Repeal And Replace: Now What?
By Mark D. Olshan
Associate Executive Vice President, B’nai B’rith International
You may have heard the story of the dog playing in the front yard of his master’s home who always ran barking after the bus that passed by until he got tired and stopped running. The next day, the same thing happened. The bus would drive by and the dog would bark and run trying to catch it. And this would go on, day after day, after day…
Well, guess what? One day, he finally caught it.
Now, what in heaven’s name will he actually do with it?
During the seven years since the passage of the Affordable Care Act (ACA), Republicans on Capitol Hill stood united in their resolute opposition to what they relabeled, derogatorily, as “Obamacare.”
Rather than accept the fact that the program could help many Americans and try to modify and improve this admittedly massive attempt to overhaul health care, making it even more affordable and workable for the American people, the goal was to deride the ACA as singlehandedly destroying health care in America.
From the moment it was enacted more than seven years ago, congressional Republicans vowed to “repeal and replace” the ACA with something “cheaper, less bureaucratic and offer far more choices.” Yet, it was only just recently that an alternative plan was finally introduced. After the plan failed to pass, House Republicans mustered a slim majority in early May, sending the measure to the U.S. Senate where it faced an uncertain outcome.
Repeal and Replace? Yes, Mr. President, It’s Complicated.
With a Republican president and his party controlling both houses of Congress, the goal of “repeal and replace” seemed within reach. But, it has been proven more difficult, especially after the nonpartisan Congressional Budget Office estimated up to 24 million Americans would lose health coverage under the Republican proposal.
Now, I don’t presume to suggest that the ACA as rolled out was perfect. There were areas that needed to be tested empirically and potentially improved. Many of us would agree that keeping our kids on our health care plans until they are 26 and better able to purchase insurance on their own are good ideas. Also, any of us with pre-existing conditions would like to have continued coverage should we move to a different insurance carrier or plan. Additionally, subsidies for persons of a certain income or facing higher age-related insurance costs are intended to guarantee acceptance into a quality insurance plan, covering an estimated 15 million to 20 million persons who would otherwise be uninsured.
But how do we pay for all this? Well, the idea was to make certain that younger, “more healthy” individuals would be enrolling, bringing in a massive infusion of dollars that would balance those older and probably more likely to require expensive health care. In essence, spread the risk around, thus keeping rates more affordable for all.
Unfortunately, many younger folks don’t think like that. I guess if you’re young and healthy, you don’t think you need to be insured because you feel that you will never need coverage. So much for that infusion of cash and young people needed to balance out the risk pool.
Obviously, this was a major sticking point in the “repeal and replace” debate. Representatives of the congressional Freedom Caucus opined that people should be responsible only for purchasing the amount and specific type of insurance they wanted. However, the suggestion that people who buy lower cost or high-deductible insurance do so because they want to, rather than because it is all they can afford, strains credulity. So much for the collective “risk pool” and understanding of how insurance actually works.
But, what about us “older” persons?
Generally, I don’t believe most people thought that seniors would be part of the discussion on “repeal and replace” because they are already covered by Medicare. While the vast majority of Americans 65 years and older have Medicare, many older persons and people concerned about aging in America have plenty at stake in any replacement system that comes to fruition.
First, for aging to look the way it does in the best brochures—with happy retirees enjoying travel, volunteer work, long walks on the beach— we need to be healthy and still have some savings to afford this lifestyle. So, from the perspective of the long game, health care coverage is essential for making “healthy aging” a reality.
When we talk about older adults, however, we aren’t magically targeting people the day they turn 65. From 50 through 64, there is a greater likelihood of becoming disabled or developing conditions like diabetes, manageable with appropriate treatment but devastating if left untreated. Health insurance for this group has always cost more—and the loss of employer coverage many suffered during the Great Recession has only heightened the problem.
For this group, the Affordable Care Act dramatically reduced the “age tax” that insurers could impose for just being older, and it eliminated exclusions from insurance for those with pre-existing conditions. Further, the law reduced or eliminated out-of-pocket charges for preventive care. The ACA also expanded Medicaid to cover lower income older adults too poor to afford insurance—even with subsidies—but not poor enough for traditional Medicaid. Many covered by the Medicaid expansion are ages of 50 to 64.
Finally, there is a great deal in the ACA for Medicare enrollees. The replacement bill eliminated cost sharing on a whole host of preventive services that help keep older adults healthy—services some skipped in the past because of cost, with expensive results both in terms of future Medicare spending, and length and quality of life. The ACA also established a timetable for closing the “doughnut hole” that makes the cost of prescriptions through Medicare prohibitive. While the “repeal and replace” measures that were floated did not specifically repeal this fix to the coverage gap, they would have eliminated the fee on manufacturers and importers of branded prescription drugs that helps pay for the benefit.
