GOP’S BEST HEALTH PLAY IS FAILURE
This is a Republican Congress far more in touch with 2016 politics than 2017 governing.
The Republican plan to undo the Affordable Care Act has spun out of control. GOP senators are frustrated by a process that excluded many of them and violates their promise to make health care more affordable. Only 12% of the public favors the abysmally unpopular plan in the latest USA TODAY/Suffolk University poll. In the face of this, the GOP Senate and president are abandoning their posts, and it’s now every man or woman for himself. Unless the bill dies, the result will reflect every bit of this chaos.
For many Senate Republicans, not passing a bill reflexively feels like failure, and bipartisanship feels unfamiliar. But some may conclude that passing the bill is the worst of all options. A Democratic poll of battleground states shows that simply supporting it could increase the unfavorable ratings of Republican senators up to 30 points.
President Trump and Republicans ran on repealing Obamacare — yet not quite six months into the president’s term, Democrats hold their largest lead over the GOP in the area of dealing with health care. And because the real impact of the bill has yet to be felt, that 12% favorable rating might not be rock bottom.
DYSTOPIAN FUTURE This level of negativity transcends usual politics. The nonpartisan Congressional Budget Office documents a dystopian future if the Senate bill becomes law — a 35% shrinking of the Medicaid safety net over the next two decades, insurance premiums up overall by 74%, insurers withdrawing across the country, many services no longer available, and low income people with no ability to buy insurance.
In normal times, with Congress following a path befitting the importance of the work, all of this would mean it’s time to step back, reshuffle priorities, and develop new proposals. But these times aren’t normal. The secretive, rushed reconciliation process the Senate is using has left Majority Leader Mitch McConnell and the GOP with little more than two weeks to amend the bill and complete voting before a month-long August recess.
Conventional wisdom is that McConnell has already lost the only two votes he can afford to lose. This means he’s forced to listen to all ideas lobbed in from everyone, no matter how bad. Sens. Ted Cruz of Texas and Mike Lee of Utah think the answer is to wipe out all the patient protections in current law and segregate Americans into two pools — the healthy in one and the sick in a separate and unaffordable one. Other senators are looking for more money to be spent — to fight opioids, to increase subsidies for low income people to get them off Medicaid, or to rectify some injustice in their state.
The problem McConnell has is that the tax breaks for the wealthy, a prime conservative motivation for repealing ACA, have left him little money for goodies. Even if he scraps some tax cuts, there’s not nearly enough funding to offset over $1 trillion in cuts to Medicaid and subsidies for low-income people.
No matter how many goodies are spread around, nothing changes, including the roughly 20 million people the CBO estimates will lose insurance over the next decade under the GOP plans.
RECESSES IN HIDING That is likely to stay the same, due to the end of the new Medicaid expansion to people making slightly above the poverty line; the GOP shift to capping money for Medicaid; the skimpier subsidies; and the lack of a mandate to buy insurance or a coherent substitute to ensure that healthy as well as sick people buy coverage.
Add to that the loss of protections for people with medical conditions and requirements that certain “essential benefits” be covered, and Republicans are still looking at a bill so unpopular, they might need to spend all their remaining recesses in hiding.
Into the chaos comes the king of chaos. Trump, apparently baited by conservative senators aiming for more radical steps, tweeted that if there is no deal to be had, the Senate should repeal the ACA and pick up the pieces later. Make no mistake. His trial balloon would mean that Medicaid expansion and subsidies for people buying their own insurance would be gone forever.
This is a mess of the GOP’s own making. Criticizing a law for seven years without a plan to replace it, losing touch with what constituents expected of them, cooking up policies without serious input from experts — these are symptoms of a Congress far more in touch with 2016 politics than 2017 governance.
If the Senate manages to pass a health bill, expect it to reflect the chaos and indifference that went into it. Trump would quickly distance himself from the mess. Senate and House Republicans would stand alone with the monster they built — and a seething public.