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Obamacare đi về đâu?
WASHINGTON DC (NV) – Chiều Thứ Tư, 26 Tháng Bảy, Thượng Viện lại không thông qua được một dự luật xóa bỏ đạo luật y tế ACA của cựu Tổng Thống Obama; quen gọi là Obamacare. Trong những ngày tới, các nghị sĩ Cộng Hòa sẽ làm gì tiếp để đạt mục tiêu “xóa bỏ và thay thế đạo luật ACA đang thi hành?”
Như chúng ta đã biết, sáng ngày Thứ Ba, 25 Tháng Bảy, đảng Cộng Hòa và Tổng Thống Donald Trump đã thành công khi Thượng Viện chấp thuận đem ra bàn vấn đề này, với tỷ số sát nút.
Có 50 nghị sĩ Cộng Hòa bỏ phiếu thuận, và Phó Tổng Thống Pence, ngồi chủ tọa các phiên họp của Thượng Viện theo Hiến Pháp quy định, bỏ lá phiếu quyết định để đạt tỷ số 51/50. Tất cả 48 nghị sĩ Dân Chủ chống và hai nghị sĩ Cộng Hòa cũng chống.
Nhưng ngay chiều Thứ Ba, dự luật xóa và thay Obamacare của ban lãnh đạo Thượng Viện được đưa ra bàn và bị bác bỏ với 57 phiếu, và 43 phiếu thuận. Ðây là dự luật đã được nghị sĩ trưởng khối đa số soạn thảo và thay đổi theo nhiều đề nghị của các nghị sĩ khác, nhưng vẫn có chín nghị sĩ Cộng Hòa không đồng ý. Dự luật này, nếu ban hành, sẽ làm cho khoảng 22 triệu dân Mỹ mất bảo hiểm.
Chiều Thứ Tư, 26 Tháng Bảy, một dự luật khác được đưa ra bỏ phiếu. Ðó là dự luật đã được các dân biểu và nghị sĩ Cộng Hòa thông qua năm 2015, nhưng bị cựu Tổng Thống Obama phủ quyết.
Tổng Thống Trump đã thúc đẩy Thượng Viện hãy đưa ra bỏ phiếu lại, nếu được cả hai viện thông qua thì ông Trump chắc chắn sẽ ký ban hành. Nhưng khi kiểm phiếu, chỉ có 45 nghị sĩ Cộng Hòa ủng hộ. Bảy người đã bác bỏ, mặc dù vào năm 2015, ngoài bà Susan Collins, sáu người kia đã bỏ phiếu chấp thuận. Các nghị sĩ Dân Chủ, 48 người đều chống. Nếu dự luật này trở thành luật, sẽ có 32 triệu người mất bảo hiểm.
Mọi người đang thắc mắc: Giái lãnh đạo Cộng Hòa ở Thượng Viện sẽ làm gì tiếp?
Trong mấy ngày tới, Thượng Viện có thể sẽ thảo luận về một dự luật được thu hồi Obamacare, gọi tên là Thu Hồi Mỏng (skinny repeal), với hy vọng được trên 50 phiếu thông qua. Dự luật Cải Tổ Mỏng này sẽ chỉ xóa bỏ một số điều khoản trong ACA mà tất cả đảng Cộng Hòa muốn xóa; đầu tiên là không bắt buộc mọi công dân Mỹ phải có bảo hiểm y tế, và buộc các xí nghiệp phải tổ chức mua bảo hiểm cho nhân viên, nếu không sẽ bị phạt; và xóa bỏ hẳn những khoản thuế đánh trên các dụng cụ y khoa. Ngoài ra, các điều mà đảng Cộng Hòa muốn thay đổi như xóa món thuế phụ trội đánh trên lợi tức cao hơn 250,000 đô la một năm; cắt bớt chương trình Medicaid (Medical ở California); và cắt bớt trợ cấp cho giới trung lưu không đủ tiền mua lấy bảo hiểm bị nhiều người chống đối, sẽ khó được đa số nghị sĩ chấp nhận sẽ có thể bị bỏ qua.
Nếu Thượng Viện thông qua được một dự luật Cải Tổ Mỏng, sẽ đến lúc phải dung hòa dự luật này với dự luật mà Hạ Viện đã thông qua tại Hạ Viện vào Tháng Năm vừa qua. Việc thỏa hiệp giữa hai dự luật sẽ khó khăn vì dự luật của Hạ Viện rất nặng tay, sẽ khiến cho 23 triệu người mất bảo hiểm, đến nỗi chính Tổng Thống Trump phải chê là “dữ quá” (mean).
