By: Yitzchak Fried  | 

Does the AHCA Mean the End of the Republican Congress?

With some minor changes, the American Healthcare Act (AHCA) has passed on the House floor. Now it’s up to the Senate to consider how much of the bill will become law—and what the repercussions will be for America, and for the Republican party. The law may be the death knell for the Republican majority in the House, as voters realize just how much they’ve been betrayed.

The current Republican majority was born in the midterm elections of 2010; back then, economics—healthcare’s Siamese twin—was also the major issue, with opposition to Obama’s stimulus package and ambivalence toward Obamacare catapulting Republicans into House seats. In the midst of an enduring economic slump, Americans felt, correctly or not, that Obama had made their lives harder.

If the 2016 House elections and the ballooning frustration of the American electorate leading up to Trump’s election is any indication, that impression hasn’t really gone away. So at first glance, it’s not clear why the AHCA should be a game changer. Some parts of the AHCA might even seem popular at first, like revoking the citizen mandate to purchase health-insurance, and rolling back the taxes that funded Medicare’s expansion. Others parts of the bill, like the fact that it allows states to impose work requirements for Medicaid beneficiaries, will most affect populations with little political clout. Ex-felons, for example, have an especially hard time finding work. But because they’re disenfranchised, they’ll suffer the consequences of revoked coverage without taking their grievance to the polls.

But other provisions of the AHCA will hit voters hard. And when they wake up, the Republicans will likely feel the heat. The Affordable Care Act (ACA, aka “Obamacare”) required insurance companies to cover patients regardless of pre-existing conditions. The AHCA allows states to waive that requirement, so long as they establish monetary pools to help high risk patients get insurance. But those pools are of dubious use. Although 100 billion dollars were added for their funding to the “Patient and State Stability Fund,” the Congressional Budget Office anticipated (in its analysis of the first round of the bill), that this would do little to ease costs of the 24 million slated to lose insurance. This, and the elimination of the ACA’s restriction on charging the elderly more for care, means that seniors and the sick will be hit especially hard.

“...provisions of the AHCA will hit voters hard. And when they wake up, the Republicans will likely feel the heat.”

Low income families are also particularly hurt. The AHCA bars Medicaid funding from any clinics that provide abortion services, including Planned Parenthood—even though abortions make up a tiny fraction of Planned Parenthood’s services, and even though Planned Parenthood is already barred from paying for abortions with federal cash. Defunding Planned Parenthood will result in less access for the poor to basic aspects of women’s care: cancer screening, pregnancy testing, contraception and STD testing. Additionally, the AHCA removes the requirement that insurers provide a basic set of services, including contraceptives and maternity care, and rolls back the ACA’s expanded Medicare by 2020. That coverage used to provide Medicare to families with income up to 138% the federal poverty level (or $33,948 for a family of four). In states like Iowa, Texas, Idaho, Kansas, Nevada, Indiana, Michigan and Ohio (to name a few), whose median household income is lower than $50,000—not to mention Arkansas, West Virginia, and Mississippi, whose median income is below $40,000—that’s a lot of affected voters.

But low income families aren’t the only ones who are going to hurt. The AHCA also remodels the tax-credit that the ACA provided for paying insurance premiums. Instead of providing credits based on income and location, the AHCA provides credit based on age alone—which means that middle class Americans will have higher out of pocket expenses for care.

With such a widely affected population, it seems likely that even voters who don’t normally parse politics will wake up when they feel the impact to their wallets. Medical care is one issue that flared up at the tumultuous town hall meetings across the country. A woman in Arkansas declared that she and her family would be “dead and homeless if it wasn’t for ACA”; Buddy Carter of Georgia was attacked when he discussed the failures of Obamacare; and a woman in Tennessee attacked her representative for not letting “the healthy people pull up the sick people” and “fix[ing] what’s wrong with Obamacare.”

The question is whether Democrats will marshal support from their former voters in the 2008 election (the last Democratic House). But a Democratic victory isn’t foregone, not least because the Dems must overcome the effects of Republican gerrymandering, and—in the words of Jonathan Tobin for the conservative National Review—“districts’ coming into compliance with the Voting Rights Act,” which has funneled black Democratic voters into minority-majority districts so as to diffuse their influence. But if Democratic politicians do what it takes to appeal to working and middle class voters, another House flip is on the horizon. Much of the AHCA—like the defunding of Medicare—won’t come into effect until 2020, so we may have to wait until the midterms of 2022 to see voters’ reactions. But when we do—if Democrats vigorously campaign in hurting Republican districts, if they blast their message of healthcare access funded by taxes on the 1%—we may see the end of the Republican House.