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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About Steve Greene
Professor of Political Science at NC State http://faculty.chass.ncsu.edu/shgreene

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

  1. Nicole K says:

    So if the house passes this there is still a slight chance of this clearing the Senate. If the Senate changes much the freedom caucus will torpedo final passage. Still this makes me nervous. I have zero confidence that the NC legislature would not pursue waivers if they are given the opportunity. My status as a nondisabled person is at risk.

  2. rgbact says:

    Liberals going crazy over the potential that a couple red states might elect to opt out of the community rating. Spreading lots of falsehoods. Seems like a big nothingburger.

    ACA is a fiscal disaster. This bill gets blue states off the free Medicaid gravy train. Good enough for me.

    • Nicole K says:

      Except for the fact that some people, including me, depend on community rating because we have expensive chronic illnesses. I remember the old insurance. There was no plan in the individual market that would pay for my current healthcare expenses. Not one plan. It did not exist. So what you call a nothingburger is pretty much my life as a healthy functioning member of society.

      You could at least try and look at things objectively every now and then.

  3. R. Jenrette says:

    This biggest lie of all is that Republicans are pro-life.
    What they mean by that is that if the mother harms the fetus by having an abortion, that’s awful and there should be a law with severe penalties against it. But if nature causes harm to to the fetus no one should be obliged to intervene unless the parents have the money to buy the necessary care.
    Also that once a child is born, he, his parents and his siblings are on their own.
    How shameful that the richest nation in the world voted for a regime that glorifies wealth, not life.

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