Yes, it could get worse

At week’s end, Republicans in Washington appeared to be resurrecting for triumphant grandstand display their slap-dashed health care “reform” measure.

Republicans in the House had taken their flawed and failed proposal— the one abandoned on the fast track a few weeks ago—and amended it to make it even worse.

By that worsening, they picked up Tea-Party, anti-government votes from the destructive and best-ignored so-called Freedom Caucus on the GOP’s extreme right flank.

The House Republican leadership was “whipping” this new vehicle Friday. That meant determining which moderate Republican House members were legitimately afraid of losing vital constituent support if they voted to destroy Obamacare, and which moderate Republicans could most likely survive voting to destroy Obamacare.

Those most likely to lose their seats because of responsible constituencies would be released to vote against the proposal while those representing higher quotients of misinformed and irresponsible constituencies would be leaned on to hold their noses and vote “aye.”

The plan is to get to 216 firm votes so that President Trump and the House Republican leadership could cite at least one legislative accomplishment on or about the 100th day of this preposterous second-place presidency.

The accomplishment, such as it is, would be transmission to the Senate of a dead-on-arrival bill, one would hope and think.

But it would amount to a bill moving in the legislative process ostensibly to accomplish something Trump and the Republicans promised faithfully to get done with ease and dispatch. But that was before Trump said he’d been surprised that health care was complicated.

The means would be passage of a bill that could put diseased people newly at risk while limiting the political risks of Republican House members—those being the priorities.

Specifically: The first bill was plenty bad and mean, presuming to phase out Medicaid expansion, which has been such a success in Arkansas that Republican Gov. Asa Hutchinson embraces it and even U.S. Sen. Tom Cotton seems by his code-speak to kind of like it.

The bill also would reduce subsidies for lower-income young people on the health-care exchanges. It would do that by redesigning those subsidies to direct most of their aid to older people including higher-earners.

Thus, it would pretty much destroy Hutchinson’s plan, which will be on display in a special session this week, to save Medicaid expansion money by moving up to 60,000 miserably poor people off state-matched Medicaid expansion and onto the federally subsidized exchange. To put it simply: The House bill would end Medicaid expansion and lower the federal subsidies on the exchanges, leaving poor people in Arkansas approximately nowhere to go. Or leaving Asa no place to put them.

But the problem was that the first measure was not mean enough to suit the Tea-Party, anti-government freakright. To pick up those votes, this new bill keeps all that draconian matter but adds two provisions.

One is that health insurance plans could offer less than Obamacare minimum benefits. The other is states would take over the issue of covering those with pre-existing conditions— meaning expensive diseases.

While carriers would be required to continue to provide that coverage, states would receive new flexibility, forbidden by Obamacare, to get federal waivers to move those sick persons off the basic insurance pool and charge more for their coverage.

House Republicans assert that the guarantee of coverage for pre-existing conditions will survive and that the state waivers on premiums would not necessarily mean simply charging sick people higher premiums. They say the new systems could include some form of high-risk pools to which federal and state governments would contribute. Those would be separate from the regular insurance pools for healthy people that cost more now because of the requirement to cover sick people.

But it comes down to this: To pass a measure out of the House and give themselves a supposed accomplishment, and to be able to argue that they are holding down basic health-insurance premiums, Republicans in the House are proposing to subject sick people to myriad and probably uneven systems set up in their various states and to punitive premiums for the crime of being sick.

This Republican House bill would replace Obamacare with something Republicans say would be cheaper, but, if so, only because of less-comprehensive coverage and a transfer of expensive sick people from the basic insurance pool to their own higherpriced but presumably subsidized pool.

Otherwise, Republicans would replace Medicaid with block grants and Medicaid expansion for the working poor with … well, nothing.

Meantime, a new Washington Post-ABC poll says Americans favor by 61 percent to 37 percent keeping Obamacare and fixing it over repealing and replacing it. But that’s a nationwide poll, meaning it includes Californians, who don’t count, as the recent electoral college taught.