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Trumpcare Is Dead

But for how long?

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The Republican push to repeal and replace the Affordable Care Act collapsed this week, leaving the future of Obamacare up in the air once again.

On Monday, July 17, Senate President Mitch McConnell announced that he was giving up on passage of the Better Care Reconciliation Act after it became clear that he didn't have the votes to even begin debate. The legislative package slashed Medicaid spending, allowed insurance companies to sell bare-bones insurance policies and repealed some of Obamacare's taxes on high earners, among other provisions.

"Regretfully, it is now apparent that the effort to repeal and immediately replace the failure of Obamacare will not be successful," McConnell said in a statement.

McConnell's admission of defeat came after several GOP lawmakers announced they could not support the bill, for various reasons. Among them: Arizona Sen. John McCain, whose recovery from an unexpected brain surgery slowed the projected timeline of the repeal vote. In a prepared statement on Monday, July 17, McCain said he wanted a bipartisan approach to reforming health care.

"The Congress must now return to regular order, hold hearings, receive input from members of both parties and heed the recommendations of our nation's governors so that we can produce a bill that finally provides Americans with access to quality and affordable health care," McCain said.

The legislation's defeat came following months of action by protestors who were dismayed by the various versions of the repeal legislation that passed the U.S. House of Representatives and was crafted behind closed doors in the Senate. The legislation was remarkably unpopular, according to various public opinion polls. A Marist poll showed that the Senate bill had the support of just 17 percent of voters; in a different poll conducted by Suffolk University, approval ratings for the bill were as low as 12 percent.

One major reason: The bill's dramatic rollback of Medicaid expansion. In Arizona, more than 400,000 people in families earning less than 138 percent of the federal poverty line (or $24,600 for a family of four) became eligible for the AHCCCS program-the state's version of Medicaid-after Gov. Jan Brewer and a handful of Republican state lawmakers teamed up with Democratic legislators to expand the program in 2013.

Both the American Health Care Act (passed by Republicans in the House of Representatives) and the Senate's Better Care Reconciliation Act proposed major changes to the financial structure of the Medicaid system, including a complete overhaul of the health care financing formula and a major shift of costs from the federal government to state governments. According to a Congressional Budget Office analysis, the Senate health care bill was projected to cut $772 billion in Medicaid spending over the next decade, mostly by phasing out state Medicaid expansions.

Fierce opposition to the GOP proposals triggered protests at the offices of McCain and Arizona's other senator, Jeff Flake, as well as Southern Arizona Congresswoman Martha McSally. Amid high tensions, one man was arrested outside of Flake's office for making comments related to the congressional baseball shooting earlier last month. A second man was arrested in May for leaving phone messages threatening to shoot McSally.

At a recent protest outside of Flake's office, nearly 100 demonstrators opened umbrellas reading "keep us covered" and held signs depicting headstones that read: "This is a monster job killer."

Kristen Randall, is one of the organizers of Indivisible Southern Arizona, a political group that organizes rallies, meetings with congressional staffers and otherwise spoke out against the House and Senate health-care bills. Randall said the Medicaid rollback would cause millions of low-income Americans across the country to lose their health insurance.

"We're talking about a lot of people losing their Medicaid," said Randall, a hydrologist, who was motivated to jump into political activism following Trump's election last year. "Those people are out. They're done. No money would be given to the states to fund these programs anymore, and that would pretty much immediately impact the country's most vulnerable citizens."

The Congressional Budget Office had estimated that the Senate's Better Care Reconciliation Act would leave an additional 22 million Americans without health care by 2026 if passed.

Following the Independence Day recess, McConnell had hoped to vote on the legislation this week. But on Monday, after several senators announced they couldn't support this version of the bill, McConnell announced he would no longer push for a vote of the legislation and would instead push to repeal the Affordable Care Act without a replacement, with the hope that lawmakers could cobble together something in the next two years.

Flake had sidestepped taking a position on the legislation, but he had announced his support for a controversial amendment proposed by Texas Sen. Ted Cruz. The amendment, known as the "Consumer Freedom Option," would have allowed insurance companies to sell policies that did not include the 10 Essential Health Benefits that the Affordable Care Act now requires, as long as the companies also offered policies that covered the 10 Essential Benefits, which include maternity care, mental health and substance abuse treatment, rehabilitative services, ambulatory patient services and others.

Major health insurers also warned lawmakers that the proposal would be a disaster.

In a joint letter, Blue Cross Blue Shield and America's Health Insurance Plans called the proposal "unworkable." The letter also went on to say that: "The Consumer Freedom Option establishes a 'single risk pool' in name only. In fact, it creates two systems of insurance for healthy people and sick people."

Aviva Aron-Dine, a senior fellow at the Center on Budget and Policy Priorities and former senior counselor to Health and Human Services Secretary Sylvia Burwell, said that the proposed changes in various versions of the Better Care Reconciliation Act didn't alter the major impacts of the bill.

