“All bark, no bite.” This phrase perfectly describes the current situation of Republicans in the Senate. After spending seven years criticizing and threatening to put an end to Obamacare, they have not only not done so, but have no plan to replace it.

Last Monday, July 17, was the last chapter of an unfortunate government soap opera who, waving the flag of the counter-form, began to sink moments after having set sail. The critics against the American Health Care bill keep growing, even within the republican bench in the Senate. Senators Susan Collins and Rand Paul were joined by colleagues and co-rapporteurs Mark Lee and Jerry Moran, who "stepped out of the closet" and declared themselves openly opposed to the bill.

And it is no wonder. According to studies from the Congressional Budget Office (CBO), between 22 and 24 million Americans would be left without medical coverage in the next 10 years if the Republican proposal is accepted and signed by the president.

Not to mention the other aspects of the document. Among the most prominent are those that have to do with the strong budget cuts to Medicaid, the program that allows access to healthcare, rejected even by moderate Republican lawmakers.

As reported by EFE, the proposal also includes an amendment that, if it remains as such, "would allow insurers to offer plans that do not comply with all Obamacare regulations, including the obligation related to pre-existing diseases."

In other words, the Republican proposal gives a green light to go back seven years and return to discriminatory practices in which having a pre-existing condition was the prelude to getting a slammed door in the face by requesting a medical appointment from an insurance company.

Now, the question is not why the Republicans cannot  agree to move forward with the political agenda of the White House, but about trying to understand who could create a law that has such a disregard for the well-being of the American people.

The reason I have been so vocal and active on this issue of protecting Medicaid is because there’s a threat to it. We haven’t had a threat to Medicaid like this since Ronald Reagan, and even Ronald Reagan as conservative as he was, would never propose what this senate bill would do to Medicaid.

This is what boggles the mind of Democrat Senator for Pennsylvania Bob Casey, one of the most critical Democratic voices in the Trump administration and, arguably, the most prominent political figure from Pennsylvania in Washington.

For Casey, this bill deserves all the epithets that may exist in the English language, but are reserved before AL DÍA’s camera; he knows that the political debate is waged with ideas and arguments, not with vulgarities and presidential tantrums.

He complies with saying that "it is the worst thing that could happen to the country" and hopes that his Republican colleagues in the Senate will show humility and accept the Democratic offer to work together to correct their defects so that some day Americans can access health services consistent with a first world economy.

On the same day that the health reform project collapsed in the Senate, Casey visited the AL DÍA office to urge Philadelphians to call their representatives in Congress and demand that they open the dialogue for a better health assistance for all.

The Republicans in the Senate were prepared to rescue their bill after John McCain returned to the upper house and President Trump urged his party to repeal Obamacare no matter what, even if there was no plan to replace it.

On this alternative, the Congressional Budget Office also published its analysis. If Republicans go through, they could leave 17 million Americans without health insurance next year, 32 in a decade.

Regardless of the scenario: whether Mitch McConnell succeeds in saving the reform bill or not, Senator Casey's words remain valid, while the debate over health reform must be made public, with broad citizen participation and leaving sectarianism aside.

People will criticize the Affordable Care Act and the process that lead to it, but there is no comparison between the process that lead the passage of that bill in 2010 and what's happened since that time.

This is a very bad bill. It's bad for almost everyone I can think of in the country, except if you are a very rich person or a corporation who is very rich; everyone else loses: the middle class, lower income kids, and cities, small town and rural areas, people with disabilities lose, seniors lose.

The part that I have focused most of my attention on is Medicare and the horrific, devastating cuts to Medicaid. The Senate bill or the last version would cut Medicaid by some 773 billion dollars on the one side, and give tax cuts of over half a billion on the other side, that's not only inconsistent, it is wrong and actually obscene.  

This bill, if it passes, especially with regards of the devastating impact on vulnerable people, by the way with Medicaid cuts, this bill will change America for the worst. We would be a different country; we would see misery in the way we haven't seen in a long time.

Let me tell you what happens when 15 million people lose Medicaid and another 7 million lose coverage in another way. I am doing everything in my power to stop this bill.

Some of the people saying this is a bad bill are Republican governors and republican officials.

That's part of the problem here: they didn't have a process which would allow people to take a closer look at the bill. People will criticize the Affordable Care Act and the process that lead to it, but there is no comparison between the process that lead the passage of that bill in 2010 and what's happened since that time.

