Just when it appears that all the Obamacare myths have been reviewed and reported, another flagrant lie is thrown into the mix. The new battle cry of the Republicans is that the two parties should come to the table and “negotiate” their differences and arrive at a “compromise” regarding ACA, because naturally that is what politicians do when they don’t agree. They present this information as if somehow they have been “cheated” out of the ability to advocate for changes to the law. The new Republican manipulation of the facts is clever, but absolutely false none the less. Reviewing the history of the Affordable Care Act from its inception to the opening of the state and/or federal health exchanges will show that negotiation and compromise happened at consistent and continuous points as the Affordable Care Act became law, just like every other bill that passes through Congress and becomes law.
The United States government was “shut down” on October 1, 2013. At the center of the debate, being played out in the media, is the notion that Obamacare should be defunded. When the Democrats and the President stated defunding Obamacare was “not on the table” the Republicans began their battle cry that President Obama and the Democrats “WILL NOT” negotiate. They suggest they (The Republicans) are willing to come to the table and “compromise”, as if no negotiations, committee meetings, and hearings were held to work out differences between the two parties. They attempt to demonstrate the validity of their argument with a picture of numerous Republicans sitting on one side of the table, and facing empty chairs on the other side of the table. (http://abcnews.go.com/blogs/politics/2013/10/house-republicans-wait-at-a-table-for-dems-to-negotiate-budget/) They indicate they are ready to negotiate waiting simply for the Democrats to give up their stubborn “my way or the highway” mentality and engage in negotiations. The Democrats along with President Obama say they have “come to the table” previously and sought compromise innumerable times in regard to ACA/Obamacare and that it is now the “law of the land” will not place the law in jeopardy with additional negotiations. President Obama and the Democrats state the Republicans have had numerous opportunities to question and amend this law during the its passage through Congress. Since its passage the Republicans have squandered repeated opportunities to be involved in tweaking certain aspects of the law because it was pursuing other recourse such as putting a forth a case for the law to be deemed unconstitutional and and voting for than 40 times to repeal the law in the House of Representatives.
In order to best understand this “battle of wills” by both parties, let’s take a stroll down memory lane to elementary school and review the lessons Americans are taught about the branches of government and how a bill becomes a law. Remember what we learned from how a “Bill becomes Law”. Our founding fathers, created three distinct branches of government: The Executive Branch, The Judicial Branch and the Legislative Branch. (http://www.congressforkids.net/Constitution_threebranches.htm) Each of these branches have specific roles in our government that are done independently, and in some cases, for example, collaboratively for a bill to become law. In a nutshell, the Congress (Legislative Branch) passes laws, the President of the US (Executive Branch) implements the laws , and the Supreme Court, (Judicial Branch) when requested, determines whether the law is constitutional. While this is a simplistic view of the branches of government, for the purposes of this discussion, it provides the foundation of understanding how one party is attempting to manipulate the facts in order to change the result. In fact, a review of the process that took place prior to ACA became the law will prove that both parties negotiated and compromised many times at many levels before the bill was passed into law. It is important to not only understand the branches of government, but also “how a bill becomes law”. (http://www.factmonster.com/ipka/A0770454.html)
- A bill is introduced by a member of Congress. In the case of The Affordable Care Act, it was first introduced into Congress as The Affordable Health Choices Act in July, 2009. It should be noted however that negotiations between the Democrats and Republicans regarding the issue of health care started long before the bill was introduced.
- The first summit about the need for national health care was held at the White House in early 2009.http://www.pbs.org/newshour/updates/health/jan-june09/healthcare_03-05.html Citizens from several walks of life came together including health care workers, law makers, lobbyists, physicians and many more groups!
- Between March/2009 and May/2009 there were no less than 17 different meetings between members of Congress discussing how the Affordable Care Act should look. (http://www.finance.senate.gov/issue/?id=32be19bd-491e-4192-812f-f65215c1ba65 )
- During the summer of 2009 a bi-partisan committee made up of three Democrats and three Republicans met 31 times for a period of over 60 hours to develop what would ultimately become the Affordable Care Act. (http://www.cnn.com/2012/06/28/politics/supreme-court-health-timeline/index.html)
- The bill is sent to the Appropriations Committee as well as many other committees as needed after it is introduced. It is during these “committee” meetings that negotiations and compromise begin on ANY bill sent to committee. Sometimes, a member of the committee may call for public hearings to gather more information about a proposed law and the impact it may have on the American people.
- In July, 2009 The Senate’s Health, Education, Labor and Pensions Committee passed The Affordable Health Choices Act. This bill contained more than 160 amendments all added by the Republican members of the committee and all were approved. (http://www.cnn.com/2012/06/28/politics/supreme-court-health-timeline/index.html) In fact, this bill remained in committee for over a month. The 160 amendments to the bill will live in infamy as a bill that was “marked up” or changed by amendments as one of the largest changes in history.
- Between July and December 2009 the bill was referred to several committees and a great deal of negotiation and compromise between the two parties continued during these meetings.
