We are hurtling toward a health-care disaster in the next 36 hours or so, for the worst possible reason. Cynicism is seldom completely absent from the operation of politics, but this is truly a unique situation. Republicans are set to remake one-sixth of the American economy, threaten the economic and health security of every one of us and deprive tens of millions of people of health-care coverage, all with a bill they haven’t seen, couldn’t explain and don’t even bother to defend on its merits.
Why? Because they made a promise to their base and now they say they have to keep it — regardless of what form keeping the promise might take and how much misery it might cause.
Tomorrow, the Senate is set to vote on a Republican bill to repeal the Affordable Care Act. What Republican bill? The senators themselves don’t even know. Here’s how Sen. Susan Collins (R-Maine) described it yesterday on “Face the Nation“:
It appears that we will have a vote on Tuesday. But we don’t whether we’re going to be voting on the House bill, the first version of the Senate bill, the second version of the Senate bill, a new version of the Senate bill, or a 2015 bill that would have repealed the Affordable Care Act now, and then said that somehow we will figure out a replacement over the next two years.
I’ve often argued that Republicans in Congress aren’t serious about policy, but this is taking their unseriousness to the level of farce. After complaining for years that the ACA was “rammed through” Congress — in a process that involved a full year of debate, dozens of hearings in both houses and 188 Republican amendments to the bill debated and accepted — they’re going to vote on a sweeping bill that had zero hearings and that they saw only hours before, because who cares what’s in it? It’s only the fate of the country at stake. If taking away health-care coverage from 20 million or 30 million Americans is what it takes to stave off a primary challenge from some nutball tea partier, then that’s what they’ll do.
No one would argue that keeping promises isn’t important. But Republicans have elevated the idea of keeping their promise to repeal the ACA to the point where it’s drained of all substance. You can see it in the way they talk about the various iterations of their bill. You seldom hear a Republican defend it on the terms of the bill itself. They don’t say, “Here’s how this bill will bring down deductibles” or “Here’s how the bill will take care of those who lose their insurance” or “Here’s how the bill will lower costs.” That’s partly because their bills won’t do any of those things, but mostly because they just don’t care.
Instead, what they say is, “We made a promise, and we’re going to keep it.” If Majority Leader Mitch McConnell (R-Ky.) handed them a bill saying that all children on Medicaid would be taken to the desert, buried up to their necks in the sand, and covered in fire ants, at least 40 of them would say, “It may not be perfect, but we have to keep the promise we made to repeal Obamacare, so I’m voting yes.”
For those few Republican senators with a hint of conscience — or whose states are particularly reliant on the ACA, and on Medicaid in particular — McConnell is trying to hand them a fig leaf they can use to justify their votes. But the goodies he’s offering are laughable. Consider, for instance, that McConnell is telling senators that he’ll put in $200 billion to help states that didn’t expand Medicaid. Sounds generous, until you realize that’s on top of over $750 billion in Medicaid cuts. It’s like saying, “I’m stealing your car, but here, you can keep the spare tire.”
The same is true of the $45 billion over a decade they’re tossing in to address the opioid crisis. Many of the states hardest hit by that crisis are ones such as Ohio and West Virginia that are most dependent on Medicaid. So for them, the Republican bill would take $15 or $20 away from the program most central to treating the addicts in their state, but toss a dollar back to make up for it. People who work with state budgets and addiction treatment have been telling anyone who’ll listen that given the magnitude of this crisis, $4.5 billion a year is a joke. But it might be enough to allow a couple of Republicans in the Senate to claim they aren’t making the problem dramatically worse, which is exactly what they’d be doing.
What you’d expect of leaders is to say, “Okay, there are a bunch of interlocking, complex problems we want to solve here. This has to be done carefully. Let’s take our time and make sure we get it right.” But that’s not what Republicans are saying. Instead, they’re saying “We have to vote on a bill now, even if we don’t know what it’s in it and even if it makes the problems we claim to care about impossibly worse, so we can say that we repealed Obamacare.” Sure, it would be bad to kick 20 million or 30 million people off their coverage — but not as bad as having to admit they failed to pass a bill!
This is even less serious and more cynical than what they’ve been doing for the past seven years. When they held dozens of votes in the House to repeal the ACA, it may have been silly, but at least it didn’t hurt anyone. Now they have the power to affect people’s lives by the millions — even destroy them — and they can’t be bothered to spend more than a day or two figuring out how to do it.