On Wednesday two separate healthcare bills were introduced in Congress. These come out of two opposed movements with one designed to chip away at the Affordable Care Act and the other directed at the formation of a single payer, universal healthcare, system.

Republican Senator Lindsey Graham and several co-sponsors have offered up what is probably one of the last fragments of a weakened and shrinking repeal and replace movement. HR 1628 (115) would leave much of the ACA in place. It proposes replacing the ACA Medicaid expansion, tax credits, and cost sharing with state-oriented programs. The plan allows states to decide how they want to approach healthcare oversight.

The measure falls far short of some of the more ambitious Republican plans of the past. As was already mentioned, it doesn’t touch a substantial portion of the ACA. For instance, it eliminates only a single tax on medical devices. It is for this reason that the bill will face difficulty among more steadfast Republican lawmakers like Rand Paul, who have repeatedly demanded nothing less than a legitimate repeal and replace of the ACA.

Paul stated flat out that there was “zero” chance that he would be voting for the bill.
Senator Graham remained optimistic albeit reflective on Wednesday, asserting that “there’s a lot of fight left in the Republican party,” despite its complete and utter failure to repeal and replace the ACA so far.

Congressional Republicans have 16 days remaining in September to pass a healthcare measure with only a simple majority. At this point it seems unlikely that they will be able to come together and agree on anything sweeping and revolutionary in such a short time. Something much smaller in scope may show a bit more promise. Along those lines, Senators Lamar Alexander and Patty Murray are making an attempt at furthering a bipartisan bill aimed at supporting ACA marketplaces.

Back in July the effort to repeal and replace lost most of its momentum. Since that time the main Republican focus has, out of growing necessity, moved on to what it perceives to be greener pastures. Tax reform will be the next battlefield.

On the Democratic side of the aisle, things are moving in an entirely different direction. On Wednesday Senator Bernie Sanders introduced his own bill. His measure, if passed, would phase in a single payer system over a period of four years. Addressing his Republican colleagues, Sanders said, “please, don’t lecture us on healthcare.” 

With a significant Republican presence in Congress it is unlikely that the measure will pass. The fact that a bill of this type has gained measurable support over time, however, indicates something important for the future of American healthcare.

It is necessary to remember that, back in January, nearly two-thirds of House Democrats threw their support behind a measure that would extend care to “all individuals residing in the United States.” Fifteen Senate Democrats are now co-sponsoring Bernie Sanders’s single-payer health care bill. Several of them look like 2020 presidential contenders.

Among the general population, universal healthcare is steadily becoming more popular and it is only likely that this trend will continue.

It remains to be seen whether Republicans are prepared for the struggle that looms on the horizon over universal healthcare. The Republican party needs to shift its focus in anticipation of the effects that this change will have on the political landscape. If the party neglects this, it risks assuming irrelevance in a single payer future.

universal healthcare, bernie sanders

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