Health care palooza

Paul Waldman:

I won’t mince words. The health-care bill that the House of Representatives passed this afternoon, in an incredibly narrow 217-to-213 vote, is not just wrong, or misguided, or problematic or foolish. It is an abomination. [bold are mine] If there has been a piece of legislation in our lifetimes that boiled over with as much malice and indifference to human suffering, I can’t recall what it might have been. And every member of the House who voted for it must be held accountable…

It is no exaggeration to say that if it were to become law, this bill would kill significant numbers of Americans. People who lose their Medicaid, don’t go to the doctor, and wind up finding out too late that they’re sick. People whose serious conditions put them up against lifetime limits or render them unable to afford what’s on offer in the high-risk pools, and are suddenly unable to get treatment…

Perhaps this bill will never become law, and its harm may be averted. But that would not mitigate the moral responsibility of those who supported it. Members of Congress vote on a lot of inconsequential bills and bills that have a small impact on limited areas of American life. But this is one of the most critical moments in recent American political history. The Republican health-care bill is an act of monstrous cruelty. It should stain those who supported it to the end of their days.



The cliché about Republicans is that they’re heartless and cold and don’t care about the weak and the poor and the defenseless. And today, in passing this abomination of a health-care act, Republicans in the House of Representatives proved that life is simple and the cliché is true.

But wait—they’re proving even more than that. Because the legislation they passed won’t merely hurt the weak and poor and defenseless. It’s going to hurt plenty of middle-class people, plenty of people they’d call good, normal Americans; people who voted for them

But that last clause describes a Republican Party of 30 years ago. Today’s GOP has been completely overtaken by rage at the people Republicans feel aren’t pulling their weight. So much so that sick people are now basically seen as Moochers — it’s their fault for getting sick.

The Mo Brooks quote above is one example of this thinking, but there are numerous others, most famously from Speaker Ryan himself, who called it “the fatal conceit” of Obamacare that healthy people have to pay for sick people.

Fatal conceit?! That’s insurance!! Healthy people pay for sick people. ..

There are things wrong with Obamacare, and there ways to fix those things if people want to in good faith. But that’s not what this Republican Party wants to do. It wants to punish people. I’m sure a lot of them don’t really think this way; certainly not in their personal lives, when a loved one or friend gets sick. But they legislate this way.

And for the rest of us, that is all that matters.

Seth Masket on why this may actually be a logical vote for GOP members by worrying more about primary challenges than the general.  Oh, I sooooo hope they are wrong.  But we’ll just have to wait and see.  Whatever actually happens on this, Democrats just need to pound and pound and pound on the message of this abomination of a bill for the next 18 months.

Meanwhile, Ezra writes about the health care hot potato that led to Republicans passing this.

Yglesias points out that Trump basically lied about everything in the bill.  But who cares I guess.  And a longer Yglesias on how the law just breaks promise after promise after promise Republicans have made.  But that’s okay, they’ll just keep brazenly lying and Fox and Rush et al., will just keep pretending otherwise.

Photo of the day

Pretty cool Atlantic gallery of photos of the earth and moon together:

Earth and the far side of the moon on July 5, 2016, also featuring Typhoon Nepartak over the Pacific Ocean, imaged by NASA’s Deep Space Climate Observatory (DSCOVR) satellite, about 1.5 million km (930,000 mi) from Earth,.


Republican health care: a summary

Love the bullet points from Drum:

With that in mind, let’s do a quick wrap-up of the bill:

  • There have been no public hearings.
  • There’s no final text.
  • There’s no updated CBO score.
  • It is opposed by virtually every patient advocacy group and everyone in the health care industry.
  • Congress is still exempted from the new rules that allow states to waive essential benefits.
  • It raises premiums dramatically for older people.
  • It removes Obamacare’s protection against being turned down for a pre-existing condition.
  • It would steadily gut Medicaid spending for the very poorest.
  • It removes coverage from at least 24 million people, probably more.
  • It slashes taxes on the rich by about a trillion dollars over ten years.

This is a depraved piece of legislation. It’s a windfall for the rich and promises nothing but misery for the poor. How is it possible that 90 percent of House Republicans are happily voting in favor of this moral abomination?

Again, highly unlikely that most of these provisions ever become law, but damn if this doesn’t say something really, really damning about the Republican Party.

