What’s Dividing Republicans and Democrats on Healthcare Reform?

Health Insurance

July 19, 2017

Since the Affordable Care Act became law in 2010, Republicans have been determined to destroy it while Democrats insist it’s the country’s best chance at reforming healthcare to make it affordable and accessible. Both parties want reform, but the approach has been fundamentally different – and for good reason. There are basic, core reasons why conservatives and liberals can’t get on the same page when it comes to healthcare reform. Let’s take a moment to dig into the details and figure out what is exactly keeping Republicans and Democrats from being able to find a middle ground on healthcare reform, so far.

Democrats want the federal government to legislate and administer healthcare while Republicans want private industry to helm the healthcare system with as minimal input from the federal government as possible.

Of course, there are always exceptions within each party because people aren’t one-dimensional. Moderates on both sides, for instance, would seek compromise wherever possible. But in general, these core ideological differences make healthcare reform particularly challenging, especially when one party holds more power. In 2010, Democrats passed the ACA without a single rightwing vote.

Right now Republican leadership in the Senate is attempting to pass its bill, the Better Care Reconciliation Act of 2017 (BCRA), without Democratic support. It’s a seemingly endless cycle, but it helps to know why – why can’t our lawmakers just get along and pass a reform bill together? It comes down to the ideological differences that separate them in the first place.

On the Left

Democrats want to preserve and protect the ACA. Since the full enactment of Obamacare, 20 million Americans now have health insurance, and the rate of people without insurance has been cut in half according to Democrats.org. Most Democrats believe that quality healthcare is a fundamental right of every American, and they want the federal government to oversee, administer and regulate the healthcare system. They oppose cuts to Medicaid, tax cuts for the wealthy and any proposal that would limit access to health insurance on the private market.

At the extreme end of the left, some have argued in favor of single-payer healthcare. That’s when the government is totally in control of all aspects of healthcare, a system that wouldn’t work in America for several reasons, not least of which is because it’s expensive to taxpayers. Even still, some argue that single-payer would solve our nation’s healthcare problems by granting coverage to everyone. Democrats believe that the government should take over healthcare, though they disagree about the extent to which that should happen.

On the Right 

On the other side of the spectrum, Republicans believe that private industry should administer health insurance as it has since the start. Believers in capitalism, personal responsibility and freedom from government regulation, conservatives view the Affordable Care Act as a violation of American independence with its individual mandate and increased taxation to cover subsidies. Rightwing lawmakers and their voters claim that since the inception of the ACA, the nation’s healthcare system is well on its way to imploding as premiums rise and private insurers leave the Obamacare exchanges.

For most right-wing conservatives, a clean repeal of the Affordable Care Act is the only solution to real healthcare reform. Senator Rand Paul of Kentucky has been outspoken about wanting the ACA repealed, and he refuses to support any reform bill from his Republican colleagues that does not throw out Obamacare. Paul did not support the American Health Care Act passed by the House earlier in the year, and he does not support the Better Care Reconciliation Act proposed by Republican Majority Leader Mitch McConnell earlier in June. He’s not alone in his fight, either.

By contrast, moderate Republicans want to see healthcare reform without shrinking Medicaid. Over the past 50 years, Medicaid has been the health insurance program for America’s low-income children and adults. The program also covers Americans with disabilities and low-income seniors. Without Medicaid, millions of Americans would have little or no health insurance. Many moderate Republicans refuse to back the BCRA with nearly $700 billion in cuts to Medicaid.

Another major sticking point between the two parties is regarding contraception and abortion. This is always going to remain the main issue that drives a wedge between those on each ideological side. The best course of action really would be for the private marketplace and government exchange (gov subsidized plans) to provide plans that do provide coverage for contraceptions and abortion and plans that do not provide for these services. It’s a women’s rights issue, it will be the United States version of the 1,000 year war, and it’s a battle that no real winner can emerge from, and politicians absolutely love it. It’s the primary way that they drive donations when they re campaigning and it will always remain the most heated of the hot button issues.

In order to avoid conflict or delays, it is best to just take a pragmatic approach that meets the needs and requirements of the insurance market, which is influenced only by consumer demand, and that in effect would require a robust selection of plan options.

Challenges under the Affordable Care Act (Obamacare)

Also known as Obamacare, the Affordable Care Act (ACA) became law in March 2010. The measure was an attempt by former President Obama to give every American access to affordable health insurance. At the time, 39 Democrats and 178 House Republicans voted against the ACA. The remaining 218 Democrats in the House voted for the ACA. The Senate passed the ACA with a 68-30 vote, with 68 Democrats and two Independents voting yea and 39 Republicans voting nay. The party-line vote exposed the ideological differences between the two sides on healthcare.

Despite widespread support among Democrats for the ACA, Obamacare has not lived up to some of its hype, and even those on the left agree that the law hasn’t accomplished its full potential over the last seven years.

Here are some of the challenges that Obamacare faced:

  • Many Americans found it difficult to understand why the law required them to acquire insurance or face a fine. To further compound the problem, most people did not understand how the law imposed the fine. Plenty of taxpayers were surprised when they got charged an additional fee during tax time.
  • The ACA is difficult to understand. Obamacare offers four levels of coverage: bronze, silver, gold and platinum. Americans who enroll in the ACA must compare the four different coverage levels and the copays, deductibles and monthly premiums that go with each. The tier structure can be confusing to people, especially those who never had insurance before.
  • Healthcare costs increased over the short term. One reason was that millions of people who were uninsured received care for the first time.
  • The ACA raised taxes. An estimated 1 million people were hit with a tax increase. Obamacare depends on taxes to fund subsidies for low- and middle-income enrollees.
  • Premiums are on the rise. As more insurance companies choose to leave the Obamacare marketplaces, companies that stick around are raising premiums to cover the cost of insuring more people.

There are also problems going forward, the biggest of which is attracting enough young and healthy people into the insurance market to balance out costs for everyone else. Insurers have fled the marketplaces due to financial losses. The ACA fine imposed for not having insurance isn’t high enough to force young people to sign up. Without addressing these and other critical failings of the healthcare law, Obamacare could unravel itself before Republicans have a chance to replace it with something else.

Paging Cooler Heads – Can We Meet Somewhere in the Middle Please?

The solution to healthcare reform isn’t easy, but it lies somewhere in the middle of these extreme ideologies. GOP leadership has been working on swaying members of its own party, but perhaps a different approach – one that includes leftwing support – would fare better in the long run. The ACA was passed without conservative support, and now, seven years later, the country is on the brink of a healthcare overhaul once more. Unless politicians work toward reaching middle ground, it’s unlikely that reform will be effective regardless of who’s in charge.