Nếu hai viện không thể thỏa hiệp và thông qua được một dự luật nào thì tình trạng sẽ ra sao?
Khi đó, đạo luật ACA, tức Obamacare sẽ tiếp tục có hiệu lực. Những người được hưởng Medicaid (hay Medical) sẽ giữ được bảo hiểm. Những người trung lưu đang được trợ cấp để mua bảo hiểm sẽ tiếp tục được trợ cấp nhưng chính phủ có quyền giảm bớt món tiền này. Những người lợi tức trên 250,000 đô la sẽ tiếp tục đóng thêm thuế để ngân sách có đủ tiền trả các khoản chi phí này.
Nhưng chính phủ và Quốc Hội sẽ phải quyết định bảo đảm cho các hãng bảo hiểm an lòng rằng các khoản trợ cấp được tiếp tục; nếu không thị trường bảo hiểm sẽ xáo động và nhiều người sẽ mất bảo hiểm. Chính phủ cũng có thể làm giảm hiệu lực của Obamacare bằng cách thả lỏng, ngưng truy tố những người không có bảo hiểm và các xí nghiệp không mua bảo hiểm cho nhân viên. Khi đó, sẽ các hãng bảo hiểm sẽ chỉ thu hút được những người bệnh nặng đi mua bảo hiểm lấy, hậu quả là giá mua (premium) sẽ tăng vọt lên, nhiều người sẽ phải bỏ.
Khi đó, các dân biểu và nghị sĩ thuộc hai đảng sẽ phải hợp tác để giữ cho thị trường bảo hiểm y tế không sụp đổ, nếu không họ sẽ bị các cử tri trừng phạt trong cuộc bỏ phiếu năm 2018. (DT)
Will John McCain Save Obamacare—and Himself?
For the past several weeks, I haven’t been feeling well—a relative concept, given my medical history. Fifteen years ago, I was ambushed by a mysterious illness that turned out to be a chronic autoimmune disorder—one of the broad and complex range of rheumatological diseases that result when one’s own immune system attacks healthy organs and tissues. Already past fifty, I had never spent a night in a hospital, never really been sick. Now I was very ill. I couldn’t dress myself. To get from my bed to the bathroom was an ordeal because, among other things, I could barely walk. Within a couple of weeks, through the intervention of friends and colleagues, I had an appointment with a rheumatologist at the Hospital for Special Surgery, in New York. The first thing he said when we met in his office was, “Tell me about yourself.” I took this as a prompt to describe my symptoms. He stopped me and said, “No, tell me about you. What are the things that matter most to you in life? What are your passions?” I burst into tears. Then I spoke of my family (especially my four children), my friendships, my love of my work. I instinctively knew that I would come to regard this doctor as my personal hero. He remains, I thank God, my doctor to this day.
I didn’t devote any time to being afraid. My pains and uncertainties were dwarfed by my gratitude that I had affordable employer-subsidized health insurance, that I could afford the out-of-pocket costs my insurance did not cover, that my doctor insisted that I send him a daily e-mail describing my symptoms as he adjusted the medications that would eventually restore me. Over the next year, I had difficulty working, and my body changed in unwelcome ways. But I got better. I stayed that way for five years and then had another serious autoimmune flare. Five years later, I was again in bad shape. Now I am old enough to qualify for Medicare. Before the passage of the Affordable Care Act, had I lost my employer-provided insurance I might as well have had “preëxisting condition” tattooed on my forehead. There have been moments when I wasn’t able to take it for granted that I would recover. Throughout the ups and downs, my belief in my extraordinary good luck has multiplied.
My recent illness has presented a mix of symptoms that don’t quite fit, blood-test results that seem contradictory. Two days ago, after another blood draw, my primary-care physician made a list of my incongruous pains and test vectors and said, “We’ve never really seen this group of symptoms present in quite this combination. I guess you have Singer syndrome. You could be in a medical journal.” Not exactly the immortality I’ve longed for. Were I a Medicaid recipient, I imagined, a doctor with a similar thought might well have had to consult my chart to get my name right. That afternoon I began to feel a bit better, and my blood-test results yesterday confirmed why. I’m heading out of the woods.
