WASHINGTON — The effort to replace Obamacare has taken divergent paths, neither of which seems likely to produce a lasting alternative.
Republicans, led by Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, proposed taking funds budgeted for the Affordable Care Act and sending it to states as block grants along with the power to decide how to spend them. But the legislation faced an uphill climb and a September 30 deadline for being passed without a requirement for 60 votes.
At the other extreme, Sen. Bernie Sanders (D., Vt.) advocated expanding Medicare into a single-payer system. With the support of 16 other Democratic senators, Sanders said, “At a time when millions of Americans do not have access to affordable health care, the Republicans, funded by the Koch brothers, are trying to take away health care from up to 32 million more. We have a better idea: Guarantee health care to all people as a right, not a privilege, through a Medicare for All.”
But without the support of Republicans, and some influential Democrats, the idea looked doomed. Among those declining to endorse it was House minority leader Nancy Pelosi of California, who said she was focused on shoring up Obamacare against President Trump’s efforts to let it implode.
“Right now, I’m protecting the Affordable Care Act,” Pelosi said. “None of these other things, whether it’s Bernie’s [bill], can really prevail unless we have the Affordable Care Act protected.”
As far as the public, a Pew Research Center poll found in June that just one-third of Americans back a single-payer system. At the same time, six in 10 of those polled said they believe the federal government has a responsibility to guarantee universal health insurance.
For his part, Graham said of the GOP bill, “If you believe repealing and replacing Obamacare is a good idea, this is your best and only chance to make it happen, because everything else has failed. If you want a single-payer health care system, this is your worst nightmare.”
Under the Graham-Cassidy legislation, money would be apportioned to states based on a complicated formula. It would take cost of living variations into account, but higher-spending states would get less than they do now. Block grants would replace ACA funding for reimbursements to insurers to offset the cost of premiums for low-income people. The bill would repeal the mandate for most Americans to have coverage and for larger employers to provide it. And Medicaid would be cut significantly.
Among the hurdles the bill faced to win passage this month with a simple majority was that it had yet to be scored by the nonpartisan Congressional Budget Office. The CBO determines how much such legislation costs and how many people would lose or gain coverage.
Sanders’ bill would expand Medicare to cover dental care, vision services and hearing aids. It would also cover reproductive, maternity and newborn care, including abortion. He listed several funding options for the measure, including an annual 1% federal “wealth tax” on the net worth of the richest 0.1% of U.S. households.
Sanders said he was ready for a long fight to make health care a right. The proposal has already emboldened progressives, based in part on the endorsement of a single-payer plan by three-fifths of House Democrats.
And a number of Democratic senators backing Sanders, including Kirsten Gillibrand of New York, Kamala Harris of California, Elizabeth Warren of Massachusetts and Cory Booker of New Jersey, are seen as possible presidential candidates in 2020.
But the legislation has already met a different reception in the private sector. “Whether it’s called single-payer or Medicare for all, government-controlled health care cannot work,” said David Merritt, executive vice president of America’s Health Insurance Plans. “It will eliminate choice, undermine quality, put a chill on medical innovation and place an even heavier burden on hard-working taxpayers.”