Last Tuesday, House Republicans unveiled their long-awaited plan to repeal and “replace” ObamaCare, rolling back a significant portion of one of President Barack Obama’s signature legislative achievements that led to 20 million Americans gaining health insurance.
The ensuing chaos from the bill’s rollout has been, to put it charitably, laughable. And the bill itself makes it abundantly clear that all of the Republicans who said they had a better way to do healthcare than ObamaCare were lying. Turns out that when Republican Speaker of the House Paul Ryan (R-Wi) claimed that he had a more patient-centered way on health care, he lied. And surprise! When Donald Trump told the Washington Post that “we’re going to have insurance for everybody” and that, under Republican healthcare reform, people “can expect to have great health care” that is in a “much simplified form” and “much less expensive,” he also was lying.
The backlash to the Republican bill, which they have referred to as the “American Health Care Act” (AHCA), has been swift. The AHCA is deeply flawed, and it begs the question: Republicans had seven years to come up with something, and they come up with . . . this?
Even ignoring the substance, the process House Republicans want to use to pass their health care bill is the height of hypocrisy. When Democrats moved to pass ObamaCare by majority vote through a procedure known as reconciliation, Republicans accused them of trying to “ram it down America’s throat.” Now that they are in charge, however, apparently pursuing the same maneuver is a perfectly acceptable “legislative strategy.” So, to recap: For the GOP, when Democrats do something, its un-American, but when Republicans do the exact same thing, it’s expressing the will of the American people. Oh well, that’s politics. I’ll get over it.
But I still cannot get over why the GOP thought it was acceptable to hold committee votes on their bill two days after releasing it, and without the benefit of a Congressional Budget Office report estimating either coverage or fiscal effects. Maybe Republicans just didn’t fully appreciated, like their president with a “very good brain,” that the American healthcare system is an “unbelievably complex subject.” Maybe Republicans were encouraged, as Sean Spicer appeared to be, that the CBO review would be completed expeditiously, given that the AHCA is literally shorter than ObamaCare. Or maybe they just don’t give a shit, as they have claimed to, about either (a) expanding access to healthcare or (b) making the healthcare system work better for Americans, and they knew that the CBO would expose them for the frauds they are.
(Guess what? That’s exactly what the CBO did).
I don’t think the last point is arguable to any reasonable person because the substance of the ACHA is puzzling if you take Republicans at their word that the AHCA is a better alternative to ObamaCare. Sure, the AHCA keeps some important (and popular) ObamaCare reforms, like the prohibition on denying coverage to people with pre-existing conditions, the ban on lifetime coverage caps, and the rule allowing young people to remain on their parents’ health plans until age 26. But, there are many, many, many reasons to hate this bill.
Compared to the status quo – i.e., a world in which ObamaCare remains the law of the land – the AHCA is much stingier, the health care coverage is worse, there is a clear preference for high income individuals, the tax-credit structure would destabilize insurance markets, the penalty for non-coverage is worse than the individual mandate, and there is absolutely no attempt to reduce long-term costs. Essentially, the AHCA would eliminate a lot of the good that came from ObamaCare (per the CBO, the ACHA would result in 18 million people immediately losing health insurance gained under the law in the first year alone, a number which would rise to 32 million people by 2026), it would entrench and exacerbate a lot of the problems introduced by ObamaCare (like the proposed 30 percent surcharge on those who allow their insurance coverage to lapse), and it would do nothing to make healthcare better.
When the Democrats passed ObamaCare, at least they had a theory of the case, an argument for how their bill would cover more people and reduce healthcare costs. What do Republicans have? What does the AHCA do better than the status quo? What is it trying to achieve? At best, all Republicans can say is that it sets fire to the American healthcare system by making every obvious metric a little worse, and it cuts taxes on rich people. But, you know, freedom!
Interestingly, the backlash to the AHCA has been bipartisan, leading to speculation that it is already dead in the water. But, with the exception of the rare Republican intellectual, the beltway narrative has been that Republicans, rather than being concerned with the obvious deficiencies of the bill, are actually troubled because the bill is not conservative enough. While I wholeheartedly disagree that the AHCA is not “conservative” enough, I can sympathize with that critique because the AHCA, in fact, does a lot of things that ObamaCare already does, just in a scaled-back form. Prohibit insurers from denying coverage to people with pre-existing conditions? Check. Ban lifetime coverage caps? Check. Allow young people to remain on their parents’ health plans until age 26? Check. It’s because of this why some Republicans have taken to calling the bill “ObamaCare Lite,” like Republican Rand Paul did on Twitter shortly after the bills reveal.
