The devil is in the details

It’s been fascinating and frightening to watch the GOP Congress and President Trump decide what they’re going to do about Obamacare. Republicans voted dozens of times during the last six years to repeal the Affordable Care Act, to no avail, most recently in 2016 when President Obama vetoed repeal.

But now that the GOP controls the U.S. Senate, the House of Representatives and the presidency, they’re having second thoughts. Some still want to “repeal and replace” although specifics on the replacement are illusionary. Other Republicans advocate “repeal and delay” so that the effective date of repeal is years away, perhaps after the 2020 election, to avoid voter anger as people lose their health care.

Recently, a few Republicans have publicly called for “repair” instead of “repeal.” Sen. Ron Johnson says that repair would be better than a repeal of Obamacare because “Nobody here wants to pull the rug out from under people.” Last week GOP Sens. Bill Cassidy and Susan Collins offered the “Patient Freedom Act,” tossing the decision of how to provide health care to individual states, a proposal sure to cause chaos in the health care markets throughout the country.

Another GOP idea is to transform Medicaid from an entitlement into a block grant, capping the federal government’s payments and giving states more flexibility. This would also likely eliminate the guarantee that everyone who is eligible could enroll.

President Trump has been all over the place, as usual. At a January press conference he pledged, “It will be repeal and replace. It will be essentially simultaneously. It will be various segments, you understand, but will most likely be on the same day or the same week, but probably the same day. Could be the same hour.”

On the afternoon of his inauguration, Trump signed an executive order authorizing federal officials to grant waivers and exemptions, reduce regulations, and delay provisions of the ACA as a first step to eliminating a program that has enabled more than 20 million people to access health care insurance, many for the first time in years.

Nevada’s Gov. Brian Sandoval is concerned about the effort to repeal the ACA, which could potentially affect 400,000 Nevadans. He wrote a letter to the House leadership in early January pleading for caution and communication with state leaders before any decision is reached. He wrote, “States are integral players in this conversation [about health care], and the decisions that are made going forward will have a profound impact on our citizens’ lives and the health care providers who serve them.” His letter outlined at great length how Nevada has benefited from the ACA and warned that gutting the law could leave many “without the care they need to live healthy, productive lives.”

Sandoval noted that implementing the ACA “decreased Nevada’s uninsured rate from one of the worst in the country, 23 percent, to approximately 12 percent, making Nevada one of the most improved states in this regard. Nevada also saw one of the most significant decreases in child uninsured rates in the country from 16 percent in 2012 to eight percent in 2015. This means over 92 percent of the children in Nevada have health care coverage … 32 percent of them by Nevada Medicaid.”

The Commonwealth Fund projects that 22,000 Nevada jobs will be eliminated if the ACA is repealed, resulting in $377 million in lost tax revenue by 2023.

If Nevada’s congressional delegation supports the GOP in their quest to deprive Nevadans of their jobs and their health care coverage while also reducing revenue to hospitals, providers and the state budget, they should be prepared to face the fury of their constituents. Progressives have established a regular Tuesday protest at noon at the federal building in Reno to make their voices heard.