By Sara Wilensky, JD, PhD
Co-author of Essentials of Health Policy and Law, 3rd Edition
After a flurry of behind-the-scenes arm-twisting by President Trump and negotiations with members of their own party, the Republican leadership tabled the American Health Care Act (AHCA) on March 24th because they did not have the votes to pass the bill. Instead of being a bill that had a little bit for everyone, AHCA ended up as a bill that did not have enough for anyone. It was too moderate for conservatives, too conservative for moderates, and managed to alienate powerful stakeholders ranging from conservative think tanks to providers to the elderly. So, what did we learn and what happens next?
First, Republicans will not be able to win votes only by relying on party loyalty or helping Trump be a successful president. Speaker Ryan and President Trump appeared to bank on his members feeling so compelled to pass something to repeal the Affordable Care Act (ACA) that they would pass anything even if they did not like the bill. In the end, policy mattered. Whether it was ideological opposition to refundable tax credits by conservatives or concern about millions losing health insurance by the moderates, the details of bill were important to members. This is not surprising given the unpopularity of the bill. A majority of those polled opposed major components of the Republican plan such as including allowing insurers to charge older individuals higher premiums (80% opposed), adding surcharges for lapsed coverage (70% opposed), reducing Medicaid funding (64% opposed), and denying funding to Planned Parenthood (56% opposed). More respondents opposed eliminating the individual mandate than keeping it (48% to 35%) and replacing income-based subsidies with age-based subsidies (48% to 16%). Overall, 56% of the public opposed the AHCA and only 17% favored the bill.