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Stuck in the Middle with Trump: The White House Tries to Rally Support for House Health Care Reform

While it may have taken President Trump by surprise, it is not a well-kept secret in Washington that health care reform is complicated. Passage of a major piece of health care legislation is an immensely challenging juggling act that forces lawmakers to balance the needs and wants of a bevy of special interest groups with the demands of their constituents, all while courting the support of colleagues in Congress and appeasing the wishes of the Executive. A President’s role in such negotiations is equal parts conductor and cheerleader, simultaneously tasked with working to see that any legislation that is crafted is in sync with the administration’s health care priorities and to ensure that it has the requisite support in the House and Senate. It took over a year of negotiation, a 906 page bill and a 60 vote majority in the Senate for President Obama to get the Affordable Care Act passed. Now, President Trump finds himself having to marshal the ACA’s would-be replacement through Congress in a fraction of the time and with a much smaller Senate majority.


At the present, Trump has to work what has become a tripartite division among Congressional Republicans around the passage of the American Health Care Act (AHCA), which is being pushed by House Speaker Paul Ryan as, “the closest [the GOP] will ever get to repealing and replacing Obamacare.” On one side, you have a group of moderate Republicans in the Senate, like Lisa Murkowski (R-AK), Shelley Moore Capito (R-WV) and Rob Portman (R-OH) whose states have benefited mightily from the ACA’s Medicaid expansion and who have pledged to vote against the House health care bill if it doesn’t provide protections for those who obtained health care through Medicaid expansion. Given the fact that over 40 percent of people living with HIV who are in care are on Medicaid, this position is a welcome one for HIV advocates and provides an opening to make some headway with Senate Republicans on protecting access to quality, affordable care for those who have low incomes and pre-existing conditions. On the other side sits the membership of groups like the Freedom Caucus and Republican Study Committee who object to the American Health Care Act on the grounds that it’s too generous, calling it “Obamacare Lite,” and maintaining that the bill merely creates a new Republican entitlement. And, scattered about the middle, sit the Republican leadership in Congress and the Trump administration.


On the surface, President Trump has thus far maintained an upbeat, optimistic demeanor. The infamously social media friendly President took to Twitter on Thursday to proclaim that, “healthcare is coming along great,” and assuring the public and The White House, “it will end in a beautiful picture!” Given the very public infighting within the Republican Party around the American Health Care Act, such a stridently confident tone might seem more like wishful thinking than genuine certainty. However, as Trump revealed to the leaders of a number of prominent conservative groups, he has a backup plan should the American Health Care Act not make it through Congress: let it all burn.


During a meeting with the leadership of conservative heavyweights like Club for Growth, Americans for Prosperity, FreedomWorks, and the Heritage Foundation, Trump divulged that his plan b for health care reform in the event of the American Health Care Act’s defeat in Congress was to allow Obamacare to fail and then place the blame on the Democrats. This line of thinking certainly wasn’t new for Trump. On numerous occasions, President Trump has voiced his opinion that the most politically expedient thing the Republican party could do regarding health care is to take their hands off the wheel and let the Affordable Care Act die a slow, painful death from neglect. That way, Republicans would not only be in the driver’s seat for any subsequent health care legislation, but they would also be able to point at the ACA as proof that the federal government should stay out of the business of health care.


Buttressing the President’s cynical approach to health care reform earlier in the week was White House Office of Management & Budget Director Mick Mulvaney, who went on MSNBC’s Morning Joe and said that health insurance is, “not really the end goal” of the Republican approach to replacing the ACA. This philosophy is born out in a recent report from the Brookings Institute that estimates that at least 15 million Americans could lose their health insurance as the result of the American Health Care Act’s passage. Later on in the interview, Mulvaney said that the Trump administration is, “absolutely convinced it will be more possible for more people to get better care at the doctor under this plan than it was under ObamaCare.” Unfortunately for them, and for millions of Americans living with HIV and other pre-existing conditions, if the American Health Care Act becomes law, none of the available evidence supports such a conviction.


For people living with HIV, health care access is a life or death matter and the expanded coverage afforded by the ACA has given many thousands of people living with HIV and millions more an assurance that they could maintain their health and wellness. The American Health Care Act provides no such coverage or assurance and AIDS United stands in unequivocal opposition to it and any other ACA replacement that fails to maintain or build upon the coverage, benefits, and protections under the current law.


We at AIDS United encourage you to stand up and make your voices heard. Let the Trump administration know that the American Health Care Act is unacceptable and that you demand that people living with HIV and all Americans have access to quality, affordable health care.

Posted By: AIDS United, Policy Department - Friday, March 10, 2017

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