So, What Now?
As we go forward, a word of caution: The devil is always in the details. Advocates for healthy aging, as well as older adults and people who love them, should be looking very carefully not at what alternative plans claim to do but what they actually would do.
Recently, we’ve heard of proposals that claim to save the Medicaid expansion but would, in reality, limit it to a grandfathered group that would shrink every year as people cycle on and off Medicaid (because of fluctuating income) and fail to get alternative coverage, thereby disqualifying them from rejoining the expansion if their income drops.
In addition, we hear about sweeping changes to Medicaid. Millions of Americans are eligible for Medicare at age 65 and for Medicaid, because they have very low incomes and few assets. Currently, states get matching money based on how much they spend on Medicaid. Under various proposals, the federal government would cap its contributions to states, no longer responding to changing circumstances that affect actual state spending on the program. Thus, the federal government would save money by giving the states less, leaving the states to bear the burden. But the resulting reduction in the federal deficit is merely a shifting of the expense to the states, which can then reduce benefits, raise taxes or incur their own deficits to make up the difference. Even now, states struggle to fund their share of Medicaid.
And finally, as it stands today, if the ACA were to be eventually repealed, those in their fifties and sixties could see premiums rise by $2,000 to $3,000 a year or more, with increases of 20 percent to 25 percent, or higher. Under the ACA, insurers cannot charge more than three times what they charge younger persons for the same coverage. This ratio was proposed to increase to five to one—or even more.
So, does the concept of “bipartisanship” still mean anything in Washington?
Perhaps it may be time to actually see where it makes sense to work “cooperatively” and “fix” certain issues of the ACA rather than continuing to tackle “repeal and replace” without any reasonable replacement. Those on the hard right clearly want to see anything from Washington just go away. However, there are more moderates on both sides of the aisle who disagree.
Let’s try something unique in this town—building consensus, as opposed to playing politics.
Can you say, “Single payer system?”
By Daniel S. Mariaschin
B'nai B'rith International CEO
This is a year of anniversaries for Israel and the Jewish people. Among them are the 120th, marking the First Zionist Congress; the centenary of the Balfour Declaration; Israel’s 69th anniversary, and the 50th anniversary of both the Six-Day War and the reunification of Jerusalem.
We are accustomed to round-number anniversaries, or those that end in 5. But Israel’s 69th should not be lost in the shuffle of activity this year. We need to pause and remember the difficult days between the Holocaust, the end of World War II, David Ben-Gurion’s reading of Israel’s Declaration of Independence on May 14, 1948, and the war that followed against Israel’s invading Arab neighbors.
On V-E (Victory in Europe) Day 1945, European Jewry had been nearly exterminated. Survivors struggled to re-establish their lives where they had lived, or in displaced person camps. Many had lost their families, their homes, their livelihoods. Mandatory Palestine, ruled by the British, was indeed hatikvah, the hope, with its Jewish-majority cities, its self-defense organizations, its farms and factories, its growing cultural vitality.
But getting there was the problem. Notwithstanding the horrendous devastation of Jewish communities and the horrors of the concentration camps—all of which were known to the British authorities, the doors were closed. Instead of being treated as the victims they were, they were prevented from setting foot on their sought-after haven.
Hard-hearted and politically motivated would be charitable terms for what the British did, but much harsher descriptions would be far more apt. Tramp steamers and old cargo ships crammed with survivors bearing concentration camp tattoos on their arms were stopped, some within sight of Israel’s coastal towns and cities and turned away, their passengers were then interned in detention camps on the island of Cyprus, which the British also controlled. The American Jewish Joint Distribution Committee provided assistance to the internees, but day-to-day life was difficult.
There were nine such camps. Among the 54,000 Jews who populated them from 1945 to early 1949 were my cousins and my wife’s uncle. The motion picture “Exodus” depicts life on Cyprus, with detainees living in corrugated tin huts and tents, their sole protection from the harsh Mediterranean sun. And there they waited, uncertain and undoubtedly anxious about their future.
Earlier this year, when B’nai B’rith International President Gary P. Saltzman and I participated in the annual Conference of Presidents leadership mission, we spent a day in Nicosia, the capital of Cyprus. Israel enjoys excellent relations with the island nation, and we heard remarks from its president, Nicos Anastasiades, and other high ranking officials. From the presidential palace, we proceeded to the site of the old British Military Hospital, where one of the most heartwarming ceremonies I have ever witnessed took place.
