The Republican attempts to repeal the Affordable Care Act and replace it with something that covers fewer, is more expensive, undermines Medicaid, and gives big tax breaks to the wealthy has failed. Senate leader Mitch McConnell brought several pieces of legislation to a vote, including the so-called “Skinny Repeal” — the last ditch effort to find a lowest common denominator that 50 Republicans would vote for. This post reviews what was in the top-secret Skinny Repeal bill and talks about how Rob Portman voted on all of the major Republican health care legislation.
What Was in the Skinny Repeal Bill?
It’s important to be aware of what was in the Skinny Repeal bill, even though it failed, because these Republican ideas keep turning up like bad pennies and resurrecting like zombies. So here is a run-down:
- repeal the individual mandate: the individual mandate is probably the least popular part of the ACA, but it is also vital to keep costs low. There needs to be some mechanism to get the young and healthy into the market to offset the costs for the sick. Simply repealing the mandate with no incentive for the young and healthy to enter the market will severely destablize the individual healthcare markets— even insurance companies have said so.
- suspend the employer mandate for 8 years: this mandate affects companies with 50 or more employees, requiring them to provide health insurance. The result, of course, could be more people without insurance turning to the individual markets. Those markets would be more expensive (see 1 above).
- defund Planned Parenthood: though this bill eliminated many of the aims of the more robust attempts, this wrong-headed provision to defund Planned Parenthood remained. It can’t be said too often: no federal funds go towards abortion. Ever. It’s illegal. So, all provisions like this do is prevent women from getting needed, affordable health care like birth control, cancer screenings, and breast exams. (Note to GOP: since 2 of the three votes you lost were female Senators, maybe you should start paying attention to the healthcare needs of literally half of the population!)
- allow states to waive out of EHB and spending limits: the ACA requires all insurance plans to cover 10 Essential Health Benefits — things like maternity care, mental healthcare and emergency services — and the ACA caps the out of pocket costs by individuals for healthcare. Allowing states to waive out of these requirements could have obvious negative effects. Though waivers are not supposed to have negative effects, once they are granted, they last for 8 years and cannot be terminated, even if they cause people to be priced out of the market or lose essential care.
- increase the contribution limit for Health Savings Accounts (HSAs): Republicans talk a lot about these savings accounts as if they are the answer to the problem of healthcare in America. But while these accounts are great tax shelters for those who have enough income to save, they are of little use to the vast majority of Americans who cannot afford to set aside large amounts of each paycheck in these accounts.
So, though in this version Republicans gave up on gutting Medicaid and giving huge tax breaks to the wealthiest Americans, they were still aiming to do plenty of harm. The CBO estimates that this bill would cost 16 million Americans their health insurance immediately, and that the premium costs in the individual market would increase by 20 percent each year between 2018 and 2026.
How Did Rob Portman Vote?
There was a dizzying array of votes over the past couple of days on healthcare. Here is how Rob Portman voted on the main attempts:
- Procedural vote to open debate on the health care bill: YES (passed 51-50, with VP Pence casting the tie breaking vote)
- Vote on Repeal and Replace option: YES (failed 43-57)
- Vote on Repeal now, Replace later: NO (thank you! failed 45-55)
- Vote on Skinny Repeal: YES (failed 49-51)
So, Rob Portman was definitely not a profile in courage on this issue, but did have a red line when it came to repealing the law without a clear replacement. He certainly deserves a THANK YOU for that, but it’s also important to remind him that people want better healthcare, not tax breaks for the wealthy, meaningless political points for the Republican party, and attacks on the social safety net. He should work with Democrats and anyone else who wants to fix the problems — costs in the individual market, continue to increase coverage for all Americans — not to create new problems with disingenuous bills.