Path Back to Plan O

Sen. John McCain.

Sen. John McCain.

John McCain is the U.S. senator most seriously involved with health care today. He told a series of truths Tuesday that both made predictions and provided guidance for health care deliberations.

McCain, R-Ariz., underwent surgery for a blood clot behind his skull and above his left eye on July 14. The Mayo Clinic said July 19 that tests by its doctors found that McCain has an aggressive type of brain cancer.

The Senate has not accomplished anything, McCain said Tuesday, and the whole body must work together if it hopes to succeed.

President Donald Trump scolded Senate Majority Leader Mitch McConnell and the rest of Republican senators last week for their inability to pass three separate bills. The bills aimed to repeal the Affordable Care Act — Obamacare — and install a weaker replacement.

The failed bills became known as Plan A, Plan B and Plan C. They are variations of the Better Care Reconciliation Act, written by Senate Republicans and guided by McConnell. They set out to improve the House of Representatives’ punitive American Health Care Act, passed May 4.

The House bill would eliminate health insurance for 14 million people in 2018, compared to present, 19 million in 2020 and 23 million in 2026, estimated the nonpartisan Congressional Budget Office on May 24.


McConnell moved the Senate to formal votes this week.

Tuesday, with the ABCs piling up, the Senate switched to descriptive names. It defeated a new variation of its bill, known as repeal and replace. The bill included an amendment from Sen. Ted Cruz, R-Texas, to allow low-coverage, low-cost insurance plans that do not meet Obamacare standards for coverage. It failed with 43-57.

Wednesday, the Senate voted on partial repeal. The proposal would repeal the bulk of Obamacare after two years, and the Senate would write a new plan in the meantime. The same proposal was called Plan C last week. It would eliminate health insurance for 17 million people in 2018, compared to present, 27 million in 2020 and 32 million in 2026, estimated the CBO on June 19.

A majority of senators found none of McConnell’s proposals an improvement over Obamacare. Plan O has brought health insurance to more than 20 million Americans.

Thursday, Republican senators tried to repeal Obamacare during a 20-hour debate.

Next on the Senate’s schedule is a segment known as vote-a-rama. This period allows any senator to offer amendments to the bill. The amendments could reach into the hundreds. One problem: McConnell has not said which version of the Senate bill will be considered.


This helter-skelter is no way to run our government.

McCain explained why in a speech during his return to floor of the Senate on Tuesday. “Our deliberations,” he said, “can be sincere and principled. But they are more partisan, more tribal more of the time than any other time I remember.” He added, “Right now, they aren’t producing much for the American people.”

Both sides are to blame for the partisan rift, including individuals such as himself, McCain said. “Sometimes, I’ve let my passion rule my reason. Sometimes, I made it harder to find common ground because of something harsh I said to a colleague. Sometimes, I wanted to win more for the sake of winning.”

The Senate is “getting nothing done,” McCain said. “Our health care insurance system is a mess,” he said. “We Republicans have looked for a way to end it and replace it with something else without paying a terrible political price. We haven't found it yet, and I’m not sure we will.”

The Trump-McConnell approach of governance by whiplash is irresponsible. Americans count on the federal government to set up a framework that allows those who cannot get coverage at work to buy insurance with proper terms at an affordable price, or to register for Medicaid. They rely on this coverage not only for health care but, in many cases, for life itself.


If all else fails, McConnell plans to introduce a final approach known as skinny repeal.

It would repeal the mandate for most people to have health insurance and it would cut several lesser requirements.

Skinny repeal would eliminate health insurance for 15 million people in 2018, compared to present, 15 million in 2020 and 16 million in 2026, estimated the CBO on Wednesday.

Eliminating the mandate for health insurance would result in many signing up only when they get sick. This would throw insurance-industry finances off balance. It would increase premiums greatly for those who need insurance for ongoing health care — a death spiral.

The American Academy of Actuaries warned against this Tuesday.

“Eliminating the mandate, by lowering financial penalties or exempting particular categories of individuals from its requirements, would likely have significant implications for health insurance coverage, and costs both to consumers and the federal government,” the academy wrote to Senate leaders.

The Blue Cross Blue Shield Association issued a similar warning Wednesday.

“If there is no longer a requirement for everyone to purchase coverage, it is critical that any legislation include strong incentives for people to obtain health insurance and keep it year-round,” the association said. “A system that allows people to purchase coverage only when they need it drives up costs for everyone.”

Insurance Coverage — Total Change (millions) with skinny repeal.png

The Republican House and Senate bills treat Americans with disdain.

Their minimalistic approach to health care ignores a fundamental rule of insurance: Plan for the worst.

The Republican proposals ignore that wisdom by planning for the routine.

Plan O has proved itself as a lifesaver, even though it has some problems.

Republicans have blocked improvements and updates to Obamacare since they gained the congressional majority and now the presidency.

However, as McCain told the Senate, passion should not overrule reason.

Rather than looking for ways to undermine Obamacare, Republicans — along with Democrats — should work to repair and improve this valuable advancement in the American Way.

The people understand. In a Washington Post-ABC News poll released July 16, respondents preferred Obamacare over the Republican approach 50 percent to 24 percent.

Health insurance should cover pre-existing conditions. Health insurance should cover young-adult children on parental plans. Health insurance should cover preventive tests and lab work to detect problems when small and curable. Health insurance should cover emergencies to take substantial cases directly from an emergency room to a hospital room. Health insurance should cover mental care equally with medical care. Health insurance should cover maternity care for mother and child. Health insurance should continue without a payout cap so a person’s coverage can provide crucial care in cases of illnesses that are difficult or require long-term treatment.

The only plan that provides such meaningful coverage is the Affordable Care Act — Obamacare.

Senators should protect and bolster the superior treatment made possible by Plan O. Focus on changes that improve health care for Americans. Make sure that everyone is covered fully.

Adapted from “Upgrade Health Plan O.”

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