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Debunk the Senate ruse

July 26, 2017
by Ron Manderscheid, PhD, Exec Dir, NACBHDD and NARMH
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The clock is ticking on the 20 hour Senate “debate” on healthcare reform. After a vote to proceed, which split the Senate 50-50, requiring the Vice President to break the tie, the Senate has moved on to consider a range of health reform bills.

Unfortunately, only Republicans can offer amendments that will be considered, so it really is euphemistic to call the process a debate. However, heroes can and may emerge from the majority. Witness Senators Susan Collins (R-Maine) and Murkowsky (R-Alaska), two women, who stood up against the male Republican majority on the vote to proceed.

Nothing good can or will emerge from this process, which is governed by back room deals, secrecy, and majority dictatorship. Hence, the desired outcome that we must embrace is that no agreement be reached on any bill during this 20 hours of agony.

Here are a few pointers on the bills likely to be considered:

Repeal and Replace: This will involve voting on the House American Health Care Act and the Senate Better Care Reconciliation Act, both terrible bills that I have described in the past. As of this writing, the Better Care Reconciliation Act has failed to achieve a majority of votes. Let’s hope that the same fate befalls the House bill.

Repeal Only: This bill could repeal major portions of the Affordable Care Act (ACA). The most likely targets would be the Medicaid expansion, marketplace insurance and care subsidies, the Prevention and Wellness Fund (currently used to fund SAMHSA and CDC programs), individual and corporate insurance mandates, and a host of ACA taxes. The major effect of such actions would be to cause a dramatic plummet in the number of Americans with health insurance, without a plan to go forward. Since uncertainty can have unknown consequences on future elections, this option seems remote.

The “Skinny” Bill: This bill likely would remove only the individual and corporate health insurance mandates and end the Prevention and Wellness Fund. Even with this narrow focus, the effects could be devastating. Some already have argued that elimination of the mandates would cause the collapse of the individual market and the elimination of major segments of the corporate market.

Other Alternatives: The most likely dark horse bill is one proposed by Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.). The core of this bill would eliminate the individual mandate and block grant Medicaid funds back to the states. In essence, this bill would transfer major costs of Medicaid from the federal government to states and counties, which the latter could not afford. Hence, it really would be a bait (flexibility) and switch (transfer costs) ruse.

Clearly, nothing good can, will, or should come out of this 20 hour process. The only way we can do all possible to assure an outcome of no action is to lobby the Republican majority around the clock. Call this morning, call this evening, call at any time, but do call and express your outrage and objection to the charade currently underway.

In these various alternatives, the numbers of newly uninsured Americans ranges from 11 million, to 26 million, to 32 million, to a high of 58 million (the latter, fully 1/6 of the U.S. population). Plain and simple, this is outrageous.

Don’t allow the Senate Republicans to get away with this theft of health and life to give tax rebates to the wealthy.



Ron Manderscheid

Exec. Dir., NACBHDD and NARMH

Ron Manderscheid


Ron Manderscheid, Ph.D., serves as the Executive Director of the National Association of County...

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