"We've now been through quite a few changes to the congressional Republican health bill, and each time there's a lot of focus on the projected changes," Aron-Dine said last week in a joint conference call with former Obama health officials. "There's been a lot of speculation about whether they will somehow change the big picture of the bill's impacts, and each time when the CBO weighs in, it concludes 'no.' The bill still causes more than 20 million people to lose coverage, and it still makes coverage worse or less affordable for millions more."

It's not just low-income Medicaid recipients and insurance companies that were concerned about the impact of the GOP's proposals. Many organizations representing physicians, nurses, hospitals and health clinics also opposed it, including the American Medical Association, American College of Physicians, American Academy of Pediatrics, American Hospital Association, American Congress of Obstetricians and Gynecologists, American Osteopathic Association and the American Psychiatric Association-just to name a few.

Tucson Medical Center Vice President of Community Benefit Julia Strange said the Affordable Care Act and the Medicaid expansion have served both patients and health care providers and recipients.

"In Southern Arizona, we have seen patient's uninsured rates drop significantly," Strange said. "More people now have the coverage they need. It allows them to take preventative measures and better eliminate costly care. We're very concerned about the implications of this new legislation. The Medicaid expansion has been very beneficial to providers and patients alike."

Physician and state lawmaker Randy Friese, a Democrat who represents central Tucson and the Catalina Foothills, warned the proposed health care bill would hurt the economy. Arizona was projected to lose 20,000 medical jobs if the Affordable Care Act had been replaced with the current bill.

"This is going to cost people a lot of money, because people without health care will access treatment through emergency rooms, where it's more expensive, or they'll wait until their illness is worse than before," Friese said. "I think we need to stop the politics. The Affordable Care Act is not a disaster. The ACA has problems, and we need to work on addressing those problems, instead of scrapping it completely."

At a recent Town Hall hosted by Congressman Raul Grijalva (D-AZ03), Dr. Nancy Johnson, CEO of El Rio Community Health Center, said the rollback of Medicaid expansion would cause 122,000 adults and 95,000 children in Pima County alone to lose their health insurance. Given that nearly 70 percent of the state's Medicaid dollars are received as a result of the Affordable Care Act's Medicaid expansion. Johnson said it would be a serious financial hit to clinics like El Rio, as well as the state's economy.

"Our Medicaid program in the state of Arizona is one of the most stellar programs in the nation, in terms of patient outcomes and cost of care management," Johnson said. "With this proposed legislation, it would be really punishing our state Medicaid system."

Stewart Grabel, a retired ombudsman at the Pima Council on Aging, warned that cuts to Medicaid would be especially hard on older Americans. While Medicaid provides long-term, specialized nursing care, Medicare does not; in fact, Medicaid funds over half of all people in long-term care facilities. In Tucson, where the cost of long-term care averages $6,000 a month, seniors stand to lose tremendously without the Arizona Long Term Care System of Medicaid. Seniors would also face dramatically increased premiums and copays.

"In a time where people are growing older and more and more in need, this act actually takes funds away," Grabel said. "This, if you follow, is the money that is intended to be given as tax breaks to the wealthiest folks in the country. That's why this act is very scary."

The list of downsides went on and on. Nearly 6,800 Arizona veterans could have lost Medicaid coverage under the proposed bill, according to the Center for American Progress. Additionally, Medicaid covers nearly half of all Arizona births, and its loss would affect 13 million women in need of maternity care, according to statistics produced by the Arizona Health Care Cost Containment System, leaving some of the state's most vulnerable populations without adequate, affordable health care.

Jodi Liggett, the vice president of public affairs at Planned Parenthood Arizona, warned Grijalva's Town Hall audience that "this is the worst bill for women's health in a generation, maybe ever." The legislation would have prevented low-income women with Medicaid coverage from being able to choose to see a doctor at Planned Parenthood for pregnancy tests, birth control, cancer screening, STI treatment and other services. "This bill disproportionally impacts women," Liggett said. "Single women raising children are the biggest subset of Medicaid patients. One in five women of reproductive age use Medicaid as their healthcare provider. When you slash Medicaid, you're hurting women and children."

Despite the collapse of the Better Care Reconciliation Act, Republicans have not given up on repealing the Affordable Care Act. But it remains to be seen how they will go forward. When he announced he was throwing in the towel on this version of the legislation, McConnell said he'd soon be scheduling a straight-up repeal of Obamacare without a replacement in place. At least nine GOP senators have said they oppose such a move, so McConnell may have trouble with that approach as well, even though Trump recently announced he likes that plan.

"Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate," Trump tweeted after McConnell gave up on the bill. "Dems will join in!"

And even as the repeal effort was collapsing, House Republicans this week unveiled a budget plan that included cuts of $1.5 trillion from Medicaid and Obamacare and $500 billion from Medicare, according to an Associated Press report.

"We're not breaking out the party gear yet," Indivisible Southern Arizona's Randall said after McConnell announced he was abandoning the Better Care Reconciliation Act. "I'm concerned about the future, if McConnell tries to do a full repeal. This isn't going away but neither are we."

Tucson Weekly executive editor Jim Nintzel contributed to this article.

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