Like a thief in the night, Senate Republicans are trying to take healthcare from tens of millions of people to pay for a massive tax cut. What we don't know is exactly how many people will lose coverage or how much rich people will save in taxes — because Republicans are refusing to make their version of the American Health Care Act public. If you had any doubts that the bill would be a substantive and political disaster, this secretiveness should remove them.
Why are Republicans hiding their work? As one Republican aide put it, "We aren't stupid." Letting the public read the bill — you know, democracy — would jeopardize their chances of undoing the Affordable Care Act "root and branch," as they long promised.
There is no recent precedent for anything like this closed process for such a major bill. Republicans and their allies in the media presented a caricatured version of the Affordable Care Act in which its passage was speedy, non-transparent and entirely partisan. But this was always a ludicrous inversion of the truth; the ACA's negotiations happened mostly in the open, took forever and continued to involve Republicans long after it was clear they wouldn't support any reform whatsoever.
When then-House Speaker Nancy Pelosi (D-Calif.) made her often-distorted statement that "we have to pass the bill so that you can find out what's in it, away from the fog of the controversy," the bill had been public for three months. The public will be lucky to examine the handiwork of an all-male group of Republican senators for three days before they try to ram it through. Senate Majority Leader Mitch McConnell (R-Ky.) is running roughshod over basic democratic norms.
The truly terrifying thing is that his tactics might work. "The Affordable Care Act," concludes Vox healthcare policy expert Sarah Kliff, "is in deep trouble." And this isn't because the Senate is likely to pass anything much different than the extraordinarily unpopular House bill. (Remember: If they thought the public wouldn't hate their version, they wouldn't be hiding it.) The pathetic faction of Senate Republicans who are inaccurately described as "moderates" are making it clear that they will cave in to the reactionary extremists who dominate the Republican conference, while getting virtually nothing in return. Probably the only concession they will win is to phase in devastating cuts to Medicaid over a slightly longer period than House Republicans proposed.
Of course the public eventually will see this horrible bill — just before it becomes law — and the public's second taste of Trumpcare will be just as bitter. But McConnell's gamble is that ramming through an unvetted overhaul of the healthcare system to inflict immense suffering on the poor while helping the rich won't endanger the GOP's Senate majority — at least not in the short term — and is therefore worthwhile.
The fact is that the 2018 Senate map is extraordinarily favorable to the Republican Party. Democrats hold 23 of the 33 seats up for election. Texas Sen. Ted Cruz won his seat in 2012 by 16 points, and yet this might be the best chance Democrats have to flip one of the three seats they would need to regain control of the Senate.
If Republicans were defending, say, 20 seats instead of 10, McConnell wouldn't try to pass a horribly unpopular bill. He'd worry that doing so would lead to Democratic control of the Senate, and thus deprive him of his ability to rubber-stamp Trump's judicial and executive branch appointments. In this alternative scenario, he would have made the bill go away quickly by forcing a losing vote.
But as things stand, McConnell knows that even a political wave that knocks Republicans out of control of the House probably wouldn't cost them the Senate. And he knows that even if 2020 is an utter bloodbath for his party, he'll have already secured control of the Supreme Court for generations to come.
Passage of Trumpcare is therefore frighteningly possible, but it's not inevitable. Opponents need to do whatever they can, starting now.
First of all, Democrats cannot act as if it's business as usual in the Senate. Republicans want to move quickly because time and transparency are their enemy; Democrats need to slow everything down to draw attention to both the bill and the process behind it.
But elected officials can't do this alone. Popular pressure helped to stop the first House attempt to strip more than 20 million people of their health coverage. The people will need to speak out yet again. Protests, phone calls and other forms of activism from ordinary citizens are crucial.
Nothing is guaranteed to stop Republicans from ramming through their reverse-Robin Hood bill. But this is a political and humanitarian crisis, and it needs to be treated as such.
Scott Lemieux is an instructor of political science at the State University of New York at Albany and a regular contributor to the New Republic and the Week.