Walking home from that appointment, I checked my phone and saw on Twitter that Senator John McCain was returning to Washington from Arizona, where he has been recovering from surgery. McCain made the journey to participate in the Senate vote on whether to proceed with debate on legislation that, if passed by the Republican majority and signed into law, would repeal the Affordable Care Act and leave twenty-three million Americans—or sixteen million, or thirty-two million, depending upon who’s doing the forecasting—with no insurance, no safety net, and the prospect of pure terror. McCain’s surgery revealed a glioblastoma, an aggressively malignant brain tumor. On three previous occasions, he has had non-life-threatening malignant melanomas surgically removed. Senator McCain has lived a life as extraordinary as any American, a well-known tale of survival, heroism, and accomplishment—and, at times, of dubious decisions inconsistent with acts of valor. (Vice-President who?) Foremost, his has been a life of public service. Whatever the course of his illness—even with treatment, the average survival for glioblastoma is fourteen months—I’m confident he has medical-care providers at least as superb as my own. Though he is a very wealthy man, as a member of Congress his bills have been paid by taxpayers.
Contrary to logic and morality, the gaslighting of America by President Trump, his coterie of handlers and enablers, and the cynical leadership of the Republican Party is, in many respects, succeeding. Each new day brings fresh reporting about the investigation of Russian interference in the 2016 Presidential election, as well as the determination by Trump to derail that investigation. Simultaneously, the work of tenacious and courageous journalists digging rigorously for facts is daily slandered as “fake news.”
The accumulation of endless, self-serving but also often self-subverting, easily refuted mendacity by the erstwhile leader of the free world—the gaslighting—has caused me to question my own sanity. Can this really be happening—to this country, in this century, this repudiation of our cherished beliefs in what “America” stands for and is capable (and incapable) of? Do we actually have a President who, as members of his own party plot legislation that could deprive twenty-three million citizens of health-care coverage, has immersed himself in the legislative process approximately as much as any other citizen who follows the story on Fox News, or who phones the office occasionally while waiting for the foursome in front to putt out on the sixteenth green of a beautiful you-will-not-believe-how-beautiful-really-really-wonderful-for-the-American-people golf course?
If the President of the United States, addressing an audience of thousands of Boy Scouts, can incite them to boo his opponent in the last election; tell bizarrely inappropriate stories; with impunity humiliate his Secretary of Health and Human Services by threatening to fire him if the repeal of Obamacare fails—who are we? These insults and liberties are all in a day’s “work” for Donald Trump. We are told that the President’s crude, bullying, authoritarian behavior has squandered any political capital he might have once had, that he is disrespected by his own party, without leverage.
Mitch McConnell, who became the Senate Majority Leader in 2015, is, of course, Trump’s most shameless enabler. In 1944, at the age of two, McConnell was stricken with polio. He was treated at the Warm Springs Institute, in Georgia, where Franklin D. Roosevelt himself was treated, beginning in 1924, three years after he received a diagnosis of polio—and where he died, in 1945. In 1990, while running for reëlection against a Democrat who was a physician as well as an advocate of universal health care, McConnell appeared in campaign ads that featured photographs of him with his family when he was a young boy. “When I was a child and my dad was in World War II, I got polio,” he said. “I recovered, but my family almost went broke. Today, too many families can’t get decent, affordable health care.”
That was then. The conniving manipulations by McConnell and his caucus during the health-care debate—with tax reform and more of the same yet to come—make plain a disingenuousness and cynicism of a piece with the theft of Merrick Garland’s seat on the Supreme Court. From the day of Barack Obama’s Inauguration, in 2009, McConnell, as the Minority Leader, dedicated himself to delegitimizing his Presidency. Among other subversions, he introduced the minority-party tactic of refusing to give unanimous consent to provide for debate on bills introduced by the majority. With the shoe now on the other foot, he will do everything he can to obstruct parliamentary payback from Democrats.
The excruciatingly anticipated vote on the motion to proceed was 50–50, with Republican Senators Susan Collins, of Maine, and Lisa Murkowski, of Alaska, the lone Republican holdouts. McCain voted in favor, and Vice-President Mike Pence broke the tie. Shouts of “kill the bill. shame shame shame!” rained down from the visitors’ gallery.
