Article originally posted in and nationally syndicated by the American City Business Journals on August 1, 2017.

Multiple attempts by Senate Majority Leader Mitch McConnell to get 50 Senate votes for various versions of a health care bill that would repeal and replace former President Barack Obama’s Affordable Care Act (ACA) have failed.

McConnell’s last attempt was a Senate bill known as the Health Care Freedom Act (HCFA), dubbed the “skinny repeal of Obamacare,” which fell one vote short of passage during the early morning hours of July 28.

The HCFA would have repealed the ACA individual mandate to buy health care insurance or pay a penalty, as well as repealed the employer mandate to provide health care insurance to their employees, among other provisions.

The HCFA was not meant to become law; its purpose was to send legislation to the House so that along with the previously House-passed American Health Care Act both acts would go to a House/Senate conference committee, where the bills would be reconciled and result in legislation that would be acceptable to both chambers of Congress.

Senators John McCain (R-Arizona), Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska) voted “no,” resulting in one vote short of the 50 needed to pass the HCFA, which would have required Vice President Mike Pence, presiding over the Senate, to cast the deciding vote for passage.

McCain, Collins and Murkowski had deep concerns about the legislation that might ultimately be passed by the Republican-controlled House and Senate, which the Congressional Budget Office projected would result in as many as 32 million people losing their health care insurance due to insufficient funding of Medicaid going forward.

The loyalty of McCain, Collins and Murkowski was to their constituents and not the Republican party. These three Senators should be viewed as courageous heroes for their concern for people who may lose their Medicaid health care coverage, not as villains, as many of their Republican Senate colleagues now view them. They showed real leadership in voting against the HCFA, unlike some of their Republican Senate colleagues, who placed loyalty to party above the welfare of the people who elected them and likely would vote for any Republican health care legislation no matter how bad it was.

Yes, these three Senators were elected by their constituents based on a platform that in part called for the repeal and replacement of Obamacare. However, they have a responsibility to vote for legislation that does not jeopardize the health care coverage of those same constituents.

Opposing the Republican House and Senate health care bills were Republican governors as well as the American Medical Association, the American Hospital Association and many other health-related industry and professional associations. Opposition from these groups was not acknowledged or addressed by Congressional Republicans.

Trump has threatened to let Obamacare collapse by withholding payments to insurance companies that help cover premiums for low-income people. This would cause additional insurance companies to withdraw from the ACA insurance exchanges, further destabilizing these markets and leaving people with fewer options to buy health care insurance.

After the Senate defeat of the HCFA, Trump tweeted, “3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let Obamacare implode, then deal. Watch!”

Mr. President, effective leaders work to fix problems. They don’t cause further hardship.

After the defeat of the Senate’s HCFA, Steve Doocy, one of the hosts of the “Fox & Friends” show on Fox News Channel, commented to his viewers, “Congratulations. You now would pay a fine or you have to have insurance. Congratulations. The healthy people are paying for the sick people.”

Why is it so difficult for Doocy and many Republicans to understand how insurance works? We all buy home insurance in the unlikely event that our house burns down. We all buy auto insurance in the unlikely event that we are involved in an auto accident. The premiums paid by those who never experience the unlikely events of a house fire or auto accident cover the costs of those who do experience these events.

Health insurance works the same way. In fact, there is a higher probability of individuals using health care benefits multiple times during their lifetime than home or auto insurance benefits. The financial loss of a home or an auto is limited to their value, except for third-party liability exposure. There is no limit to the financial cost of an illness, and those costs could be huge just with the costs of diagnostic tests and only a few days in the hospital.

Health insurance, like any other type of insurance, relies on some policy holders rarely filing a claim. If younger and healthier people don’t buy health insurance, the premium costs for everyone else skyrockets, making insurance unaffordable. This is why the individual mandate is so important.

Health and Human Services Secretary Tom Price, who wants to see the individual mandate eliminated, stated on July 29, “The individual mandate is one of those things that is actually driving up the cost for the American people.” He fails to acknowledge that the individual mandate is the one thing that makes health insurance affordable for many Americans in the ACA risk pool.

Unfortunately, some of those young, healthy people will suffer an unexpected illness or accident and will need health care, and in some cases, health care not covered by “skinny” policies favored by the Republicans. Who will pay for their care?

Do they expect to get a free ride on the backs of those who bought health insurance coverage and have paid premiums? This would certainly be contrary to Republican ideology.

On July 28, after the early morning defeat of the HCFA, McConnell signaled that he is open to inviting the Democrats into the process. Said McConnell, “We look forward to our colleagues on the other side suggesting what they have in mind.”

Time will tell if McConnell is serious.

Stan Silverman is founder and CEO of Silverman Leadership. He is a speaker, advisor and nationally syndicated writer on leadership, entrepreneurship and corporate governance. Silverman earned a Bachelor of Science degree in chemical engineering and an MBA degree from Drexel University. He is also an alumnus of the Advanced Management Program at the Harvard Business School. He can be reached at
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