The primary motive for the latest Republican plan to repeal Obamacare is, as one of its co-sponsors explained in a written statement, a “deadline.” Republicans have one more week to abuse the budget process in a way that would allow them to overhaul the health-care system without any Democratic votes. The frantic rush has created a shambolic piece of legislation whose directional impact is clear enough — it would massively reduce federal funding for health-care coverage — but whose specifics are barely knowable.
Two aspects of this shoddy design have recently come to light. One is that the bill, like previous repeal efforts, would ban the use of tax credits for abortion. The difference, as Charles Gaba points out, is that insurance plans for 2018 will be finalized before the bill is voted on. Millions of Americans will buy health insurance with the expectation of federal subsidies that could be illegal. What’s more, California, New York, Massachusetts, and Oregon require insurers to make abortion coverage available.
How will the states figure all this out? Tara Straw at the Center on Budget and Policy Priorities tells me, “Part of California’s protection of abortion services is wrapped up in courts’ interpretation of its constitution. That makes it all much more complicated for the state.” I queried University of Michigan law professor Nicholas Bagley, a health-care expert, who floated some theories but no firm conclusions. “At a minimum,” he says, “you’d want an answer to that question before passing a major piece of legislation that could affect hundreds of thousands of Californians.”
Christopher Jacobs, a conservative health-care policy analyst, finds an even crazier aspect of the bill. The basic rationale for the law is to remove power from Washington and give it to states in the form of block grants. But how will the grants be calculated? In the short run, its authors have carefully designed the formula to help pass the bill through the Senate (including by handing a special bonus to Alaska, where Senator Lisa Murkowski may cast a key vote). But starting in 2020, the secretary of Health and Human Services is authorized to adjust the formula “according to a population adjustment factor developed by the Secretary.”
The bill says that adjustment must be based on “legitimate factors,” but otherwise places no specific limitations. So, if President Trump wanted, say, to reward a political loyalist or punish a political foe, he could order the secretary to come up with any facially plausible reason to shift around money as he sees fit. This would be written into permanent law if it passes, but it seems especially relevant that Trump is completely open about his corrupt view of politics and expectation of loyalty above all else, and HHS Secretary Tom Price is, uh, not exactly a paragon of ethics. A Republican senator who gets too nosy about, say, the Russia scandal might suddenly learn that his or her state’s health-care needs were less serious than previously believed.
These are just two of the incredibly serious problems that have come up today. This is a massive, vague piece of legislation that could melt down the individual health-care markets very quickly. The lack of public responsibility on the part of those attempting to rush it into law is a first-order scandal.