Durch die USA zieht sich ein tiefer gesellschaftlicher Spalt. Das wird auch in der Debatte um Obamacare und die von US-Präsident Trump vorangetriebene Abschaffung dieses Gesetzes deutlich: Der von Trumps Amtsvorgänger installierte Patient Protection and Affordable Care Act (PPACA) sollte eine vom Kontostand der Patienten unabhängigere medizinische Versorgung gewährleisten. Welche Auswirkungen die Abschaffung von Obamacare haben wird, ist noch nicht absehbar. Im Ringen um die notwendige Zustimmung für ihren American Health Care Act (AHCA) müssen die Republikaner wohl zumindest ein paar Zugeständnisse machen – auch auf Drängen von Ärzten und anderen Stakeholdern aus dem Gesundheitswesen.
Considering the current situation with U.S. health care policy, the biggest question for Americans and their government leadership is, of course, what direction do they wish to be heading? Obamacare, for all its faults (and it has many) has been the law for seven years. Its enactment puts America firmly on the side of trying to decrease the uninsured population in the U.S. It’s uncertain that, in electing President Trump and his promise to “repeal and replace” Obamacare (the Affordable Care Act), Americans were voting to return to pre-2008. This “disconnect” is why Republicans are having such a difficult time keeping their promise to repeal Obamacare.
But the Republicans keep trying.
Last week, the U.S. House of Representatives voted to pass the revised American Health Care Act (AHCA) by a 217-213 margin. Not a single Democrat supported the bill and 20 Republicans voted against it. The bill survived a number of last-minute changes as House leaders and President Trump worked to win sufficient votes to pass it. Almost immediately upon passage, Republicans in the Senate disavowed the House bill and, over the weekend, made it clear that the Senate would write its own bill. Republicans hold a 52-48 majority in the U.S. Senate. Because it is unlikely that any Democrats will support the Republican effort to repeal Obamacare, Republicans can afford to lose only two Senate votes (Vice President Pence can vote in case of a tie). It is not at all clear whether a Senate bill will resemble the House bill or if it will be dramatically different. Should Republican Senate leaders succeed in developing a bill that can pass the Senate, there will next need to be a conference during which the Senate and House bills must be reconciled. Ultimately, both bodies must pass identical legislation…and the U.S. Congress remains a very long way from achieving that result.
Should legislation resembling the current House bill indeed become law, there are a number of concerns held by many health policy experts. These critics worry that the bill’s structure might result in increasing – rather than decreasing – the number of Americans without health insurance. The bill changes the structure of health insurance subsidies available to individuals to purchase insurance and makes very large cuts to Medicaid, the federal-state program designed to provide health insurance to America’s poor and underserved. The proposed legislation also may result in changes to the availability and/or cost of insurance to people who have pre-existing conditions and go without insurance for a period of two months or more.
For the U.S. healthcare industry – hospitals, physicians and nurses, biopharmaceutical and medical device companies in particular – having more people with good health insurance is a good thing. Also, all physician and hospital groups opposed the House-passed bill and will be working hard to ensure their voices are heard as the Senate begins its work. Pharma companies want to see more people with insurance and they’d much prefer that the health insurance that people carry offers lower deductibles and co-payments.
In the end, virtually no health care organizations supported the House-passed bill. Republican Senate leaders will need to work to win the endorsement of at least some health care stakeholder groups if they hope to succeed. Only time will tell whether the Republican promise to undo Obamacare will see the light of day.