What’s Next For Ryancare

As Larry David once said “A good compromise is when both parties are dissatisfied.”

By that measure, the new health care bill is a great compromise. The bill, called the American Health Care Act (“AHCA”), is the long-awaited Republican plan to repeal and replace the Affordable Care Act (“ACA”), which Republicans often refer to as Obamacare. The new plan was released this week and is already facing a range of criticisms from all sides.

So far the list of those dissatisfied with the bill includes, but is not limited to, Republicans who think the new bill is too similar to the ACA, Republicans who are worried about constituents losing coverage under the new bill, Democrats, advocates for family planning and women’s health, people who want health insurance to be affordable, those who want to ensure the elderly have access to health coverage, millions who would lose coverage under the plan, hospitals, and doctors. In spite of this, House Speaker Paul Ryan has claimed that he has “no doubt” the AHCA will pass. And it might, but it’s going to be a hard sell, especially since Ryan came to power as speaker on the promise of bottom up leadership that listened to the voices of his fellow Republicans, rather than just telling them to get in line behind policy. Right now many of those Republican voices are not happy and even if Ryan could get them all in line behind the bill there is still formidable opposition from others.

If Ryan and the other crafters of the bill decide to stick with this version, it seems destined to become an intractable conflict that consumes much of the next legislative year, probably to the detriment of other legislation. In order to avoid that, they will need to come up with a new plan. And if they want that plan to succeed, they will probably need to make a definitive choice between universal health coverage or not. Both the ACA and the AHCA tried to hedge their bets on this and please both sides. The ACA mandated health insurance and the AHCA would encourage health insurance, but both plans still let private companies compete selling coverage to individual Americans. Neither plan satisfies those who want truly universal health coverage or those who want the government uninvolved in health coverage and these failed attempts at compromise are weaknesses for both plans.

Choosing to simply repeal the ACA and go back to the old system would have a lot of disadvantages, especially leaving millions and millions of Americans without health coverage, again. It would also be breaking the recent promises from the GOP leadership that they would offer a replacement for the ACA that solved many of its problems. But a simple repeal would have the advantage of pleasing those on the far right who are opposed to government-subsidized health coverage of any kind. The other option is for Ryan and the GOP to make a decision to try to write a bill that creates health coverage, which is both truly universal and truly affordable for Americans. The hard part about this will be the fact that the Republicans have basically talked themselves into a corner in terms of opposing this type of health care for years and it will be pretty hard to justify this big of a reversal on this type of policy.

Making this call might be easier if the Republicans deciding our health care future had a better grasp of our health care past. We have had universal health care for decades. Prior to the ACA, people who were uninsured would forgo health treatment until they were having an emergency and then go to the emergency room. ERs were, and are, legally-required to treat people regardless of their ability to pay. So, technically, everyone still had access to some kind of health care; it just wasn’t very healthy, since people only got treated when something was already very wrong. And it wasn’t very cost effective, because emergencies tend to be a lot more expensive than preventative treatments. This expense meant that people who were uninsured and got treatment often went into huge debt that they sometimes had no way of ever paying, so the costs were defrayed with tax dollars and by hospitals charging more for those who could pay or who had insurance.

Going back to this type of system may be a compromise that some elected Republicans are willing to make, because they have employer-provided health insurance, paid for by tax dollars, and they either don’t care or don’t understand how expensive and unhealthy it is not to have that. But, if we want to go forward with a better health care plan for America, Paul Ryan is going to have to make a decision to move away from those in his party who want some Americans not to have insurance. When he gets to work revising his health care plan, hopefully he will understand that it’s impossible to write a successful healthcare plan if he’s trying to appease people who don’t want a successful health care plan.

Alexis Chapman is a Political Consultant and Writer specializing in policy analysis, from international law to local ordinances. She’s lived in Australia, Ghana, Vermont, Hawaii, and Texas and has worked for small and large NGOs, state legislature, industry associations, and a variety of publications. She is a regular contributor to Political Storm and you can find her on Twitter @AlexisAPChapman.