Sen., Lindsey Graham has said that if the Republican senators can't get agreement on the Senate health care bill withing two days, they should start working in a bipartisan basis with Democrats. Those who have publicly come out in favor of working with Democrats include Collins of Maine, Murkowski of Alaska, McCain of Arizona, and Johnson of Wisconsin, at least. MSNBC has come out with a scorecard of how Republican senators stand on the health care bill: eight "no," five "yes" and thirty-nine "undecided." Sen Ron Johnson has morphed from a "no" to "undecided," meaning that he has changed from a Profile in Courage to a Profile in Indecision.
At a meeting over lunch yesterday, divisions between moderates and conservatives were reported to have widened, not narrowed. Sen. John McCain (R-AZ) came out of the meeting comparing getting fifty votes for passage to pigs flying. Although it may be presumptive to call anyone a "moderate" in a political party that exerts such iron discipline, the divisions in the Republican Party are not strictly between ideological opposites, as some GOP senators are opposed to one or more provisions in the bill on their merits or workability, and some are very concerned to support a bill that is so enormously unpopular. Three recent polls have shown favorable ratings of twelve, sixteen and seventeen percent.
The Affordable Care Act has been unpopular as a whole since its enactment; the individual provisions have been very popular. When the Kaiser Family Foundation polled seven provisions of the bill separately, the only one that didn't get strong majority support was the individual mandate. Doing away with the individual mandate means that people who are healthy, no matter if they are young or not, have no incentive to buy insurance if they can't be denied insurance due to a preexisting condition. They can just wait until they are diagnosed with cancer, Type 1 diabetes, early-onset Parkinson's, or any of the myriad illnesses of the body or mind that require high-cost care, to buy health insurance.
If Senate Republicans were to make tax credits more generous to make insurance costs more affordable, they would deepen the ire of those who see tax credits as a new entitlement. If they were to abandon the steep cuts in future Medicaid funding, they would lose the support of those many Republican lawmakers -- especially in the House of Representatives -- who see steep Medicaid cuts as crucial to reducing future budget deficits. Putting more money into the bill as advocated by President Trump, increases the future budgetary deficit. The point here is that the Senate Republicans are boxed in by needing to avoid including ACA provisions and diverse priorities of their own members and Republican governors.
The Affordable Care Act is now being lambasted chiefly because of rising premium costs and insurers leaving the market; however, the positive good it has done is being completely ignored. It has greatly reduced the number of people without health insurance; it has reduced the number of people who are under-insured; and its preventive medicine features reduce high-cost medical treatment that would otherwise occur by catching problems in the bud.
Although premium costs have risen and continue to rise under the ACA, the Kaiser Family Foundation has found that premium costs were rising at a faster rate in time periods before the ACA was enacted. There was a time when those uninsured roughly equaled the number who were under-insured, a fact that the under-insured often learned only after they developed a serious medical problem. By requiring insurance policies to meet certain standards, the ACA has reduced the number of those under-insured.
Finally, the problem of insurers leaving the market has been caused in part by the instability President Trump has created by issuing contradictory statements about whether he will withhold subsidies for medical care providers.
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