Senator Ron Johnson has called the Affordable Care Act the “greatest assault on freedom in our lifetime.” He’s been denouncing the healthcare law for years, devoting press releases, interviews, town halls and op-eds to its alleged failures and flaws. Like many of his colleagues in the GOP, he campaigned on the promise of repealing and replacing it.
When Senate Republicans finally got their chance to do so, Johnson made it clear that he wanted to be an integral part of that effort. It was surprising, then, when he turned up as a possible hindrance and wavered for weeks about where he actually stood.
“He was a no, he wasn’t a no; it was back and forth,” says Julie Rovner, chief Washington correspondent at Kaiser Health News. “It sort of came out of nowhere. Who had Ron Johnson on the ‘no’ list?”
In the end, Johnson remained a reluctant “yes,” framing his votes not as endorsements so much as means to an end. He later co-sponsored the Graham-Cassidy Bill—named after Senators Lindsey Graham and Bill Cassidy who authored it—which would have repealed the ACA and changed the fundamental structure of Medicaid. Like the earlier attempts, the bill failed when enough senators came out against it.
Kevin Kane, organizing director at Citizen Action of Wisconsin, said that, while Johnson’s “exact motivations were never fully clear,” a few things are evident: The senator wants very much to get rid of the ACA, he wasn’t ready to give up after the initial failures, and he’s not ready to give up now. “Because they failed the last time, it’s not surprising that he’d want to bring it up again, and he will probably continue to talk about it,” Kane says. “I don’t see him dropping it any time soon.”
A Surprise Detractor
Throughout the convoluted “repeal and replace” debate, Sen. Johnson often complained that the process was moving forward too quickly and behind closed doors. Issues arose in May when Sen. Mitch McConnell formed a core “working group” of 13 fellow senators to draft the repeal legislation. Johnson wasn’t listed among the group’s members and later said he had to “kind of muscle my way in.” While the member list attracted a lot of attention (mainly because there weren’t any women on it), Rovner explains that it was also somewhat misleading.
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“It’s not like those members were writing a bill,” Rovner says. “McConnell’s staff and some of the staff from those members’ offices were writing a bill. Did [Johnson] want his own people working with the people who were writing it? I’m sure he did. But it’s not like they were meeting in a room and he wasn’t there.” Nevertheless, the idea of a “working group” helped the impression that the process was surrounded by a wall of secrecy—one that Johnson himself was struggling to scale. But Johnson also had leverage. Republicans currently hold a precarious two-vote majority in the U.S. Senate, which amplifies every critical voice.
When the first senate bill was drafted, Johnson was one of the four conservative senators saying they’d reject it unless significant changes were made. He was evasive when asked how he’d vote, saying he needed more time or didn’t have enough information. And in July, when he heard McConnell was meeting privately with moderates and suggesting that some of the promised Medicaid cuts might not actually happen, Johnson accused the majority leader of a “breach of trust” and suggested he may have to withdraw support after all. “He made it so his party had to deal with him,” Kane says.
The suspense continued on the day the Senate voted to open debate for the “skinny” repeal bill. Johnson arrived late and proceeded to engage McConnell in what appeared to be a heated conversation on the Senate floor. “He was pretty visibly unhappy,” says Rovner, who was in the chamber for the vote. “I can tell you from the body language that they were not each other’s best friends.”
The discussion ended when Sen. John McCain, who had just shared the news of his brain cancer diagnosis, arrived to a standing ovation and voted “yes” to begin debate on the repeal legislation (he would eventually vote “no” on passage). After McCain’s vote to begin debate, Johnson then voted “yes” as well, casting the final vote to proceed. In spite of his earlier objections, Johnson went on to vote in favor of the Better Care Reconciliation Act, the partial repeal amendment, and finally the “skinny” repeal, which failed when McCain cast that decisive “no” vote.
Johnson’s strained relationship with the Senate Republican leadership has been linked to the 2016 election, when the National Republican Senatorial Committee pulled their investment in his campaign once it looked like he was going to lose. This break from the establishment—combined with the fact that he apparently won’t be seeking reelection—positioned Johnson as an independent figure, free to ignore political pressure and act on his convictions. Ultimately, it was Senators Lisa Murkowski, Susan Collins and John McCain who took that stand, but Johnson did manage to keep his name in the conversation.
