House Republican leaders said Wednesday that they plan to bring their controversial plan to revise key parts of the Affordable Care Act to a vote on Thursday, capping weeks of fits and starts in their attempt to fulfill a signature campaign promise.
The flagging Republican effort to reshape the nation’s health-care system picked up steam Wednesday as GOP leaders tried to address concerns about people with preexisting medical conditions. But independent analysts remained skeptical that the new proposal would fully address the needs of at-risk patients who receive coverage guarantees under the Affordable Care Act, underscoring the contentious nature of the Republican effort.
In an audacious move, the House leadership says it intends to force a vote on a bill that has not been scored in its current form or been seen by the vast number of members. The vote will occur without any financial justification for a new allotment of $8 billion over five years (a sliver of the amount that experts say is needed to provide accessible and affordable coverage to people with preexisting conditions through high-risk pools). Members will still be voting for a huge tax cut for the rich (contrary to Trump’s populist message), which simultaneously making coverage more expensive for older, rural Americans. It has been opposed by virtually every medical association (plus AARP) and retains provisions that a large percentage of Americans oppose (e.g. rolling back Medicaid, kicking as many as 24 million people off coverage, abolishing the essential benefits that must be offered).
By most outside whip counts, the vote will be close — only a few votes above or below the 216 tally needed for passage. If the speaker needs to pull the bill or risk losing on the floor, he’ll suffer a humiliation that may well lose him the support of his conference.
As of this hour, a number of questions remain unanswered:
- Do GOP leaders really have 216 votes, and if not, will they pull the bill once again?
- How will the GOP justify voting for a bill not scored, not subjected to scrutiny for even 24 hours and not strenuously defended on the merits?
- If moderates take the plunge, will they get hammered at the polls in 2018?
- If the hodgepodge of incoherent provisions makes its way to the Senate, where it almost certainly will fail (and likely won’t qualify under the Byrd rule for reconciliation), what then?
- Will House members get bashed for passing a bill so awful that even a GOP Senate couldn’t approve it?
- Will moderates revolt against House Speaker Paul Ryan (R-Wis.), who is setting them up for a vote indefensible on the merits and potentially fatal to their political careers?
- When the inadequacy of the bill becomes clear, will House Republicans have buyer’s remorse?
The degree to which the House feels compelled to undertake unprincipled, even reckless, action may startle some observers. However, by now we should be accustomed to a president without concern for the merits of any measure and a right-wing contingent that is more afraid of failing to pass something than it is of hurting millions of Americans. Ryan no longer has the will or the ability to be the adult in the room who can bring his members to their senses.
Democrats seemed ambivalent. On one hand, they plainly would like to put a stake through the heart of Trumpcare. Many Democrats and a few thoughtful conservatives sounded mortified that so many House members could be swayed by an $8 billion fig leaf that would obviously be insufficient to protect hard-to-insure Americans. (The liberal Center for American Progress calculated that “even if the House were to throw an additional $200 billion at high-risk pools to keep them afloat, that would do nothing to help consumers outside the risk pools. The other 9 in 10 people with pre-existing conditions would be vulnerable to thousands of dollars in health-based premium surcharges, and the return of medical underwriting would unravel the insurance market.”) Democrats honestly (and with some justification) think the GOP will deprive millions of Americans coverage for lifesaving care and, to be blunt, kill people.
On the other hand, most Democrats seem convinced that the Senate will reject this mess of a bill. A House vote for the bill will be the perfect cudgel to use against Republicans in 2018 and again in 2020. In essence, they figure, “Hey, why not let Republicans vote for something so bad that it’ll fail anyway and may well cost them the House majority and eventually the Senate majority and White House?”
We will be watching to see whether Trumpcare does in fact pass, and if so, what the consequences for Republicans may be. The only thing we can say with certainty (we think) is that the bill in its current form will never become law. GOP senators are much too smart to go along with this policy and political debacle.