Republicans scramble to defend healthcare reform despite party divide

Jon Swaine
Activists rally in Brooklyn in defense of the Affordable Care Act. Photograph: ddp USA/Rex/Shutterstock

The Trump administration claimed on Sunday that no Americans would lose money under the controversial Republican plan to overhaul healthcare, an extraordinary promise that experts have so far widely contradicted.

Tom Price, Trump’s health and human services secretary, told NBC’s Meet The Press that “nobody will be worse off financially” under the party’s Affordable Care Act replacement proposal, which has come under withering bipartisan criticism.

Analysts have concluded that the Republican plan, the American Health Care Act, would in fact drastically cut tax credits for many people who buy health insurance on the open market; allow insurance companies to charge older people more; and sharply cut Medicaid, the government program that provides free or low-cost healthcare to the poorest Americans.

Insurance industry figures have also warned that, by scrapping the government mandate that forces Americans to buy health insurance, the plan will push more younger and healthier people away from buying coverage, which would sharply increase prices for those who do.

At the same time, tax cuts within the plan would save people earning $1m a year or more about $157bn over the next ten years, according to the Joint Committee on Taxation, a non-partisan congressional panel.

Senator Bernie Sanders of Vermont, the former Democratic presidential candidate, said on Sunday that the Republican bill was an “absolute disaster” and “a disgrace” that had been put forward with a “cowardly” lack of transparency.

“What this has everything to do with is a massive shift of wealth from working people and middle income people to the very richest people in this country,” Sanders said on CBS’s Face The Nation.

The Congressional Budget Office, a non-partisan research office, is expected to say early next week in its “scoring” of the plan that the overhaul would also result in millions of people losing health insurance coverage.

Paul Ryan, the House speaker, claimed on Sunday that while “on paper” the Republican plan indeed appeared to provide coverage to fewer Americans than the existing Affordable Care Act (also known as Obamacare), ultimately the Republican plan would encourage more coverage by “lowering the cost”.

“But we’re not going to make an American do what they don’t want to do,” Ryan told CBS. “You get it if you want it. That’s freedom.”

The plan also continued to come under heavy fire from within the Republican party. Rightwing members of the House of Representatives complain that it does not go far enough in dismantling Obama’s system, while members of the Senate warn that it is too radical to pass the upper chamber.

Senator Tom Cotton of Arkansas, who has become one of the party’s most outspoken critics of the bill, said it “would have adverse consequences for millions of Americans” and had no chance of being passed by the Senate in its current form. Although far to the right of many of his Senate peers, Cotton said the plan could well be toxic for Republicans in the 2018 midterm elections.

“I’m afraid that if they vote for this bill, they’re going to put the House majority at risk next year,” Cotton said of his colleagues who control the lower chamber on ABC’s This Week.

Representative Mark Meadows of North Carolina, the chairman of the hardline conservative Freedom Caucus, told CNN’s State of the Union on Sunday that he and his colleagues were “not even close at this point” to supporting the Republican plan, which he said required significant alterations.

Republican governors, too, have moved against the plan. Ohio governor John Kasich, a former presidential candidate, flatly rejected Vice-President Mike Pence’s claim that the bill would give his state resources to “literally offer our most vulnerable citizens even better coverage”.

Appearing on NBC’s Meet the Press, Kasich was asked: “Is he right?”

“No, he’s not right,” Kasich answered, citing his state’s 700,000-person Medicaid expansion, which would be rocked by changes to coverage for mental health, drug addiction and chronic illness. “The bill needs a fix. The current system doesn’t work,” he said. “But you don’t want to throw the baby out with the bathwater.”

Mick Mulvaney, Trump’s budget director, told CNN the Republican proposal released last week was a “framework” to begin work. “But we encourage the House and the Senate to try and make the bill better.”

Mulvaney echoed the Republican leaders’ promises that healthcare costs would eventually fall, despite continued findings that the tax credits allowing millions of people to afford coverage would immediately shrink.

A report by the Kaiser Family Foundation, a healthcare nonprofit, concluded last week: “Generally, people who are older, lower-income, or live in high-premium areas (like Alaska and Arizona) receive larger tax credits under the ACA than they would under the American Health Care Act replacement.”

The Kaiser analysis estimated that a 60-year-old in a rural, Trump-voting West Virginia county, earning $30,000 a year, would face an $8,000 reduction in tax credits under the Republican plan. When reminded of this finding on Sunday, Price said this failed to take into account that the person in question should have more choice under the Republican plan’s marketization.

“Who knows what that 60-year-old wants? I know that the federal government doesn’t know what that 60-year-old wants,” said Price.

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