The Republican Health Care Bill Is in Limbo. What Should Trump Do Now?

Article originally published in the American City Business Journals on July 5, 2017

Republicans in Washington, D.C., have not yet been successful in crafting a suitable replacement of former President Barack Obama’s Affordable Care Act, a top priority of President Donald Trump.

The Republican-controlled House passed the American Health Care Act on May 4. The non-partisan Congressional Budget Office, in assessing that legislation, projected that 24 million more Americans could be uninsured over the next 10 years due to cutbacks in Medicaid funding and affordability issues than if Obamacare remains in place.

The House AHCA was so unpopular that the Republican-controlled Senate stated it would make improvements in its Better Care Reconciliation Act. However, the CBO projected that over the next 10 years under the Senate BCRA, 22 million more Americans could be uninsured compared to Obamacare, not much different than the House-passed AHCA.

Latest reports indicate that nine moderate and conservative Senate Republicans oppose the Senate bill as written, which ensures the bill would not get the votes to pass. The Republicans can only afford to lose two votes.

The moderates object to 22 million Americans losing their health care coverage. The conservatives object to the bill for not sufficiently reducing spending on Medicaid. Senate Republican leadership withdrew the bill from a vote until after the Fourth of July holiday recess.

Both the AHCA and the BCRA have been labeled as being disruptive to the delivery of health care for our most vulnerable citizens. The American Medical Association and others within the health care industry oppose the Republican legislative initiatives to replace the ACA.

Many governors oppose the AHCA and BCRA because they ultimately place the burden of the growth of Medicaid costs on the states – which they can ill-afford.

Both the AHCA and BCRA include significant tax cuts for wealthy Americans. The optics are terrible: tax cuts funded primarily by cuts in Medicaid. One can only imagine the House and Senate mid-term campaign rhetoric by the Democrats against Republican candidates who supported the AHCA and BCRA.

This is a battle of ideology and a polarized political environment. The Republican opposition to Obama’s ACA has been intense ever since the legislation was passed by a Democrat-controlled Congress and signed into law by Obama in 2010.

Soon after the ACA was passed, issues became apparent that needed to be fixed. Instead of supporting those fixes, Congressional Republicans voted to repeal Obamacare more than 50 times since its passage. They have had seven years to write a replacement to the ACA. Now that the Republicans are in the majority in both the House and Senate, why can’t they get their act together?

A PBS-Maris-NPR poll taken from June 21-25 indicates that only 35 percent of Republicans approve of the BCRA, while only 17 percent of all Americans approve of the legislation. Other polls indicate similar results. Additionally, polling shows that 55 percent of Americans support Obamacare.

Are the Republicans tone-deaf? Is ideology driving them to pass legislation that is unpopular with the citizens they represent? At this rate, they will pay a price come the next Congressional mid-term elections in November 2018.

It is time for President Trump to show some leadership. Trump has made many supportive statements about Medicaid. On May 7, 2015, Trump tweeted, “I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid….” On July 15, 2015, he tweeted, “The Republicans who want to cut SS & Medicaid are wrong.”

These tweets are representative of Trump’s many statements both before and after he was elected, promising not to cut Medicaid.

In Trump’s victory speech after he won the election, he said, “Now it is time for America to bind the wounds of division. … To all Republicans and Democrats and independents across this nation, I say it is time for us to come together as one united people. I pledge to every citizen of our land that I will be president for all Americans….”

Trump now needs to show leadership and fulfill that pledge.

However, on June 30, Trump tweeted, “If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date.” The repeal would involve phasing out Obamacare over a period of time. This was previously rejected by the Republicans. It is not politically wise.

After describing the AHCA as “mean,” the president says he wants a health care bill that “has heart.” So, why is Trump so supportive of the BCRA that cuts the growth of Medicaid and could adversely impact 22 million Americans?

Trump is not ideological. What is important to him is a win. He thought supporting the Republican health care legislation would get him that win. So far, that approach is not working. It has not resulted in a win that Trump so highly desires. The divide between conservative and moderate Republicans may be unbridgeable.

Trump can get his win by demonstrating leadership and telling the Republicans to work with their Democratic colleagues and write new health care legislation that will satisfy the needs of Americans.

In a speech on the Senate floor on June 28, Senate Minority Leader Chuck Schumer (D-NY) said, “President Obama invited both parties, Democrats and Republicans, to Blair House, to discuss health care reform in front of the American people early in his first term as president.

“President Trump, I challenge you to invite us, all 100 of us, Republican and Democrat, to Blair House to discuss a new bipartisan way forward on health care.”

To date, the Republicans have not asked for any input from the Democrats, but it might be the only way for Trump to get his win and do what is right for the American people.

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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