The process

All the headlines say Republicans have the votes.  Again, just insane what incredibly bad policy they are willing to support.  And those who presumably know better are voting for it over $8 billion, which is just a tiny fraction of what’s needed.  And, the process, my God, the process.  Chait:

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.

All so Trump can get a “win.”  And, again, as for the bill:

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.

Of course, a reminder, it’s impact on people’s lives can fairly well be predicted:

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.

Particularly enjoyed this tweet from Yglesias:


Why are Republicans about to pass such a bad health care bill

Okay, first we’ve got to see if it actually passes, but if they do, why vote for something so demonstrably stupid.  Yglesias:

Republicans’ basic problem on health care is simple: They want to substantially reduce the amount of money the federal government spends on providing people with health care so they can free up cash for a tax cut on the rich — but cutting taxes on the rich is unpopular, and providing people with health insurance is popular. Consequently, the GOP has chosen to spend years running against the Affordable Care Act on the false premise that Republicans want to replace it with higher-quality health plans

In reality, everything in the various versions of the AHCA points in the opposition direction. Millions of people will lose Medicaid coverage. The health insurance industry will face laxer regulation and be able to offer skimpier plans. Spending on subsidies will fall, so patients will face higher out-of-pocket costs. And in turn, Republicans will be able to roll back Obamacare’s tax increases.

The bill has changed through fig leafs, not improvements

In a big-picture sense, that’s why the original AHCA failed.

And nothing that’s changed since then addresses the basic dissonance. Instead, House leadership has run around chasing votes through a series of epicycles that avoid the core point:

  • They got the Freedom Caucus on board by adding provisions that would gut Affordable Care Act consumer protections, thus making the bill even more of an unpopular deregulation machine.
  • Then they assuaged nervous vulnerable members by changing that into a provision that would allow state governments to waive the consumer protections, thus allowing moderates to tell themselves that patients were still taken care of.
  • When that wasn’t good enough, they offered Rep. Fred Upton (R-MI) an $8 billion boost in funding for high-risk pools to take care of people with preexisting conditions. Nobody thinks that’s remotely enough money to actually solve the problem, but it allows Upton to say he got changes made to the bill to address the problem.

This is the point at which normal legislators acting in good faith would stop and wait for a new CBO analysis of the bill.

What’s weird is how the “moderate” Republicans have seemingly been convinced to vote for a catastrophically bad, which is slightly less catastrophically bad because of $8 billion.  Dylan Scott:

So the Upton amendment pushes even more funding — $8 billion over five years — toward those costs. It is an addition to the $100 billion-plus fund originally included in the bill for states to create programs that reduce insurance costs.

The new money is designated specifically for states that seek a waiver under AHCA and for people in those states who would see higher insurance premiums or out-of-pocket costs because of that waiver.

States could use the money to pay insurers directly to keep costs down, to help people buy insurance in the high-risk pool, or to provide direct subsidies for people to buy their own insurance, Larry Levitt at the Kaiser Family Foundation told me.

But, Levitt said, “There is still nothing in the bill that guarantees people with pre-existing conditions will have access to affordable coverage if states waive community rating.”

The problem is that the bill neither specifies how the money should be spent nor provides enough of that money, Levitt said. People in states with the AHCA waivers could see “massive premium increases,” he told me: “There’s no way a reinsurance program or direct subsidies could ever fully offset that for everyone, and states aren’t required to do so.” [emphasis mine]

As for high-risk pools, which Vox’s Sarah Kliff explained here, Levitt said the funding is “inadequate” and “there are no requirements for what the eligibility, premiums, or benefits in high-risk pools would have to be.”

It seems, that this is mostly about certain Republicans being able to say that it preserves the almost-universally-loved (by all but the Freedom Caucus types) protection for people with pre-existing conditions.  The reality– it simply doesn’t.  No matter how much Paul Ryan and Fox News might argue otherwise.  For millions and millions of Americans this would represent a genuine health care disaster.

My theory for the “moderate” Republicans?  They are so phenomenally ignorant on health care policy by living in the Republican policy bubble for so long that they truly do not understand the issue at all and have managed to be convinced by a few charlatans within their own caucus that this actually solves the problem.

I honestly think if this somehow became law it would be a political disaster for Republicans.  The attack ads practically write themselves.  But I sure as hell hope it never comes to that, because those attack ads depend upon real people’s lives being ruined.  Thus, let’s just hope the Republicans don’t actually have the votes because all though the Senate looks doubtful, there are no sure things in politics, as Trump reminds us every day.

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