Fight over health care just getting started

The fight for health care is far from over.

Last week, President Trump and Republican leaders in the U.S. Congress suffered a humiliating defeat when they were unable to muster enough support to pass the American Health Care Act.

Lacking support from moderates and conservative Republicans — and from the public — Speaker of the House Paul Ryan was forced to pull the bill from the floor without ever taking a vote.

For seven years Republicans have been at war with the Affordable Care Act. They weaponized the law against Democrats and spewed a mix of misleading facts and outright lies about the law’s effectiveness.

Voters rewarded the Republicans because they really are frustrated with the health care system. But the cure Republicans offered would have made those frustrations even worse, and they would have cost 24 million people their health insurance.

While Obamacare is far from perfect, it did expand health care coverage to millions of people through a combination of subsidies and Medicaid expansion. The uninsured rate in the United States is at historic lows. And the quality of the insurance people have has gotten better, as policies are required to provide essential benefits for things such as maternity care, prescription medicine and health screenings.

Republicans, Trump included, now say they are ready to move on to tax reform. Ryan went so far as to say that Obamacare would remain the law of the land for the “foreseeable future.”

Don’t believe it.

When Trump and Ryan talk about tax reform, they aren’t really talking about making the tax system better, simpler or more efficient.

House Speaker Paul Ryan discusses the demise of the American Health Care Act. Jonathan Ernst | Reuters

Their top priority isn’t working people and the taxes that are taken out of their paycheck every two weeks. Their priority is to slash taxes for the wealthy.

Inside the Republican caucus there are real divisions about taxes, just like on health care. Ideas such as a border adjustment tax or tariffs are controversial, and there are deficit hawks who could demand that any changes in the tax code actually be paid for.

And that’s how we end up right back to health care.

The AHCA was built upon the pillar of providing huge tax cuts to the country’s richest people by devastating Medicaid. The AHCA would have cut $880 billion — that’s “billion” with a “b” — out of the program that provides health insurance to children, people with disabilities and older Mainers.

The bill also destroyed the federal-state partnership that funds the program by adopting per-capita caps or block grants, which would have further eroded federal support for health care.

Republican leaders, including Gov. Paul LePage, are perfectly comfortable taking life-saving health care away from people. They’ve done everything they can nationally and in Maine to ratchet down coverage.

It’s mean-spirited, and it’s bad policy.

But it’s also the only place in the federal government outside of defense spending that they can find the money they need to pay for tax cuts for the wealthy.

Progressives, moderates and anyone who believes everyone should have access to health care have the right to celebrate the demise of the AHCA last week. The calls they made to congressional offices, the protests, the letters to the editor — frankly, the honest pleas for help — made a real difference.

They may have literally saved the lives of thousands of people who would have lost health care. And they certainly moved members of Congress to do the right thing.

But the fight is far from over.

Republican leaders will try again, and you can bet that any plan to rewrite the country’s tax laws will once again come for Medicaid and the coverage that the program provides to 265,000 Mainers.

There’s a lot at stake for our communities and our state.

But we also have to remember there’s a lot at stake for Republicans. They’ve made a lot of promises. And there will be tremendous pressure from their base and from their funders for them to deliver.

That’s going to require us all to redouble our efforts to hold the line, particularly around health care.

After all, at least in the House, it wasn’t the devastating cuts to Medicaid that kept the most conservative members from supporting the AHCA. They were perfectly willing to strip health care away from millions of people. It was the fact that the AHCA wasn’t more draconian that kept them away.

Imagine: 24 million people without health insurance wasn’t enough pain and suffering.

Planned Parenthood, Medicaid, Medicare. They’re all still in Republicans’ sights. The fight over health care is far from over.

David Farmer

About David Farmer

David Farmer is a political and media consultant in Portland, where he lives with his wife and two children. He was senior adviser to Democrat Mike Michaud’s campaign for governor and a longtime journalist. You can reach him at