The Future of Universal Health Care Is Medicaid

Because John McCain landed the final blow, he has gotten the lions’ share of credit for killing the Republican health care bill, a “skinny” repeal that would have eliminated Obamacare’s individual mandate and partially repealed the employer mandates, causing premiums to spike and increasing the ranks of the uninsured by 15 million. But actual credit belongs to the lawmakers who stood against the bill from the start, as well the activists who drove the bulk of opposition to the Republican Party’s effort to gut the Affordable Care Act.

Had Republican Sens. Lisa Murkowski of Alaska or Susan Collins of Maine surrendered to pressure from their colleagues, the bill would have passed. Had conservative Democrats in Trump-friendly states—lawmakers like Joe Manchin of West Virginia, Joe Donnelly of Indiana, and Heidi Heitkamp of North Dakota—broken ranks with their colleagues, the bill would have passed. And if activists weren’t as mobilized and aggressive in confronting lawmakers on both sides of the aisle, the unified opposition needed to defeat the bill in any of its iterations may not have existed in the first place.

But there’s a bit more to the story, an important wrinkle. The part of Obamacare that saw the most support—the part that formed the foundation of its defense—was the Medicaid expansion. By expanding the program, the Affordable Care Act created a large constituency for its preservation, one that even included Republican governors like Brian Sandoval in Nevada and John Kasich in Ohio, who cared more about their constituents than fulfilling the national Republican Party’s campaign promises. And looking forward from this fight, durability of Medicaid provides a lesson for advocates of universal health coverage. The path to enduring reform isn’t through the exchanges or other market-based policies—it’s through government guarantees.

It’s worth repeating that “Obamacare repeal” was something of a misnomer for the larger Republican health care effort. In both the Senate’s Better Care Reconciliation Act, crafted in June, and the American Health Care Act passed by the House, the most significant cuts were for Medicaid. Friday morning’s failed “skinny” repeal didn’t contain Medicaid cuts—it focused largely on the the ACA’s regulated insurance markets—but it would have opened the door to a bill that did, had the Senate passed it and Congress progressed to writing a final version in conference committee…

Read full story at Slate Magazine

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