Two days before the Kentucky Derby, House Republicans hit the trifecta: They used an undemocratic process to pass a healthcare bill that’s awful on the merits and can only hurt them politically.
Republicans created a myth about the Affordable Care Act, claiming that Democrats rammed it through under cover of darkness. For years they mocked then-House Speaker Nancy Pelosi’s statement that “we have to pass the bill so that you can find out what is in it.” But this phrase was taken out of context: She was talking about how the news media had distorted the bill. At any rate, this story about the ACA was completely false. Democrats let the Congressional Budget Office carefully score the bill and if it was rushed it was with the slowest haste in legislative history — the process took more than a year.
Everything that Republicans said about the process that led to the ACA and worse is absolutely true, however, of Speaker Paul D. Ryan’s American Health Care Act. As Republican Sen. Lindsay Graham conceded on Twitter, the bill was “finalized yesterday, has not been scored [by the CBO], amendments not allowed” and only “3 hours final debate” were permitted. Astonishingly, the people’s representatives voted to radically upend the healthcare sector before a public version of the bill was even available.
There’s a reason for this rushed and opaque process — you don’t refuse to wait for a CBO score if you expect good news. As Pelosi said before the vote, “forcing a vote without a CBO score shows that Republicans are afraid of the facts.” Indeed, it’s hard to overstate how scary the facts really are.
If it becomes law, the AHCA will strip insurance coverage from millions and millions of working people while giving the upper class a massive tax cut. At the last minute, Rep. Fred Upton offered an amendment to help states reduce premiums for people with preexisting conditions — but no one who’s taken either a math class or visited a doctor’s office believes the amount set aside ($8 billion over five years) is nearly enough. Many people with preexisting conditions (which includes people who have sought treatment for sexual assault) will therefore be locked out of the insurance market. Meanwhile, savage cuts to Medicaid will cause many poor people to lose access to healthcare entirely. The AHCA could also eliminate caps on out-of-pocket expenses for the lucky people who get insurance through their employers, preventing them from continuing expensive treatments.
(Excuse me for not using precise numbers but, as stated, the GOP refused to allow the CBO to score the bill.)
Precisely because the bill is terrible, voting to pass it will be a political disaster for the Republican Party. The first version of the bill was massively unpopular, and this version won’t do much better. There simply isn’t any public constituency for passing a huge cut to federal healthcare spending, causing millions to lose insurance, and giving the money to the rich. Pelosi was right that the public would like Obamacare more when they found out what was in it, because most of its components were individually popular even when the bill was not. The same isn’t true of Trumpcare — virtually everything in it is unpopular. It will almost certainly cost some blue-state Republican House members their seats in 2018, and it won’t help Trump’s bad approval ratings either.
It’s unlikely that this slapdash and morally monstrous bill will be able to pass the Senate, even in modified form. Unlikely — but not impossible. Perversely, the political hit Republicans will take for going on the record in favor of Trumpcare might make it more likely to pass the Senate. For wavering Republicans, putting the party’s House majority at serious risk and not even getting anything out of it would be the worst-case scenario.
Trumpcare would quite simply be a humanitarian nightmare, resulting in untold avoidable death and suffering for no good reason. At least it’s now obvious — though it should have been obvious long ago — that Trump is not a compassionate populist and that Ryan is not a policy wonk. The fact that Republicans plan to hold a party to celebrate this great “victory” should make great fodder for midterm election attack ads.
Scott Lemieux is an instructor of political science at SUNY Albany and regular contributor to the New Republic and The Week.