Since his first days in office, President Donald Trump has demanded the undoing of Obamacare, but often found himself thwarted, including when Asheville Republican Congressman Mark Meadows, chairman of the influential and conservative House Freedom Caucus, helped wreck Speaker of the House Paul Ryan’s previous effort in late March.
Meadows, advocating for two specific issues in that instance — high-risk pools for pre-existing conditions, and state waivers for essential medical services — finally signed on to the bill, known as the American Health Care Act of 2017, on May 4.
“After weeks of negotiations, conversations, and substantive changes to the bill, I believe we reached the point where both of these criteria will be sufficiently met,” Meadows said in an email that same day. “I believe the revised AHCA will substantially reduce healthcare premiums and provide a strong net of protection for the most vulnerable Americans.”
The bill was approved by a narrow 217-213 vote, without a single vote from Congressional Democrats; 20 Republicans also voted no, and aren’t the only ones crying foul.
"Angel Medical Center in Macon [County] is shutting down labor and delivery because it can't afford to offer them, thanks to cuts to Medicaid,” said Asheville Democrat Matt Coffay, Meadows’ first official challenger. “Meadows voted for the AHCA, a bill that cuts $880 billion from Medicaid. I think it's sad that Meadows is so out of touch with the needs of working people in his district."
Meadows, for his part, insists that isn’t the case.
“I took 17,240 phone calls in the month of March,” he said. “We continually have had interactions, but there’s no one more keenly attuned to what is critically important to my constituents than I am. We get over 200,000 emails a year that we not only respond to but also keep very close track of; at the end of the day, the vast majority of people I represent understand they’re my priority, and not the special interests. I think if you do right thing for the right reason, it will take care of itself.”
The House bill has not yet become law — first, it must make it through the U.S. Senate, which needs only 51 votes to pass it.
But there are only 52 Republican Senators, meaning Senate Majority Leader and Kentucky Republican Mitch McConnell can only afford to lose one vote.
North Carolina Sen. Tom Tillis said in a March 7 statement on his website that “any replacement must be an improvement over Obamacare,” and his colleague Sen. Richard Burr has been vocal for more than a year in his claim that “Obamacare is imploding.”
He may be right, but more moderate leaders in the Senate may draft a compromise bill that could leave House Republicans hopping mad, or even doom the attempt altogether.
Meadows thinks that’s unlikely; although he didn’t get everything he wanted in the house effort, he says that whatever comes of it, his dual goals of lowering costs and increasing services for needy Western North Carolinians will still become a reality.
“What we call the individual mandate and the employer mandate will get better flexibility on the individual market,” Meadows said. “The high risk pool should lower premiums for business in the individual market by as much as 38 percent and allow the tax credit to offset most of the premiums.”
Vote ‘em out? Fat chance: AHCA opponents face tough battles
Even before Obamacare repeal passed the House, Democrats across the country have been salivating over the chance to use it against vulnerable Republicans in the 2018 mid-term elections.
The theory goes that since Republicans — including President Donald Trump — fared very well last November in the poorest states and counties in the Union, many of those voters who are more likely to need affordable health care coverage may revolt if the AHCA doesn’t provide it.
But North Carolina’s Republican Congressional Delegation has little to fear; of the eight, one — Walter B. Jones in the mostly-coastal 3rd Congressional District — joined Democrats in opposing the AHCA, and the other seven won their elections by such margins in 2016 that it would take a monumental defection by GOP voters to unseat them.
Mark Meadows (NC-11)
• 2016 vote total: 64%
• Counties: Avery, Burke, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Swain, Transylvania and Yancey, with part of Buncombe.
Patrick McHenry (NC-10)
• 2016 vote total: 63%
• Counties: Polk, Rutherford, Cleveland, Gaston and Lincoln, with parts of Buncombe and Catawba.
David Rouzer (NC-7)
• 2016 vote total: 61%
• Counties: Bladen, Brunswick, Columbus, Duplin, Johnston and Sampson, with parts of Cumberland, Hoke, Lenoir, New Hanover, Pender and Robeson.
Mark Walker (NC-6)
• 2016 vote total: 59%
• Counties: Caswell, Person, Rockingham, Surry and Stokes, with parts of Guilford, Alamance, Durham, Granville and Orange.
Richard Hudson (NC-8)
• 2016 vote total: 59%
• Counties: Anson, Montgomery, Richmond, Scotland and Stanly, with parts of Cabarrus, Davidson, Mecklenburg, Randolph, Robeson, Rowan and Union.
Virginia Foxx (NC-5)
• 2016 vote total: 58%
• Counties: Alexander, Alleghany, Ashe, Davie, Watauga, Wilkes and Yadkin, with parts of Catawba, Davidson, Forsyth, Iredell and Rowan.
Robert Pittenger (NC-9)
• 2016 vote total: 58%
• Counties: parts of Iredell, Mecklenburg and Union.