Afterward, McCain, whose Senate colleagues had given him a standing ovation as he entered the chamber, rose to speak. Moving slowly, a seven-inch surgical scar extending from his left eyebrow, he braced himself against the lectern.
McCain made clear that his vote to proceed was one he regarded as a duty of his office. He spoke, in tones both sentimental and sober, on behalf of “regular order,” of “rules and customs” that had been in place from when he entered the Senate, in 1987, until this year, when McConnell decided to flout them. He seemed aghast that the leadership was “trying to convince skeptical members” to support unconscionable legislation that was being formulated “behind closed doors” because it was “better than nothing.” He paused. “Better than nothing?” Instead, he made a heartfelt plea for bipartisanship going forward.
Throughout his political life, John McCain has for many reasons enjoyed bipartisan respect and even reverence: his independence of mind (usually), his candor (usually), his decency, his love of country, and especially his incalculable-to-most-of-us loyalty to his fellow-prisoners of war when, following his capture by the North Vietnamese, in 1967, he—the son and grandson of four-star U.S. Navy admirals—refused an offer to be freed. McCain remained a prisoner until 1973, during which he was permanently disabled by the torture his captors inflicted. His was a patriotism that transcended all of our clichéd flag-waving (and Bible-thumping) associations with that word. But those same reverent admirers, especially orthodox conservatives, recognize—and they hope John McCain recognizes, too—the fiscal profligacy, never mind the inhumanity, of a Republican scheme that abandons classic conservative principle. McCain seemed to be addressing a diverse audience: “I will not vote for this bill as it is today. It’s a shell of a bill right now.”
Yesterday afternoon, McCain joined the majority on a procedural vote to open debate on an Obamacare repeal, and last night he voted for an Obamacare-replacement plan also backed by McConnell. Opponents of the Republican repeal effort criticized him, some fiercely, but his spokeswoman insisted this morning that both votes were procedural, that McCain “would not vote for the health-care bill in its current form,” and that he had filed three amendments meant to address concerns from Arizona officials regarding Medicaid cuts. This afternoon, McCain voted against a McConnell-backed partial repeal. More votes are expected. The intense attention focussed on McCain reflects the lingering uncertainty surrounding what he will do should a repeal bill come to a final vote.
One wonders how and why voting against McConnell’s process and proposal is a difficult call for McCain. It should be the simplest of choices, a capstone to the life of a good but at times contradictory man who, presented with an ultimate dilemma, simply draws upon his enormous reserves of courage.
When the news broke of McCain’s return to Washington, one week after brain surgery, James Fallows wrote in The Atlantic about another senator who, in eerily parallel circumstances, cast a fateful vote that contributed to the passage of the Civil Rights Act of 1964. Fallows was asking, in effect, “Might Senator McCain’s devastating medical prognosis become doubly tragic?” Then he gently offered advice on how to avert such a legacy.
In June, 1964, Senator Clair Engle, a Democrat from California, occupying a seat that previously had been held by Republicans for more than sixty years, died in office—of a brain tumor. Only weeks earlier, he had appeared in the Senate, partially paralyzed, too ill to stand or speak, and waved his hand—indicating a vote in favor of a cloture motion that ended a filibuster by Southern senators, led by Strom Thurmond, who were irresolutely determined that there would be no Civil Rights Act, now or ever.
Fallows wrote, “Clair Engle, although he could not stand, wanted to take a stand, and did. And if he is remembered, this will be the reason why. . . . [His] most bravely memorable moment as a legislator was his last, when he voted: Yes.”
Fallows acknowledged McCain’s foibles and inconsistencies, most notoriously his choice of Sarah Palin as a running mate, in 2008, thereby “steering American politics down the path that led to Donald Trump.” In an ironic echo of Trump’s disgraceful appeals to African-American voters during the election, Fallows wrote, “What does John McCain have to lose, by doing what he knows is the right thing?” And then, a more severe warning, if McCain votes for a final repeal bill, “he will deserve all the opprobrium that follows.”
Donald Trump, who has publicly insulted John McCain in ways that men of more delicate sensibility would regard as unforgivable, praised McCain’s first procedural vote. “Senator McCain, a very brave man, he made a tough trip to get here and vote.” Hearing this, one could only speculate upon McCain’s most intimate thoughts. Nay or yea? Will he, as during his P.O.W. ordeal, again place honor and love of country above excruciating personal pain and hollow freedom? Or will he be uncharitably remembered as one of the captured?