The Congressional Budget Office report on the American Health Care Act — showing that as many as 24 million people could lose health insurance, Medicaid would be drastically cut and older, poorer Americans would suffer the most — leaves us with a number of questions:

Why did House Speaker Paul Ryan (R-Wis.) force votes in two committees and then spring the disturbing CBO score, revealing that members voted rashly (not knowing the effects) or don’t care about loss of coverage and regressive consequences? Perhaps he is so convinced that his members will vote for anything that he made no effort to spare them from votes they one day (Election Day 2018, for example, and especially in districts Hillary Clinton carried) will regret. It is far from clear what he thought he was going to “get away with.” Unlike President Trump, he cannot merely dismiss inconvenient facts and plunge forward. Well, he can, but he puts his members’ seats and his own speakership at risk.

What’s the point of passing something so obviously unacceptable to the Senate? Sen. Susan Collins (R-Maine) blasted the effort: “The CBO estimate that millions of Americans could lose their health insurance coverage if the House bill were to become law is cause for alarm. It should prompt the House to slow down and reconsider certain provisions of the bill.” Her colleague and Trump supporter Sen. David Perdue (R-Ga.) echoed Sen. Tom Cotton’s advice on Sunday to “get this right.” Sen. Lindsey Graham (R-S.C.) argued, “[L]et’s say the CBO is half-right. That should be cause for concern. So, rather than attacking the CBO as the exclusive way of moving forward, I would think the prudent thing for the party to do is to look at the CBO report and see if we can address some of the concerns raised.” Sen. Bill Cassidy (R-La.) scoffed at the notion the bill would really save money. “Society is going to pay for health care whether it’s through insurance or not,” he remarked.

AD
AD

Will House Republicans walk the plank for nothing? Since the House GOP plan has no chance of passing the Senate, it remains to be seen whether members will vote for something so easily converted into attack ads in 2018. (Incumbent votes to slash Medicaid and fatten billionaires’ wallets!) It will be exceedingly easy to find people harmed by the bill to appear in such ads. Moreover, if a state’s GOP senator(s) vote against it, a House member will face the obvious criticism: Even Senator X voted against it!

What will Trump do? Trump’s White House initially ridiculed the CBO report. However, once he gets wind of how much opposition there is and which voters (the “forgotten men and women”) are stuck paying more, he might save himself, declare Ryan’s effort a failure and tell Congress to go try again. He’s not a party loyalist so he might not care all that much if the GOP loses one or both houses. After all, he could keep his promises (e.g. cover everyone, don’t touch entitlements, everyone pays less) by making a deal — with Democrats — for a single-payer system. And don’t think he wouldn’t do it in a flash if he thought he could rack up a “win.”

What happens to Trump’s populist message? The bill is the opposite of populist — the rich get tax breaks and the poor pay more for health care. Trump can pretend the CBO numbers are phony, but voters around the country will do their own calculations.

AD
AD

Advocates for poorer, older, disabled and rural Americans are slamming the bill. The American Medical Association joined the chorus. “Unfortunately, the current proposal — as the CBO analysis shows — would result in the most vulnerable population losing their coverage,” the AMA said in a statement. “Importantly, we hope the CBO estimates will motivate all Members of Congress to find a pathway to work together on significantly improving  proposed health reform legislation so it is more focused on serving the very real needs of patients and improving the health of our nation.” The Boston Globe reported, “The Massachusetts advocacy group Health Care for All estimated that 300,000 people would be dropped from MassHealth, the state’s Medicaid program, based on the CBO estimate of a 17 percent loss of Medicaid enrollees. MassHealth enrolls 1.9 million people. ‘The CBO report provides more proof that the president’s health care proposal would be devastating for Massachusetts,’ a statement from Health Care for All said.”

AD
AD