We learned that, in that hospital, many of the 2,200 babies were born to Holocaust survivors on Cyprus between 1946 and early 1949. A monument to those births, a project initiated by a survivor-detainee, has been erected on the site. Speaking to us that day were the Israeli ambassador to Cyprus, Yael Ravia-Zadok, and the Cypriot defense minister, Christoforos Fokaides.
In his remarks, Fokaides noted “that hope can be found even in dark times. It is for this reason that Cyprus is, as depicted by Yad Vashem, a corner of hope, marking the start of a new beginning.” He said that local residents shared food and clothing with the detainees, and as some of those interned have noted, “the grace exhibited by local Cypriot communities toward them contributed to the start of the restoration of their shattered belief in what is good in humanity.”
During the ceremony, the Cypriot and Israeli flags fluttered in a late winter breeze, blowing under a cloudless sky. Since then, I have thought often about the births of those babies to parents who only months before had experienced the worst possible horror known to mankind. Despite their detention, they would not be denied their future. Nor would their fellow Jews in pre-state Israel, who would declare a sovereign Jewish state a short time later.
In this year, when we celebrate the realization of the Zionist dream, let’s think of all those who made it happen, and flourish, including those detained—and born—in Cyprus, on their way to the Jewish homeland.
By Gary P. Saltzman
B'nai B'rith International President
B’nai B’rith President Gary P. Saltzman (center left), Israeli U.N. Ambassador Aviva Raz Shechter (center) and B’nai B’rith Executive Vice President and CEO Daniel S. Mariaschin (center right), with the B’nai B’rith delegation to the United Nations Human Rights Council and United Nations Education, Scientific and Cultural Organization in Geneva.
Sometimes progress can be measured only incrementally, and views of success have to be adjusted. This is especially true on the international stage, where global politics and policy can seem to be moving so slothlike that you question if they are moving at all.
In March, CEO Daniel S. Mariaschin and I led the annual B’nai B’rith mission to the United Nations Human Rights Council (UNHRC) in Geneva and met with officials at UNESCO (the United Nations Educational, Scientific and Cultural Organization) in Paris.
Both organizations have a reliably anti-Israel record.
The Human Rights Council has only one standing item when it meets three times a year: to consider Israel’s human rights record. Under the general agenda “Item 7,” the council, made up of such human rights luminaries as China, Iraq and Venezuela, routinely castigates Israel.
And so, B’nai B’rith attends the council’s spring session as a matter of routine. We meet with representatives of dozens of nations, asserting the bias and unfairness of this two-tiered system and offering solutions on how to even the deck that is so currently stacked against Israel.
Since voting blocs are endemic to the Human Rights Council system, we recognize that success is going to come one country at a time so, we make our case one country at a time. Our delegation met with senior diplomats from the United States, Brazil, Egypt, Germany, Greece, Japan, Russia, the United Kingdom and dozens more.
We are particularly encouraged by the opportunity to develop relationships with several African nations. We had quite a few positive meetings. And Israel is making it a priority now to have economic and agricultural outreach to many nations. These first-hand connections, the face-to-face meetings and diplomacy, are vital to increasing fairness.
Two recent developments in the U.N. universe give us a renewed sense of purpose. The new United Nations secretary-general, António Guterres, seems particularly attuned to anti-Israel bias. In March, Guterres adamantly and forcefully rejected a U.N. committee report that called Israel an “apartheid regime that dominates the Palestinian people as a whole.” At the same time, the ambassador to the United Nations from the United States, Nikki Haley, also unequivocally condemned the same report and demanded its withdrawal. It seems that the message we have been delivering to the world body for decades—that Israel is systematically singled out, usually at the expense of vital human rights issues facing many in the world—may finally be resonating in important halls and offices.
UNESCO also presents itself as anti-Israel. And we have long challenged the organization’s twisting of history into a political tool wielded with venom against the Jewish state. UNESCO has been quick to adopt the Palestinian narrative that outright erases documented historic connections of Jews to Judaism’s holiest sites: the Temple Mount and the Western Wall.
The rewriting of history is not just a problem for Jews. Christians and Muslims also lose when history is viewed as malleable.
In March, at meetings with staff liaisons and with UNESCO Director-General Irina Bokova, B’nai B’rith leaders provided expert analysis and guidance, demonstrating the irrefutable, thousands-year-old ties of Jews to the land as well as suggesting ways for UNESCO to publicly recognize Israel’s history.
As we reiterate the unfair treatment of Israel at the Human Rights Council, UNESCO, the General Assembly and basically all U.N. affiliates, we are seeing slow but possibly measurable progress in eliminating unfairness. We are not complacent. Often, one step forward finds two steps back someplace else. But each time we whittle away at bias, it’s a success.
B’nai B’rith is honored to be part of the solution. Though it might be slow in coming, we see our efforts can pay a dividend.