Perhaps the image of healthcare burned most freshly in the nation’s collective mind is the repeated struggles to repeal the Affordable Care Act, colloquially referred to as Obamacare. Congressional Republicans have long had a repeal of this act in their sights, often referring to a plan they called “repeal and replace.”
However, in the multiple attempts to repeal the law, which expanded healthcare access and coverage across the United States and made changes to existing policies, plans to replace the bill were scarce and not typically a part of the vote to repeal.
The nonexistence of a method to replace the ACA, combined with predictions from the internal scoring agency for Congressional bills that the proposed repeals would cause premiums and costs to skyrocket, and would result in millions of people uninsured, the July bill to repeal was ultimately defeated by a margin of just three senators: Linda Collins, Lisa Murkowski and John McCain, who unexpectedly arrived on the Senate floor after a cancer diagnosis and gave the bill his literal thumbs-down.
When Congressional Republicans attempted to repeal it again, in September, Collins and McCain, joined by Senator Rand Paul, were enough to halt the bill again and the vote on it was never brought to the floor.
Congress was trying to pass the bill under a process called “budget reconciliation.” The rules of budget reconciliation allow a filibuster to be broken with just 50 votes, rather than the 60 typically allowed under Senate rules, according to the LA Times. However, budget reconciliation included a September 30 deadline.
Because the latest attempt to repeal the ACA, with the Graham-Cassidy bill in September, failed, the initial impression was that repeal is effectively dead, and the ACA will stand.
However, as Vox reported in September, it is possible that under a new tax bill, Congressional Republicans could again pass another set of budget resolution rules and throw the future of the ACA into question once again. This would most likely be linked to a tax reform bill, which is expected to be released after November 1.
In the meantime, the administration has begun what appears to be an effort to disassemble pieces of the ACA. The Department of Health and Human Services recently rescinded a presidential mandate that required employers to cover birth control methods in their insurance policies offered to employees. This has opened up the possibility that more employers will pull back on insuring birth control methods, which could cause the out-of-pocket costs for contraceptives like the pill, IUDs and others to increase substantially, according to The New York Times.
This move was made as a part of a broad “religious protections” effort, which included guidance from the Justice Department that employers and organizations citing religious convictions may claim exemption from nondiscrimination cases in court, a move that could have deeply negative effects on the civil rights of those who are gay, lesbian or trans.
“More than 55 million women have access to birth control without co-payments because of the contraceptive coverage mandate, according to a study commissioned by the Obama administration. Under the new regulations, hundreds of thousands of women could lose those benefits,” The New York Times wrote in October.
In May, Congress also voted to allow states to de-fund Planned Parenthood, a move that will likely affect primarily states that are already restrictive. The move was passed after Vice President Mike Pence broke a tie in the Senate.
Advocates have stated that this type of move, should states choose to de-fund their support of Planned Parenthood, access to women’s health services, including mammograms, PAP smears and other healthcare services, will be affected. As mandated in the Hyde Amendment, federal money, through programs like Medicaid, are already disallowed from going toward abortions, which have been the major sticking point for many ideological and religious conservatives, except in several narrow cases, including pregnancy through rape or incest, and cases where continuing a pregnancy will endanger the life of the mother.
However, the past year has also seen the public move toward favoring more comprehensive healthcare coverage plans, including single-payer and universal healthcare initiatives, according to recent data.
A poll published by the Pew Research Center in June stated that 60% of Americans believe that it is the government’s responsibility to ensure that all Americans are insured, a number that remained steady from January through the first half of the year.
Nearly 33% of those people believe that the government should offer a single-payer system for healthcare, a number that jumped five percentage points in six months earlier this year, and was up 12 points from 2014.
A similar poll conducted by Politico pointed to a growing percentage of the population beginning to support single-payer healthcare. This system of insurance would insure all Americans through a government-sponsored plan, rather than through a mix of public and private offerings, as exists now.