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ACA Deathwatch: Damned if they do…or don’t

GOP Representatives are being strong-armed by President Trump and wooed by House leadership, and nowhere is the stress more intense then where I live – upstate New York.

While Trump blusters and leadership cajoles, wheedles, and bribes, Katko, Tenney, Faso et al (upstate GOP Congresspeople) are facing furious constituencies livid at the possibility that they and their neighbors will lose coverage – and that their state is being held hostage.

photo credit WSKG News

New York is the only state that requires counties to pay a chunk of Medicaid expense – 13% to be precise.  In my home county, Onondaga, that amounts to just over $100 million, and costs the average  homeowner about $600 annually in property taxes. In an effort to bribe/force upstate’s Republican Representatives to support AHCA, the bill was modified to specifically force New York to eliminate counties’ financial requirement and shift it to the state.

In Onondaga, 80,000 people, one out of six residents, is covered by Medicaid.  There are 26,000 healthcare jobs in the county paying $58,000 each.  If the AHCA passes and Medicaid expansion funding disappears, we’re going to lose over a thousand jobs – and $60 million in wages. Sure property taxes will go down, but state taxes will have to increase.

Syracuse – the biggest part of the county – has the highest minority poverty rate in the nation, and the lowest economic opportunity of any municipality as well.  Other upstate communities are better off – but not much.

If AHCA passes, an already desperate economic and health situation will get immeasurably worse.  That’s why Katko won’t hold town halls and is avoiding any and all public appearances; he knows that a NO vote on AHCA will cause a tweetstorm while a YES vote will likely cost him his seat.

That’s the dilemma facing all House Republicans, even those in “safe” seats. While Freedom Caucus members don’t know it yet, passing AHCA would cost many their seats. Voters HATE losing things they already have, and now that they have health coverage, and were promised the replacement will be better/cheaper/with lower deductibles and more access, when that proves to be false they are going to be really pissed off.

Medicaid cuts will result in their parents losing coverage for nursing home stays, neighbors’ disabled kids losing medical care, friends losing jobs in healthcare, and hospitals in rural America closing.

Fortunately, it’s extremely unlikely AHCA will pass, as several Republican Senators are strongly opposed to AHCA and will not be intimidated by Trump tweets.

What does this mean?

Elections have consequences – and so do votes.

If upstate Republicans vote to overturn ACA and the bill doesn’t pass the Senate, they are going to pay a very heavy price from voters on both ends of the political spectrum.  

4 thoughts on “ACA Deathwatch: Damned if they do…or don’t”

  1. That’s the game when you only look at the process as political. Healthcare, health insurance coverage is NOT a political football. Our legislative leaders made it so. People will always need to get care for their health needs. If they have insurance they will use it and if they don’t they will go to the ED. WE all pay one way or another. If the politicians were true leaders they would demand that they do what would be good for the Amercian people regardless what is good for them politically.

  2. The critiques employed by the GOP\’s years-long campaign against the ACA should down in poli-sci textbooks on how not to argue your position. You can\’t say the ACA is unsuccessful in lowing premiums, etc., while at the same time try to keep the ideological position that gov\’t subsidized healthcare is morally wrong and/or economically detrimental.

    It\’s analogous to Dems saying that the countries affected by the travel ban haven\’t committed acts of terror. You\’re then backing yourself in a corner to defend the notion that the ban needs to go further to cover countries that have, when you don\’t even want the ban in the first place. Just say you don\’t want a ban for moral reasons and make the case from there…

    The GOPs backing of themselves into a corner is how we have this wildly unpopular AHCA; a grand compromise, misaligned somewhere in the middle of trying to keep up Trump\’s grandiose promises, improve on McConnel\’s critiques of the ACA\’s shortcomings, and humor those morally opposed to a welfare state.

    What is the GOP trying to accomplish?

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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