is a victory, but not cause for opponents of Trumpcare to let their guard down. They know all too well that the House bill came back from oblivion to pass by a slim 217-213 vote. How do they prevent a repeat?

The Washington Post reports that "progressive groups began laying the groundwork to attend senators' public events, while medical providers and groups representing Americans with chronic illnesses predicted that the bill could leave millions without access to adequate medical care." That's not all:

Advertisement

"CREDO Action, which had organized 45,000 phone calls to Senate offices, planned to increase that number when senators went home. NARAL, Planned Parenthood, MoveOn and Daily Action were organizing their own phone banks, while Indivisible groups were organizing visits — and perhaps sit-ins — at local offices.

"All of that would supplement under-the-radar but attention-grabbing TV ad campaigns from AARP, Protect Our Care and other progressive and industry groups. The goal, said activists, is to educate voters and break through to local media, which had not often put the development of the Senate bill on front pages or newscasts."

Let me start by observing that for a party tearing itself apart after last Tuesday's special election in Georgia's 6th Congressional District (which seems a year ago now), this is a much better place to be. Democrats can keep their base engaged and recapture their message as the party of the working and middle class.

A few words of advice may be useful.

First, these groups should ignore the hard-line conservatives. They will not be swayed by attacks from liberal groups; indeed, it will stimulate their tribal instincts, prompting them to rally around GOP leadership. It will be up to principled conservatives to hold Sens. Rand Paul, R-Ky., Mike Lee, R-Utah, and others to their promise not to create Obamacare-on-the-cheap.

Second, they should focus on the senators who did the right thing in opposing an atrocious bill because it hurt their states. Respectful but consistent pressure needs to be applied to remind them that whatever goodies the White House and Majority Leader Mitch McConnell, R-Ky., dole out, a bill that reduces subsidies to those in the exchanges (especially older and poorer Americans) and slashes Medicaid will never be acceptable. Voters should be urged to call, write and meet with the senators to express gratitude and to make clear the voters expect them to stick to their guns. Sens. Susan Collins, R-Maine, Rob Portman, R-Ohio, Dean Heller, R-Nev., Lisa Murkowski, R-Alaska, Shelley Moore Capito, R-W.Va., have acted responsibly when presented with the facts, namely the data on how the bill would affect their states. This is a mini-battle in those five states (and perhaps Louisiana as well) where figures and situations applicable to each lawmaker's state remain uppermost in their minds. The unpopularity of Trump in their states should also be emphasized.

Third, governors must get into the game. We've seen bipartisan groups of governors come together to raise opposition. Democratic Gov. John Hickenlooper of Colorado and Republican Gov. John Kasich of Ohio have been especially visible. Both publicly and privately they need to cajole their Republican senators not to put partisan loyalty above responsibility to their state constituents. No one should have any doubt that the bill is bad for their states. Governors should also volunteer to take Collins up on her offer to sit down and work out fixes. Perhaps governors can champion one simple principle: We cannot cut Medicaid to give tax cuts to the very rich. That principle should transcend party lines.

Fourth, Trumpcare opponents need to present real people who can speak to the hardships that would be visited upon seniors in nursing homes (and their children who would need to help foot the bills), parents of disabled children and the working poor who are on Medicaid. It is also essential to broaden the discussion to the larger population that receives health care from their employers. As the Congressional Budget Office found, "Under current law, the prospect of paying the employer mandate penalty tips the scale for some businesses and causes them to decide to offer health insurance to their employees. Thus, eliminating that penalty would cause some employers to not offer health insurance." CBO continues: "Similarly, the demand for insurance among employees is greater under current law because some employees want employment-based coverage so that they can avoid paying the individual mandate penalty. Eliminating that penalty would reduce such demand and would cause some employers to not offer coverage or some employees to not enroll in coverage they were offered." The one thing that can be said about Obamacare is that it essentially did not disturb employer-provided insurance (particularly since the "Cadillac tax" was postponed); Senate Republicans cannot say the same of their bill.

Fifth, don't forget about the senators who were cagey and quiet. Sen. Marco Rubio, R-Fla., represents a state with more retirees, some of whom depend on Medicaid for nursing care. Sen. Tom Cotton, R-Ark., represents a state that expanded Medicaid. Consider that "total enrollment in expanded Medicaid in Arkansas had reached 324,000 (about 7 percent of them were 'medically frail' and are covered by the state's traditional fee-for-service Medicaid rather than the Private Option). And by December 2016, there were 331,000 people enrolled in the state's expanded Medicaid. The state's total Medicaid enrollment (including the newly eligible population as well as people who were already eligible under the previous guidelines) grew by 70 percent from the end of 2013 to December 2016, reaching 948,181." Voting to cut Medicaid would deal a debilitating blow to his state's finances.

Finally, much as Democrats would like to tout the advantages of Obamacare, we are talking about persuading Republican lawmakers. It's a dodge for them to shift the discussion to Obamacare's faults when their own bill is worse. If anything, anti-Trumpcare advocates should be more honest and forthcoming about ways in which Obamacare's shortcomings can be remedied. Like it or not, the more anti-Trumpcare activists talk about President Barack Obama, the less chance Republican lawmakers opposed to Trumpcare will stick to their guns.

Rubin is a Washington Post columnist.

Advertisement
Advertisement