In John Boehner’s angry, rousing 2010 floor speech denouncing the Affordable Care Act — the one in which he famously shouted “hell, no!” repeatedly — the Republican House leader ended on a magnanimous note. “Join me, join me in voting against this bill, so that we can come together, together renew, addressing the challenge of health care in a manner that brings credit to this body and brings credit to the ideals of this nation. And most importantly, that reflects the will of the American people,” he begged. Even in this moment of tea-party hyper-adrenalized rage, the party was not lashing itself to the status quo. It was instead pleading for a different, more bipartisan approach to solve what all agreed was a terrible problem.
The Republican Party has never changed its health-care strategy since Bill Clinton tried to reform the system. Republicans posture in favor of the goal of providing medical care to those who can’t afford it, while opposing any specific plan that does so, and refusing to defend the policy outcome their actual position would bring about. They held to that strategy during the Obamacare debate, and through years of voting to repeal the law while promising their alternative would come soon. It was the strategy they tried to carry out earlier this year, when they would repeal Obamacare immediately and replace it … eventually.
Watch Paul Ryan make an argument in 2009 that should convince him to vote against Trumpcare.
Republican efforts to repeal Obamacare without a replacement failed. But they are attempting the next closest thing: a bill the party leadership will try to rush into law without the barest elements of due diligence. There have been no hearings, no studies, no Congressional Budget Office analysis; not even the text of a bill circulated the day before Thursday’s vote.
The heart of the bill is the same one that was polling at under 20 percent and failed two months ago: a near-trillion dollar tax cut for wealthy investors, financed by cuts to insurance subsidies for the poor and middle class. They have added a series of hazily defined changes: waivers for states to allow insurers to charge higher rates to people with preexisting conditions and to avoid covering essential health benefits, and a pitifully small amount of money to finance high-risk pools for sick patients.
The implications of these changes are vast. The Brookings Institution notes that if a single state eliminated the cap on lifetime benefits for a single employee, then employers in every state could actually follow suit, thus bringing back a horrid feature of the pre-Obamacare system, in which people who get hit with expensive treatment suddenly discover that their insurer will no longer pay for their care. This would affect not only those getting insurance through Medicaid or the state exchanges, but also through their job.
The ambiguity of the details is the strategy. Republican leaders have been “assuring centrists that the Senate would make changes to allay their concerns and insisting that few states would actually use the waivers allowing higher premiums for pre-existing conditions,” reports The Wall Street Journal. Sean Spicer says it would be “literally impossible … to do an analysis of any level of factual basis.” Representative Fred Upton told reporters that if the Congressional Budget Office says the bill is underfunded he will push for more money — after it passes his chamber.
They are rushing through a chamber of Congress a bill reorganizing one-fifth of the economy, without even cursory attempts to gauge its impact. Its budgetary impact is as yet unknown. The same is true of its social impact, though the broad strokes are clear enough: Millions of Americans will lose access to medical care, and tens of thousands of them will die, and Congress is eager to hasten these results without knowing them more precisely. Their haste and secrecy are a way of distancing the House Republicans from the immorality of their actions.