Not long ago, a Senate Republican aide made a devastating confession to reporter Caitlin Owens about the GOP health-care law: “Best to get it over with and move on to things Republicans are good at.” The devastating part here is not the desire to “get it over with” but the concession that writing legislation concerning health care, one of the most vital domestic functions of government, is a function the party is constitutionally incapable of performing.
The Republican Party is incapable of passing a health-care bill that is not absolutely horrific. That may sound like a partisan statement, but it is one Republicans themselves have shown, not only through their words but also through their actions, that they believe themselves.
The American Health Care Act, which passed the House last month, is a shockingly unpopular bill that even most conservative policy analysts dislike. They hate the bill because it fails to advance any theory, conservative or liberal, of a functioning health-care system. It does not harness any set of incentives or mechanisms that could plausibly reduce costs or resolve the failures of the system. The only thing it does is cut spending for people in the exchanges and on Medicaid.
The details of the emerging Senate bill seem to be conceptually similar. Republicans promised to take their time and get it right, but they very quickly changed their mind about this. The Senate bill replicates the House bill in its overall design, which is Obamacare-but-a-lot-less-of-it.
The primary emerging difference between the Senate health bill and the House appears to be that the Senate is phasing in its cuts to health-care subsidies more slowly. Rather than a three-year phase-out, they may go for five years or even seven. That is the “moderate” wing of the Republican party in its essence: They will complain loudly and then ultimately do the same thing the far right wants, only not quite as fast.
The slower phase-out is designed to insulate incumbent Republican elected officials from the public backlash that is sure to ensue. By the time the cuts take effect, the vote to enact them will have been long past. Indeed, Republicans may not even control government at that point.
In pointed contrast to the leisurely pace of implementing the GOP plan is the frantic pace of passing it into law. The Senate GOP is determined to vote before the end of the month. Rushing to pass a bill that won’t take effect for many years may seem like a joke, but both elements serve the common purpose of minimizing democratic accountability for its extremely unpopular choices.
In 2010, when the Democrats passed their health-care bill after dozens of hearings and months of open debate, Nancy Pelosi made a statement that Republicans made infamous: “We have to pass the bill so that you can find out what is in it — away from the fog of the controversy.” Pelosi believed that, once the public could actually see how the new system operated, its features would be understood — the bill did not contain death panels, did not force people out of their employer insurance, did not threaten Medicare beneficiaries, and so on. It was an optimistic, perhaps naïve belief. (Obamacare did not become popular until this year, when Republican threats to end the law made the public finally appreciate what it had.) But Pelosi did believe that public exposure to the law’s actual operation would redound to its benefit.
Republicans have a very different belief. They have no confidence the public will like what the law does when they see it. Instead they believe the opposite, which they have confessed with shocking bluntness. “I don’t think this gets better over time,” said Republican Missouri senator Roy Blunt, a member of leadership. “This is not like fine wine, it doesn’t get better with age,” admits Lindsey Graham.
The Republicans have spent eight years insisting that they could produce a better health-care-reform plan if they had the chance. They have come to realize that this promise was false. The only thing they can do is rip away the benefits Obamacare has given millions of Americans. Their sole objective now is to do so with the minimum level of transparency or accountability.