(...) The Senate Finance committee had hearings over the course of a year. I was a member of the Health Education Labor Pension Committee, we had our own health care bill and the Finance Committee had their bill and then they were brought together and the House had changes, we had changes... it was a long process, a lot of it in public.

(...) So we have nothing approaching that in terms of a process. In terms of the product, there are parts of that legislation that we now know need improvements or adjustment. But we shouldn't lose sight of what was the monumental achievement of that bill: 20 million people got health coverage.

That was good for those 20 million families and their communities, but also for everyone, because when someone gets health care we're all better off, when someone doesn't have health care, we all pay. That diminishes us as society.

(...) That's number one. Number two, seniors got unprecedented help with the prescription drug, so-called "donut-hole" which is a kind of benign way to describe a terrible situation: if you are a senior and you have to pay a very high deductible on your prescription drugs, that is a hole into which you fall. What the Affordable Care Act did was try to fill that hole over time, so here we are seven years later and about 26 billion dollars was spent just to help seniors with their prescription drug cost. So more than 10 million seniors received about 27 billion dollars.

(...) This republican bill would interrupt, in short, change that prescription drug help that we gave to seniors.

The third accomplishment is something that affects folks with employer coverage. When you do the estimates of the number of Americans covered just by employer coverage, who may be thinking, “Well, the Affordable Care Act had nothing to do with me,” oh yes it did, because it put in place protections that insurance companies had to guarantee that never had to guarantee before.

In the old days, before 2010, it was legal to discriminate against someone because of a pre-existing condition, and it was legal to discriminate people based on other factors.

(...) My point is that there is a lot to be positive about current law, but here’s some problems we can work on if they weren't obsessed with repealing, just wiping everything out and hurting a lot of people and starting over.

If we kept the current law in place, and say there are strong features of what we did, but there are some changes we should make...

There are a couple. Number one: You have some parts of the country, sometimes it’s in a rural area, where people don't have a big hospital or hospital system nearby, people might have a rural hospital in the orbit of where they live but it is 20 miles this way or 50 miles that way. When you are in a city, often you have big medical institutions, big research organizations and you have a diverse insurance pool so usually the potential is for premiums to stay steady and not grow as much. In a rural area if there is one insurer and you don’t have other dynamics there, sometimes that one insurer has very high premiums.

So what do you do about high premiums, deductibles and co-pays?

One thing you can do - and this could be done very quickly if our Republican friends worked with us on this, we could pass a singular bill just on a Medicare-like public option. Which we tried to do in 2010 but we didn't have the votes for it.

In that case you have one insurer in a rural area, who is jacking up premiums, but if you bring in a Medicare-like public option to have that competition, it would have an immediate impact on premiums. We can have a bill just on that.

Number two. Let's have a vote on that. We can have a separate bill just saying that the federal government, whether it’s the Congress and the Administration are in agreement, we are going to make sure this so-called Cost-Sharing Reduction Payments. The uncertainty about that is causing insurance companies to raise their premiums or leave a market.

So these are the things we can do immediately that would stabilize some of the insurance markets.

The main problem in the system right now is Republicans creating uncertainty on the Cost-Sharing Reduction Payments, not agreeing to put in place some stabilizers and so far not agreeing to put some competition by a way like Medicaid-like public option.

I think there are some things we can do in a bipartisan way, but the first thing we have to do is to make sure this destructive bill doesn't pass.

Well first of all I don’t accept the premise. Journalists have to make an assessment and they’re free to do that. I don’t think it’s a shift in policy or beliefs, anyone who knows me, knows that I’d be in the same fight on protecting Medicaid and the vulnerable 5 years ago in the Senate if it came up then. It didn’t come up then because we had a democratic president who was trying to grow and strengthen Medicaid not decimate it.

When I was in state government, I fought a lot of battles that were very similar to this. I led the fight against a co-payment increase in state government where they wanted to jack up the co-payments for childcare for working moms who are lower income. I fought like hell against that and we won. We beat an administration that tried to ram it down people’s throats.

The reason I have been so vocal and active on this issue of protecting Medicaid is because there’s a threat to it. We haven’t had a threat to Medicaid like this since Ronald Reagan, and even Ronald Reagan as conservative as he was, would never propose what this senate bill would do to Medicaid.

I think it’s more of a question of the times within which we live, where a lot of the things the president has done which has caused me to speak out and fight against because we’ve never had these threats to basic programs especially programs like Medicaid.