First it was great. Now it's mean. President Donald Trump seems to be changing his mind about the House-passed version of the American Health Care Act.
Mean is one word to describe a bill that would eliminate health insurance for anywhere from 13 million to 23 million people. You could add cruel since the legislation also allows states to remove coverage for behavioral health and substance abuse treatment services in the middle of opioid abuse and obesity epidemics; shrinks and eventually undermines the state-based Medicaid system, which provides essential coverage for 74 million poor, disabled and nursing home-bound citizens; and imposes large premium increases on people in the individual market who are older and sicker.
But what the president says about the AHCA isn't relevant in the drama that will play out over the next several weeks. His only role is to sign a bill-any bill-that the Republicans in Congress pass. He just wants something he can call a win, which, he will assure us, will be great.
That's why the healthcare industry is in a perilous moment. Senate Majority Leader Mitch McConnell is looking to cook up a compromise that can cobble together 50 votes before the July 4 recess. That's why he's having the bill written in secret without public hearings or a Congressional Budget Office score.
Contrast that behavior with the dozens of hearings held by the Democratically controlled Senate in the year before the Affordable Care Act passed. Every major interest group-hospitals, doctors, insurers, drug and device makers-had their chance to weigh in, as did leading Republicans such as Chuck Grassley of Iowa and Orrin Hatch of Utah, who won amendments in committee before voting against the final package.
This time, Democrats have been completely shut out of the picture. They are not being offered the chance to offer amendments. Nor have the Republicans working on the bill publicly responded to the opposition of virtually every major healthcare industry lobbying group, which until last week mostly took the form of public letters.
McConnell isn't going through the pretense of seeking a bipartisan bill because what he really needs is a fig leaf for moderates while remaining faithful to radical demands of the right wing of the Republican Party. That fig leaf could take the form of postponing the effective dates of the Medicaid transition, or holding on to some of the taxes to give more generous funding for high-risk pools.
No matter. The fundamental flaws at the heart of the legislation will remain. Anything that can pass the House during reconciliation will be a huge setback for the nation's healthcare system.
Last week, a coalition of eight healthcare groups including the American Hospital Association, the Federation of American Hospitals and the American Medical Association finally recognized that letters won't be enough. They launched a series of events to pressure moderate Republican senators in Colorado, Nevada, Ohio and West Virginia, which stand to lose the most if the ACA is repealed.
They should also flood the airwaves with advertising that dramatizes how this legislation will harm everyone, not just those immediately affected through lost coverage. Economists at the Milken Institute School of Public Health at George Washington University last week estimated that the AHCA will result in a loss of nearly a million jobs in the U.S. economy by 2026. States that expanded Medicaid-such as Ohio and West Virginia-would see the steepest losses since three-quarters of the lost jobs would be in healthcare.
They should also remind voters that their own employer-based policies will see steep price increases when the uninsured rate resumes rising. People without insurance get treated later and at greater expense. Those uncompensated care costs are eventually passed along to every paying customer.
No one will be immune to the grievous harm of the AHCA, even a milder Senate version.