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US Republicans struggle to deliver on Obamacare repeal vow


Frantic closed-door negotiations intensified at the US Congress on Tuesday to try to salvage President Donald Trump’s key campaign pledge to repeal Barack Obama’s health law, as the number of Republican holdouts continued to swell.

At this point, the party does not have the votes to pass the legislation unveiled by Senate leaders, as a small group of ultra-conservatives and moderates have declared their opposition — for different reasons.

Senate Majority Leader Mitch McConnell was expected to announce Tuesday whether he would formally open debate on the bill this week. His original goal was to see it passed by Friday, before a short July 4 recess.

Trump had promised in his run for the White House to repeal and replace Barack Obama’s signature Affordable Care Act, commonly known as Obamacare — a promise first made by Republican lawmakers in 2010.

The Senate legislation was designed as an amended version of a draft passed in the House of Representatives last month, so as not to pull the rug out from under the millions of Americans who were able to get health insurance under Obamacare.

The draft would allow states to drop several benefits which are now mandated, such as maternity care and hospital services, and also would abolish the requirement for most Americans to have health insurance.

But it also would delay cuts to the Medicaid program and initially maintain the tax credits included in the Affordable Care Act to help lower-income Americans purchase coverage.

Conservatives say the Senate bill does not go far enough, and would still put too heavy a burden on government coffers. Moderates say they can’t vote for a bill that would see the number of uninsured Americans balloon to pre-Obamacare levels.

“It’s the biggest signature issue we have. And it’s the biggest promise we’ve ever made in the modern era,” House Speaker Paul Ryan said Tuesday on Fox News.

“We said if we get elected, we will repeal and replace Obamacare. We did this in the House. It is now the Senate’s turn and I think they’re going to do it.”

But Ryan’s optimism is not borne out by the numbers.

Republicans hold 52 seats in the 100-member Senate. They need at least 50 votes to win, as Vice President Mike Pence would break the tie in favor of the measure. But at least five Republicans senators have said they will vote no.

– Who would be affected? –

America’s health care system is a labyrinth of public and private structures, operating at the federal, state and local levels.

The Republican reform plan would not directly affect half of Americans, who receive health insurance benefits from their employers. It also would not affect those over the age of 65 who are eligible for government benefits under Medicare.

It would however cut into Medicaid, America’s public health program for the poor and disabled. Medicaid costs are rising at a fast and ultimately unsustainable rate, critics say.

Republicans want to gradually cap Medicaid expenditure — which would mean 15 million people would lose their benefits by 2026, according to a report by the non-partisan Congressional Budget Office.

The Republican plan also would modify the system of federal tax credits to assist people buying their own health insurance, and for some people those plans would be cheaper in the long run, given that services previously mandated could be cut.

The CBO estimates that seven million people who buy individual insurance would lose coverage over the next decade, as compared with the status quo under Obamacare.

“We can’t turn the government into a health care organization alone. There’ll be no money for the department of defense or any other department,” said Republican Senator Lindsey Graham.

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