Susanne Beechey on Health Care

Kate Grumbles

On March 24, 2017, House Republicans withdrew the American Health Care Act before it was put up for a vote. On Tuesday, March 28 Wire reporter Kate Grumbles spoke with Associate Professor of Politics Susanne Beechey about the bill’s implications.

What did you see as the main reasons for why the repeal of the ACA did not go through?

The main reason that the Republicans were not able to repeal the Affordable Care Act was because the Republicans couldn’t agree. They were not able to bring together their party in the House behind what one version of the repeal should look like. The failure to pass the bill through the House is an example of the diverse opinions in the Republican caucus around healthcare, and what the best form of government involvement in healthcare should be. Essentially, they ran into the same problems the Democrats had when trying to pass the Affordable Care Act, which is that it’s a really delicate political balance with lots of competing interests. The Republican speaker Paul Ryan wasn’t able to gather together the votes he needed to pass it. Republicans typically do a pretty good job of being able to wrangle the votes for the legislation that the party leaders are supporting, but part of why this is particularly hard with healthcare is because healthcare is really hard. It’s really complicated and the Affordable Care Act itself is a delicate balance of political compromises. As soon as the Republican stance moved from simply repeal, to repeal and replace, then they were putting themselves into that really difficult political contest around how you balance the competing interests and constituencies around healthcare. They weren’t able to find a compromise.

How stable is Obamacare in the long run? Do the assumptions that it will break down in the near future have any truth to them?

I think that’s a hard question, and there are multiple answers. My first answer is, I don’t know. I think there are problems with the Affordable Care Act. Certainly those problems are not going to be addressed and so there is an aspect here that is to wait and see, ‘what does that mean?’ I am less pessimistic than some who say that the whole thing is going to collapse in on itself. I don’t think that it’s going to collapse in on itself, but I do think that there are likely some particular constituencies that will find themselves falling through holes or trapped in no-win situations. I don’t think that the ACA is doing everything that I would like to see the state do for people, in terms of being able to get quality and affordable healthcare. I do think that there are folks who will be harmed by this ‘let it run its course,’ I also think overall it’s substantially better than repealing.

What would the major differences have been if Obamacare had been repealed?

We had the bill that was under debate in the house, but it didn’t pass. Part of why it didn’t pass was because they did not reach the compromise. I would not necessarily expect that it would pass through unchanged in the Senate. We still don’t know what a replace would look like, in that the replacement didn’t happen. We saw that there were some important provisions of the ACA that were kept in the Ryan bill, and there were some that were removed. But, that’s still in the world of repeal and replace. We haven’t lived in the world of simply repeal, so I think there’s speculation about what that would look like. We certainly know that some regulations would go away, we know that some people’s access to purchasing health insurance would go away. I think what happened last week was a sort of an affirmation that we’re not in the world of repealing, and we did not replace. So we’re in the world of the Affordable Care Act with an executive branch that’s tasked with implementing a law that it’s not fully in support of. I’m less concerned about what it means to repeal, and I’m more concerned about … how [the ACA] will change from the Obama administration to the Trump administration. That’s another way in which administrations can change the meaning of laws by changing what they’re doing or not doing with regard to implementation. We may see some chipping away or atrophying.

Does this failure to repeal the ACA signal a change in the power dynamic between the Republicans and Democrats in the House?

I think of what happened with the healthcare bill more as a loss for the Republicans than a win for the Democrats. It wasn’t so much that the Democrats stopped the Republicans from doing what they wanted to do, it was that the Republicans couldn’t get on the same page to agree what it was they wanted to do. I think it signals that some of the concerns that folks had immediately after the election with the President of the same party of the House and Senate majority that situation would result in this railroading of legislation through–what we’re seeing is that these are still political processes and there are still political compromises to be made. I think we’ll have to see, it may have emboldened the Democrats to hold firm together in moments when their opposition can stop something that the Republicans want to push through, but this was not a case of the Democrats holding firm and stopping the Republicans. This was a case of the Republicans not coming together. I think where we’re going to see an opportunity for the Democrats to hold firm together is in the Senate around the Supreme Court nomination. There, the Democrats are seeking to stop the confirmation from going through. I think that’s the place where we’ll see Democrat action or inaction mattering.

What happens next for healthcare in the U.S.?

I don’t think that we’re done debating health care in the U.S., I think that the conversation is likely going to turn to Medicaid and maybe Medicare, although there’s substantial political support for Medicare. I think that’s a more difficult one to take on. There’s still very real questions about costs and access and affordability that continue to be really important. I think we should remember that Affordable Care Act is one piece of the health care infrastructure of the federal government. Medicaid and Medicare are also parts of that infrastructure. Medicaid I think is likely the place where the debate will go next. I think more broadly, we’re going to continue to talk about healthcare, and particularly access to quality healthcare and affordability of insurance and healthcare. I think the Affordable Care Act was a compromise and my sense is that the federal government will need to come back to that compromise at some point, but it looks like that’s not going to be in the near future.