And what hypocrisy: House Speaker Paul D. Ryan (R-Wis.) claims to be restoring fair process to his chamber, and then orchestrates a vote on this hugely consequential bill before the Congressional Budget Office can tell lawmakers what it would cost or how many people would lose access to health care as it took effect.
Carelessly, the bill would threaten the integrity of even employer-based health-care plans in every state, apparently by accident. Recklessly, its drafters introduced just one day before the vote legislative language that an independent expert called "incoherent, arbitrary, and technically complex." Tragically, the repeal-and-replace effort is causing so much uncertainty that, even if this bill dies in the Senate, it may unravel the existing health-care system.
There can be no doubt that this legislation would erode protections for people with preexisting conditions. States seeking to weaken regulations protecting vulnerable people would face few legal barriers. The Brookings Institution's Matthew Fiedler warns that once these states got federal waivers allowing insurance companies to hike premiums on sick people, many of those with preexisting conditions would be priced out of any comprehensive individual insurance market plan, whether or not they kept coverage continuously to that point. There would be few requirements on states to offer a real backstop — no mandates on who or what a high-risk pool must cover, or even that a high-risk pool be created.
And the $8 billion Mr. Upton secured? "If all the states with Republican governors opt for waivers, the $8 billion will dwindle into insignificance," wrote health-policy expert Nicholas Bagley.
Meanwhile, the bill's sloppy drafting means that employer-based health-care plans might be permitted to impose annual spending limits and lifetime coverage limits — even if most states attempted to keep strong market protections in place. And do not forget that much of the bill is unchanged from March, when the CBO found that it would result in 24 million fewer people with health insurance. It would still roll back a Medicaid expansion for the near-poor and unlink federal health-care subsidies from income and region. The money saved would go to wealthy people in the form of tax cuts. Poorer, sicker and older people would feel the pain.
This process began with Republicans seeking to solve a problem that exists only in their imagination: the supposed catastrophic failure of Obamacare. Their solution has involved half-baked legislative language and magical thinking at every step. It is beyond sad that this is what passes for a “win” for President Trump and the Republican majority in Congress.