Bernie Sanders recently offered on Twitter what he described as a display of all the Senate Republicans’ public considerations of the American Health Care Act, aka Trumpcare: a photo of a blank piece of paper.
Not a bad jibe, and a window into the deepening bipartisan dismay that Majority Leader Mitch McConnell and his Republicans soon will try to jam through the next step in their long-sought effort to repeal and replace the Affordable Care Act, aka Obamacare.
Does McConnell have the 50 votes he needs so Vice President Pence can break a Senate tie and move Trumpcare closer to reality? Will this occur in just days, before Congress heads to its July Fourth recess? Or will it happen in the small period before the long August recess, when Trump Administration officials also want Congress to take up an increase in the debt ceiling and to tackle a budget and maybe some tax law changes?
If senators vote soon on the AHCA, their deliberations will have occurred in what seasoned congressional watchers say is unprecedented secrecy, and with factual misstatements that many call outright lies.
McConnell declined to send the House-passed AHCA to any Senate committees, as normally would occur. He invited no discussion with Democrats. He limited even his own caucus members from full participation, launching the Senate Trumpcare deliberations with a group of 13 senators—all white men. He since has held lunches at which GOP senators have discussed their broad views of health care and health insurance, with reports of a rare inclusion of a guest with expertise in a sector that comprises 18 percent of the nation’s GDP. (McConnell and the GOP mostly have turned away experts as they ponder the complexities of health care—possibly because nearly all major medical and patient advocacy groups have ripped Trumpcare).
But senators, to their growing upset, say they have not seen any bill that details a Senate version of Trumpcare to be voted on. News reports suggest, though, that the Congressional Budget Office, the nonpartisan agency that scores bills so lawmakers can know how much they cost and what their effect might be, may be getting something soon and directly from McConnell and his allies, without senators seeing any bill.
Have GOP senators—as they, President Trump, and Health and Human Services Secretary Tom Price promised—figured a better alternative to Obamacare, a health bill that would insure more Americans, offer them more coverage and with greater access and less costs? Have they taken the AHCA that squeaked out of the House and was later panned by the president himself as “mean” and skimpy, and improved it?
If so, why can’t their plan withstand the sunshine?
Or will McConnell make many “backroom deals” to give GOP colleagues political cover by adding money, say, to combat the prescription drug abuse epidemic or by making giant cuts to Medicaid still but doing so more gradually to try to tamp down voter anger.
Republicans already have a health care disaster looming. The frenetic House work on Trumpcare, including representatives’ vote before their bill was CBO scored, has displeased voters. AHCA deliberations have made Obamacare popular as it never was while Trumpcare polls as poorly as any piece of legislation in recent memory—and it’s sinking and now rejected by those surveyed in all 50 states.
We know that partisans seem pleased with themselves for getting part way toward killing Obamacare with a House bill that takes away health insurance for tens of millions of Americans. It savages the old, the chronically ill, the disabled, and those with mental conditions, including addiction. It also, Uncle Sam’s actuary estimates, will increase health insurance premiums and deductibles, saving the nation less and costing more that the CBO has said.
It’s not worth speculating if the Senate, in a month or so of its hush-hush operation, has found miracle cures to the awful AHCA and its reverse-Robin Hood approach of robbing the poor and middle class to give the rich, Big Pharma, medical device makers, and tanning salon operators a huge tax break.
We all need to look to our future and ask if we want 50 million-plus Americans uninsured by 2026. What will be the effect when, through Medicaid cuts and slashes to other safety net programs for them, we raise tens of millions of our children with bad health—and zero promise that we will improve their care or prevent the worsening of their conditions? Are we willing to give the most able, affluent Americans hundreds of billions in tax cuts while doing so means that at least a million well-paying health care jobs evaporate? Do we wish to return to a time when insurers could decide—to their economic benefit—whether we had preexisting conditions and deny us coverage or charge exorbitant rates , say, to expectant moms or those with mental illnesses?
It’s a bit wonky, but experts say that GOP senators wrongly may be comforting themselves by thinking their Trumpcare won’t allow insurers to deny coverage for cancer—while at the same time their measure will let them refuse to pay for cancer care.
Senators, strangely, are now saying their caught up in forces they can’t control, and Republicans, in particular, can’t seem to come to grips that it’s their leaders who are jamming through in secret sweeping changes in a part of the economy where Americans spend $3 trillion annually.
They keep talking about health insurance’s soaring costs, when the Trump Administration’s inaction on Obamacare cost-sharing subsidies for the poor and lower middle-class has muddled markets with uncertainties that insurers are blaming for big impending rate hikes.
Further, senators seem baffled about addressing high-deductible policies that make medical care so costly out of pocket that many Americans skip needed treatment. Many of these plans aren’t part of Obamacare and are provided by employers—an area of health insurance that Congress insists it doesn’t want to harm. But the House’s Trumpcare allows state waivers for “essential health benefits”—the basics that insurers must provide, now including emergency care, drugs, maternity, female reproductive health, drug abuse, and mental illness therapies.
How long do Republicans think that profit-driven companies, already acting in their own and not their employees’ best interests and in a constant complaint about and hunt for cost savings, will follow Trumpcare and either shift even more medical expenses to middle-class workers, or even cut employer-provided coverage so much that it will be as if Americans have no health insurance at all?
The GOP may “win” with Trumpcare, with what one commentator (yes, a partisan but also a thoughtful policy expert) describes as three key tactics: sabotage, speed, and secrecy. You needn’t be a member of either or any American political party to think that’s a miserable way to make laws and policy. We should be avoiding it because we’re all going to pay a price if it succeeds.