Healthcare profiles in courage and cowardice

President Trump was elected promising to “drain the swamp.” Yet there has perhaps never been a murkier exercise than the Senate’s Better Care Reconciliation Act (BCRA). In its drafting, Senate Majority Leader Mitch McConnell not only shut out Democrats, but excluded most fellow Republicans and every affected healthcare advocacy group. It has also been embarrassingly clear that the president, who believes young adults pay $12 a year for health insurance, has no grasp whatsoever of what is in the BCRA.

In contrast, the Affordable Care Act was the subject of an interminable public process in 2009, with the Senate Finance Committee’s longest markup process in two decades. As one columnist wrote, then Finance Chairman Max Baucus of Montana “wasted four crucial months that summer in seemingly endless discussions with two Republican members of his committee who never could say what they wanted, were never going to bring other votes and, in the end, could not withstand pressure from their caucus to vote yes.” And, for good or ill, President Obama took ownership of the law that would pejoratively bear his name with critics, in myriad hands-on meetings and in an address to Congress.

{mosads}It is regrettable if the lasting lesson of that process, and the ACA’s enduring politicization, is that any further reforms to our healthcare system should be as opaque and un-inclusive as possible. The ACA is by no means perfect, and certainly needs fixing. Its defenders have too often glossed over its infirmities. Yet McConnell’s secretive process, as was true of the House-passed American Health Care Act, has — under cover of darkness — done far more than address the ACA. It has aimed to undo traditional Medicaid as well.

The Senate’s vote to proceed on floor debate, then, cannot be viewed as anything other than an endorsement of secrecy and a complete lack of public process, as well as a clearing of the runway toward potentially unconscionable outcomes. And it revealed some profiles in courage and cowardice.

Last month, Sen. John McCain (R-Ariz.) joked that he hadn’t “met any American” who had seen the Senate’s repeal and replace bill, but that the Russians probably had. But, when push came to shove, he voted to allow debate to proceed upon the BCRA while dramatically pledging, “I will not vote for the bill as it is today.”  It was perhaps the last occasion for pundits and politicians to swoon over the ailing McCain’s “maverick” nature. 

But hours later McCain was one of just 43 senators to “vote for the bill as it is today.” According to an analysis shared with the National Governors Association, Arizona would eventually lose 35 percent of its federal Medicaid funding under the bill McCain voted for. What should have been an opportunity to cheer a political icon became just another sad example of political cynicism.   

Adding to the incongruity, after Sen. Lisa Murkowski (R- Alaska) voted against proceeding on the bill, she related that McCain told her she did the right thing. Yet Trump slammed her on Twitter, saying she “really let the Republicans, and our country, down yesterday. Too bad!”

And a fellow procedural defector, Sen. Susan Collins (R-Maine), had a public spat with a Republican congressman, Rep. Blake Farenthold (R-Texas), who suggested he would duel her, Murkowski, and Sen. Shelley Moore Capito (R-W.V.), if they were men. Perhaps the threat of a Farenthold duel, or presidential rage-Tweets, caused Capito, and other professed moderates who had so bravely stated they would not allow debate to proceed, to fold. 

Where do we go from here? Politics have never seemed so polarized, and lives hang in the balance. As Ohio Gov. John Kasich said, “The American people will come out on the losing end if Senate Republicans try to force through a new healthcare proposal with no bipartisanship, transparency or open dialogue.” This process is unbecoming a democracy. 

Brendan Williams is the president/CEO of the New Hampshire Health Care Association, which represents 90 long-term care facilities. Williams is also an attorney, former Washington state deputy insurance commissioner and former Washington state representative.