- Each committee makes a decision about whether to table the bill, which means the bill is basically dead, or they can pass the bill, or they can hold hearings and further discuss the bill. The bill which would ultimately become the Affordable Care Act was passed by all the committees that reviewed it in the House and the Senate and sent to the full House and Senate for a vote.
- When the bill has passed all its committees it is sent back to the House and Senate. While they utilize a similar process, the House bill and the Senate bill are often very different.
- When the bill comes back to the full House or Senate, the bill is debated again on the Chamber floor. During this time there is continued negotiation and compromise before a bill can be voted upon. Members of the House can offer amendments to the bill and each of these as well as the bill itself is voted upon. It was a long and arduous process as the Affordable Care bill was debated in both chambers. Some of the “Obamacare” myths that are repeated over and over again in the media originated in these strenuous debates such death panels, chips being placed under someone’s skin to follow them and numerous others.
- By December 2009 both the House and the Senate had passed their individual versions of what would become the Affordable Care Act. (http://www.cnn.com/2012/06/28/politics/supreme-court-health-timeline/index.html
- If the bills passed by the House and Senate are identical then there is no further action needed. However, if there are differences in the two bills, then the bill is referred to a JOINT House and Senate Committee for negotiation and debate until one single bill can be agreed upon. After the agreement has been reached one single bill is returned to both the House and the Senate for further debate and a vote. ((http://www.factmonster.com/ipka/A0770454.html) In terms of the Affordable Care Act, the “clean” bill, one that everyone or at least a majority of Congress could agree upon.
If anyone wants to change or repeal a bill, it is done via the legislative process. Another bill could be introduced, committee processes can be reinitiated, votes in the house and the senate can take place again, and conference between the two congressional chambers can occur again and ultimately the bill can become law or may result in neither bill being passed. . Once a bill becomes law it is rarely overturned or repealed. Bill Moyer said this: “Once upon a time when I was a young man working on Capitol Hill, it was commonplace that when a bill became law, everybody was unhappy with it. But you didn’t bring down the government just because it wasn’t perfect. You argue and fight and vote and then, due process having been at least raggedly served – on to the next fight.” (http://billmoyers.com/segment/bill-moyers-essay-shutdown-showdown/)
It is confusing at the very least to understand how members of either party could suggest there has been no negotiations or compromise on the Affordable Care Act. In fact, it would appear that this bill had significantly MORE than the average amount of debate and compromise associated with it. Even after the bill had been sent to the joint House and Senate committee, there was continued negotiation and compromise. President Obama and leaders of both parties held a televised summit to explain what would become the Affordable Care Act. The bill was passed by both the House and the Senate and on March 23rd, 2010 President Obama signed the bill into law. (http://www.cnn.com/2012/06/28/politics/supreme-court-health-timeline/index.html)
There is always a winner and a loser in politics, but hopefully out of the continuous negotiation and compromise, a law will be enacted that the average American can live with even though they may not like all aspects of the bill. One party or the other will claim victory which is to be expected when our democracy is based on the fact that the majority wins. This certainly was true of the Affordable Care Act. The Republicans, controlled by a small number of extremist conservatives called the Tea Party, were none too happy about the passage and subsequent package of the Affordable Care Act. Immediately upon passage of the Affordable Care Act into law, the Republicans in Congress worked with Republican Governors and asked the Court to find that the law was unconstitutional. Two years after the passage of the Affordable Care Act, the Supreme Court ruled that ACA was constitutional although it indicated states could not be forced to expand Medicaid in their state and that provision was struck down. (http://kff.org/health-reform/issue-brief/a-guide-to-the-supreme-courts-affordable/) Now, one would assume that since the Affordable Care Act was not overturned by the Supreme Court, it would simply be law and the parties would work together to implement the law. Unfortunately, that was not the case. The Republicans, again controlled by the Tea Party, appeared unwilling or unable to accept that the Affordable Care Act was the law of the land. When the Supreme Court failed to overturn the law, the House began repeated attempts to repeal the bill. They did not make one or two attempts, they made over forty at a cost of more than fifty five million dollars. (http://www.huffingtonpost.com/2013/08/02/gop-obamacare-vote_n_3695871.html) As the date of implementation got closer and closer the rising frustration of the Republican Party was easily seen. They threatened, screamed, ran millions of dollars worth of ads, and told lie after lie about the impact of Obamacare on the American public. They have tried to present themselves as martyrs, indicating they are doing what the majority of the nation wants. Ironically, the polls suggest just the opposite is true, less than 1/3 of the American public wants the Affordable Care Act defunded or the government shutdown. (http://www.forbes.com/sites/theapothecary/2013/09/30/new-poll-only-one-third-of-americans-support-repealing-defunding-or-delaying-obamacare/) With every passing day, the costs of this government shut down, approximately 12.5 million dollars an hour, is escalating beyond control. (http://www.nbcnews.com/business/money-nothing-government-shutdown-costs-12-5-million-hour-8C11308802) It appears however, that the Republican battle cry of “we want to negotiate” or “the Democrats won’t compromise” is at the VERY least disingenuous and clearly appears to be a lie or rhetoric they are trying to make the American tax payer believe in an effort to hold our government hostage and extract even more concessions from the Democrats and President Obama.