Healthcare Coverage in Wisconsin
Back when he was still waffling between “yes” and “no,” Johnson stated he wouldn’t support a bill unless it halted Medicaid expansion and lowered premiums. He blamed high premiums in part on guaranteed issue mandates that protect people with preexisting conditions and touted high-risk pools as one way to bring down costs. He pointed to Wisconsin’s former Health Insurance Risk-Sharing Plan (HIRSP) as a model for this.
However, Bobby Peterson, executive director of the public interest law firm ABC for Health, cautions against remembering HIRSP too fondly. “People were segregated into high-risk pools where they had higher premiums and waiting periods,” Peterson says. “They weren’t a great option. They were the best option in a terrible system.”
Jon Peacock, the research director of the advocacy organization Kids Forward, says that the HIRSP served about 21,000 people, which “barely made a dent” in the more than half a million who were uninsured in Wisconsin at that time. What has had an impact, Peacock argues, is the ACA. Between the individual marketplace and the partial Medicaid expansion, the state’s uninsured rate has dropped 42%. “Senator Johnson has said that Wisconsin didn’t need the ACA, and I couldn’t disagree more,” Peacock says. “There are 218,000 fewer uninsured Wisconsinites now, and that’s just one of many benefits of the law.”
Expanding coverage helps control healthcare costs as well. A recent study from the Commonwealth Fund found that states in which Medicaid has expanded saw significant reductions in uncompensated care, leading to billions of dollars in savings. Peterson says that when Gov. Scott Walker rejected the federal expansion money, he not only passed on millions of much-needed dollars but also instituted a confusing eligibility system that kept people from getting coverage, leading to more uncompensated care. “When we provide coverage for people, we help eliminate uncompensated care, which costs the system and society a lot more,” he says.
Graham-Cassidy would have changed Medicaid from an entitlement to a block grant system, where states had a finite amount to spend on the program each year. Experts have said that devolving control to the states in this way would create more confusion, raise costs for people with preexisting conditions and limit coverage through spending caps. “Over time, those caps would force states to ration Medicaid services,” Peacock says. When promoting Graham-Cassidy in an interview with MSNBC on Thursday, Sept. 21, Johnson fielded repeated questions about whether anyone would lose coverage under the bill, which he repeatedly declined to answer. According to the Congressional Budget Office, millions would.
Beyond ‘Repeal and Replace’
Hours after Graham-Cassidy was called off, Johnson held a telephone town hall where he told constituents he still hoped to pass the bill by some other means. The same day, a statement released by Graham, Cassidy, Johnson and co-sponsor Sen. Dean Heller assured that “it is just a matter of time until we fulfill our promise to repeal and replace Obamacare [ACA] with something far better.”
“I don’t think it’ll ever really end with them,” Kane says.
Medicaid, which covers about one million Wisconsinites and one-fifth of the U.S. population, remains threatened regardless of what happens to the ACA. Peacock points out that the idea of block granting Medicaid is a separate issue that was rolled into the ACA debate. “Even if repeal and replace legislation dies, the efforts to cap Medicaid spending will continue in other legislation—in the budget process or in tax cut legislation,” Peacock says. “Those threats to Medicaid are going to come up in numerous different places.”
At the same time, the Trump administration is actively working to undermine the ACA. It has cut the 2018 open enrollment period in half, released videos attacking the law’s effectiveness, and gutted outreach and promotion funding. The Centers for Medicare and Medicaid Services (CMS) recently announced that healthcare.gov will be shut down for 12 hours every Sunday during the open enrollment period (except for Sunday, Dec. 10), due to “system maintenance.”
On Thursday, Oct. 12, President Trump signed an executive order to expand the use of cheaper, stripped-down “association health plans,” which could lure healthy people out of the marketplace, raising premiums for those who remained. Hours later, he announced a plan to end payments for cost-sharing subsidies that reduce expenses for low-income enrollees. These changes would disadvantage vulnerable Americans and further destabilize the individual markets. Such overt sabotage is terrifying—especially for the people who consider the ACA a lifeline, not an “assault on freedom.”
“What freedoms were compromised by the Affordable Care Act? To me, it’s just the opposite,” Peterson says. “I’m not saying it was perfect. But the Affordable Care Act provided care to a lot of folks. It enhanced their lives, their freedom to pursue life and liberty.”
The 2018 open enrollment period begins on Nov. 1 and runs until Dec. 15, 2017.
