Why Has the Senate Kept Us in the Dark about the American Health Care Act ?

The House of Representatives passed the American Health Care Act of 2017 (House Resolution 1628) on 4 May 2017. While the Senate is in the process of re-writing this legislation, it is being done completely in secrecy. Democrats, Independents and even Republicans are being kept in the dark. When Republican Senators are asked about even the broad outlines of the bill, their response is: We don’t know. Because they don’t know. This re-write is being done behind closed doors. Dislike the Affordable Care Act (ACA) if you wish, but it was written and discussed in the day-light; there was time to debate and discuss. What are the Republicans hiding?


In HR 1628, the losers from this very vile piece of legislation are effectively everyone who is neither rich, nor young, nor healthy. Between 13 and 23 millions of us lose access to health care. The Washington Post reported (21 June) that with the 23 million citizens whose health insurance is removed, a total of 51 to 52 millions of us will be uninsured. This is NOT repeal and replace, it is plunder and destroy. While Representative Raul Labrador (R-Idaho), famously said “People don’t die from lack of insurance”, he clearly knows nothing about medicine or human health.


Medicaid is slashed; some large portion of the 75 millions of us – that is about 25% of the US population – that rely on Medicaid will be cut loose. Older people will be charged premiums that are unpayable – well, perhaps they COULD choose between food and health care. The House bill eliminates Federal Standards guiding the plans insurance companies offer. No standards mean that the insurance companies do what they want, offer what they want; if you choose the wrong plan, or can’t read their unreadable prose, too bad.


The House bill eviscerates Women’s health. Planned Parenthood provides care to working and poor women. Without this, many women have no access to cervical or breast cancer screening, no access to birth control. Both the House bill and what is known about the Senate bill will defund Planned Parenthood, making birth control and safe abortion more difficult to obtain. The Kaiser Family Foundation reported (21 June) that the Senate plan bans abortion coverage in all marketplace health plans. One may wish abortions didn’t occur, but to ban safe abortions ensures that women will die from backstreet, unsafe procedures.


These men – they are almost entirely men – are playing with 20% of our country’s economy. They are toying with the lives of our friends and families. Both sides of the aisle are NOT to blame for this secrecy. With the ACA, there were months of open discussion and debate. The “back-room” talks did happen, when Senator Baucus tried to convince Republicans to support the bill. But these were not the same as is happening now.


Here is my prediction as to what you might expect. I am no Cassandra, but there is writing on the wall (sorry for the mixed metaphors):

  1. Once the AHCA is passed, job losses in health care will begin. About 24,000 in 2018, increasing to about 725,000 to one million by 2026, according to Leslie Small, writing for FierceHealthcare.
  2. State revenues will decrease by $ 93 billion and business output by $ 148 billion. So, for jobs and revenue – in New York, Pennsylvania, Florida, Michigan, Illinois, New Jersey, Ohio, North Carolina, California and Tennessee –this bill will be a disaster. The economic and employment losses will be felt by the very people Trump promised to help.
  3. Premiums will rise significantly for the older population and fall for the young.
  4. There will be an assault on Planned Parenthood. It appears our Republican brothers and sisters are pro-life only if the “life” is in a woman’s uterus. After that, they clearly don’t care. Uterine cancer? Cervical cancer? Breast cancer? You won’t be able to go to Planned Parenthood, or anywhere else, for help.
  5. Insurance companies will be allowed to write plans that don’t cover chemotherapy, or cover drugs such as insulin. Those with pre-existing conditions – a broad category of problems – will not be able to find or afford coverage.
  6. The top 0.1% of income earners in the US will see tax cuts approximating $ 1 trillion.


The health of our nation will continue to deteriorate. We will continue to be the most expensive system on earth with some of the worst quality outcomes.


It needn’t be this way; we can address the flaws of the ACA. The American Health Care Act, drafted out of spite and re-written in the dark, is not the way.


Published in:



The Daily Item 1 July, 2017



About AJ Layon

AJ Layon was, for 28 years, at the University of Florida College of Medicine, in the Division of Critical Care Medicine, in Gainesville, FL. For the approximately 10 years until September 2011, he was Professor and Chief of Critical Care Medicine at UF; In September of 2011 he became System Director and Co-Chairman of Critical Care Medicine in PA; this ended in 2017. He served as a Physician in the Surgical Group with Médecins sans Frontières (MSF, Doctors without Borders) through 2018 and is presently an intensivist in Florida, struggling through the SARS-CoV-2 crisis. While his interests are primarily related to health care, health care reform, and ethical issues, as a citizen of our United States and our world, he will occasionally opine on issues of our "time and destiny". Follow on Twitter @ajlayon
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