Rand Paul, the junior Senator from Kentucky and one of the Republican supporters of the government shutdown was heard on an open microphone saying the following to Mitch McConnell, the senior Senator from Kentucky, “I think if we keep saying, ‘We wanted to defund it. We fought for that and that we’re willing to compromise on this, I think they can’t, we’re gonna, I think… well, I know we don’t want to be here, but we’re gonna win this, I think.” (http://www.politico.com/story/2013/10/mitch-mcconnell-rand-paul-government-shutdown-97795.html) Contrary to what the Republicans are trying to make the public believe, the Democrats have negotiated, compromised, and attempted to find resolution in this battle between the parties. Additionally, what the Republicans don’t want anyone to know is that the Affordable Care Act is actually based on a proposal by the conservative think tank, The Heritage Foundation, who suggested the vast majority of the tenets of this law in the early 90′s as an alternative to the committee led by Hilary Clinton that put forth a single payer system. (http://www.pennlive.com/editorials/index.ssf/2012/03/ironic_challenge_affordable_ca.html)
Based on the record, the Democrats have made substantial compromises with the Republicans, even after the Supreme Court ruling. The Democrats agreed to keep funding of the government at the sequester levels, way below where they would like the funding to be. They also did NOT try to shut down the government when they lost the battle about Food Stamps. So, the Republicans argument that the Democrats have not negotiated or compromised is null. Shutting down the government should not be a game about bypassing the legislative process as defined in the constitution, who is going to win, or worse the government and the American people should not be held as ransom to get what a particular party wants to occur.
With the shutdown of the government the Republicans in the House didn’t just stop at trying to defund ACA/Obamacare they have also added language to the Continuing Resolution (CR) about women’s reproductive choice options and additional corporation subsidies while continuing to defund social programs such as SNAP which are so desperately needed in this time of recession. As if that wasn’t bad enough more than 800,000 federal employees are furloughed, services are not available that people count on such as meteorologists who can warn residents about upcoming bad weather, employees who approve VISAs and Passports for overseas travel, national parks are closed. There are also many other negative impacts to our safety and economy due to the government shutdown. This is why both the Democrats and the President have been calling on the House Republicans to bring a bill to come to the full House that is a clean CR. Additionally, they have also called upon the Republicans to raise the debt ceiling so that the American economy is not sent into unknown chaos, but also in a few weeks when the current debt ceiling is reached, the world economy is not sent into chaos.
What is clear is that the Republicans think this is some kind of game they can “win” by saying they want to compromise or negotiate, banking on the hope that no one will call their bluff and confront them with the amount of compromise and negotiation the Democrats and Republicans have already done. (http://www.cbsnews.com/8301-250_162-57605369/government-shutdown-whats-the-impact/) Negotiations about the tenets of the Affordable Care Act, as can be seen by the previously documented evidence, occurred over and over again as the bill was introduced, and as it wove its way through various committees, including the joint House and Senate reconciliation committee prior to it being passed by both chambers and sent to President Obama for signature.
The Affordable Care Act is not perfect, but it is a step in the right direction of insuring every American citizen has adequate health care coverage. Since the Affordable Care Act became law in 2010 the Republicans have had many opportunities to renegotiate certain aspects of the law and/or work with the Democrats to fix certain items that have been found to be troublesome such as people in labor unions being punished tax wise due to their excellent insurance plans, the lack of Medicaid Expansion in many states, federal employees being unable to use their employer contribution when using the federal health care exchange along with many others. The Republicans, rather than working on these issues and resolving the problems, refused to participate in any such meetings instead spending their time working on the Supreme Court case to overturn the law and when that didn’t work, they made repeated efforts to repeal the law more than forty times. Imagine this we, the United States of America, are walking a fine line where this small group of rogue Tea Party Republicans could send the entire world economy reeling because they do not want to use the defined constitutional legislative process to accomplish their goals. They are attempting to govern by temper tantrum, manipulating data, and outright lying in order to get their way and “win” the game. It kind of reminds me of the big melt down Charlie Sheen had when he went on his “winning” tour. Nothing he said made sense, just like the actions taken by the Tea Party Republicans make no fiscal sense. Clearly for Republicans to suggest that the Democrats have not negotiated or compromised on the Affordable Care Act is false and deserves a label of “liar, liar, pants on fire.”
About the Authors: By: Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO and Lynne Smith, MSSW. Barbara is an industrial engineer with an MBA. She worked in the pharmaceutical industry for many years before moving into the healthcare industry where she had a company where she provided top quality coding, compliance and revenue cycle management services for physicians. She has since moved into full time consulting for physicians. Barbara is a nationally known expert known for her education, consulting and expert witness services. Lynne has dedicated her career to helping others. She has experience as a social worker in a rural county, an administrator in a large hospital network and as a College Professor. She uses the skills she developed over the years as an advocate in a variety of areas including her most recent venture serving as a Healthcare Advocate. Together, Lynne and Barbara own the ACA Healthcare Advocates consulting firm and are available to individuals, families and businesses to help them meet the requirements of the Affordable Care Act in order to meet the specific needs of the client while optimizing the fiscal considerations. Please direct your questions and/or inquiries to email@example.com.