An optimistic view of the similarities between the AHCA and ObamaCare is that it speaks to how entrenched ObamaCare has become since its enactment. That’s good news if you were happy to see federal healthcare policy lurch leftward, and it is the clearest example yet of how Barack Obama fundamentally shifted the discussion on healthcare policy in the United States.
The “ObamaCare Lite” argument is understandably troubling, though, to Republicans and organizations who have argued that ObamaCare has failed, and they are doing the country a favor by getting rid of it. All of it. On Tuesday morning, two staunchly conservative activists, Heritage Action and the Club for Growth, explained their opposition like this: “[The AHCA] is bad politics and, more importantly, bad policy. Rather than accept the flawed premises of ObamaCare, congressional Republicans should fully repeal the failed law and begin a genuine effort to deliver on longstanding campaign promises that create a free market health-care system that empowers patients and doctors.” The Club for Growth pejoratively dubbed the new bill “RyanCare.”
Despite Republican opposition, the White House has gone all in on the AHCA. Trump tweeted, “Our wonderful new Healthcare Bill is now out for review and negotiation. ObamaCare is a complete and total disaster – is imploding fast!” Then, after a meeting with House Republicans he said, “We’re going to do something that’s great. And I am proud to support the replacement plan released by the House of Representatives.” Selling this turd to the country, though, is proving to be a difficult mountain to climb. Selling it to skeptical conservatives is going to be like attempting to summit Mount Everest without the benefit of a sherpa, oxygen, or jacket..
Donald Trump appears to have not been paying attention to Republican party politics vis a vis health care policy for the last seven years. If he was paying attention, maybe he would have realized that Republicans are incapable of fixing the numerous problems that need to be addressed about ObamaCare, and are not interested in passing or maintaining any reform that actually improves America’s health care system.
Don’t mistake the “not conservative enough” argument for an implication that these “principled conservatives” actually have a coherent, more conservative version of the AHCA that would improve the lives of Americans. Republicans have opposed every major piece of healthcare legislation for the past few decades – including Medicare, Medicaid, and – and they have quashed any attempt to pass universal health care legislation. And since 2010, the GOP tried to repeal ObamaCare more than 60 times. Not once did they ever vote to replace it. Republicans, simply put, don’t give a damn about your healthcare. They didn’t then, and they don’t now.
Despite support from the White House, to the extent that such support is worth anything, the AHCA will not pass as currently designed. The obstacles – which include unified opposition from Democrats, powerful special interests (like the AARP, American Medical Association, and American Hospital Association) already voicing their opposition, and Republicans who can’t get their act together – are too numerous, and neither Trump nor his team have the capacity, or the patience, required to manage those obstacles. While Trump’s hedge that the “Bill is now out for review and negotiation” might leave him the wiggle room to walk back his support, it’s difficult to imagine a scenario where this doesn’t end in embarrassment for Donald Trump.
And if there’s one thing that the notoriously thin-skinned (so-called) president hates, it’s anything that exposes him for the fraud that he is. The AHCA’s failure will spark intense Republican infighting. Trump will outwardly blame the dysfunction on Democrats and the media for covering the bill “unfairly.” That’s his modus operandi. But you can be sure to read reports of discord between Trump and congressional Republicans from “unidentified sources” and “senior officials.” Cue more outrage about leaks and a few temper tantrums on Twitter. And meanwhile, while the children bicker, the mounting uncertainty will destabilize health insurance markets, the cost of healthcare will continue to increase, and ordinary Americans will suffer.
If it weren’t for the fact that they are committed to ripping health care away from millions of Americans and otherwise making health care worse, I might feel bad for Paul Ryan and the rest of Republican leadership, which is caught between a rock and a hard place. On the one hand, the AHCA is an admission from Ryan that repealing ObamaCare without a credible replacement would be politically disastrous. He knows that Republicans will pay a heavy price in the 2018 midterms if they upend the health insurance industry by repealing Obamacare without a replacement, just as Democrats paid a heavy price in the 2010 midterms by upending health insurance by passing Obamacare in the first place. The irony here is palpable.
On the other hand, Paul Ryan is in charge of a party that is only concerned with erasing the Obama legacy from the congressional record, and don’t give a shit about your healthcare. If Republicans were being truly honest, the first paragraph of the AHCA would read: “Nice little health care plan you’ve got there. Be a shame if anything happened to it.”
I’m not necessarily surprised, but the shamelessness here is astounding, even for Republicans. But, again, they don’t care. Because when it comes to health care policy in the United States, the Republican party is as bankrupt as the four companies Trump bankrupted as a businessman.