What House Republicans did yesterday was utterly unconscionable. Without bothering to wait for an official CBO estimate of what it would cost or how many would lose coverage from it, they passed a health care bill that eviscerates Medicaid, dramatically reduces subsidies for rural, older, poorer, and sicker Americans, bars Medicaid reimbursements to Planned Parenthood, and, thanks to the final revisions that allowed its passage, allows states to return to the wild west of preexisting conditions and inadequate health plans. The CBO estimate on the previous version of the bill said it would cause at least 24 million Americans to lose health insurance coverage, and the final revisions can’t have made those numbers any better. Nevertheless, they passed it. With Bruce Poliquin’s help.
A main reason the bill is so terrible as health policy is that it’s really a tax cut bill disguised as a health care bill; it directly transfers $1 trillion from health care funds to the wealthy, and–thanks to a complicated Paul Ryan scheme–would allow even more massive tax cuts for the wealthy and corporations to be made permanently. The main reason the bill has been so rushed is that it needs to pass through the 2017 budget reconciliation process, which reports suggest can’t really be dragged out beyond the summer, and is holding up the tax cut bill, meant to be passed later in the year as the 2018 budget reconciliation bill. This, combined with Trump’s personal interest in getting the bill passed so they can move on to tax cuts, means that there will be intense pressure on McConnell to get a Trumpcare bill passed soon. The good news is that reconciliation rules require bills to get CBO scores before they’re voted on, so McConnell won’t be able to ram a bill through anywhere near as quickly as just happened in the House.
Early signs are that McConnell is looking for Senate Republicans to put together their own, somewhat less awful, Trumpcare bill that is conservative enough to pass the House. He’s assembled a working group of 13 Senators to draw up a Senate bill, but since he excluded Senators Collins and Cassidy–who are the only Senators that have been actively working on an ACA replacement bill and who sit on relevant committees (both on HELP and Cassidy also on Finance)–but included Cruz and Lee, who don’t sit on any of the three relevant committees but have close ties to the House Freedom Caucus and criticized the original Trumpcare bill from the right, it seems his plan is to get 50 votes by keeping the bill conservative enough for Cruz/Lee/Paul, risking the loss of Collins and one other moderate Republican. To become law, any bill that passes the Senate will either need to pass the House unchanged, or be negotiated in conference with the House, so a Senate bill negotiated to please Cruz & Lee would be much likelier to pass the House become law than a more moderate one negotiated with Collins. It seems likely she will ultimately be cut out of the process.
Senator Collins issued a statement soon after the bill’s passage in the House outlining several specific areas of concern, and a general principle that any reform should expand access to affordable health care. With the House version of Trumpcare being so unbelievably awful, there is a risk that a somewhat less awful Senate bill causing, say, only 10 million people to lose coverage, could be hailed as a great compromise that increases coverage. We need to push Collins to insist that any ACA replacement result in an increase in coverage from the ACA status quo, as determined by the CBO. If she takes that clear stand, it will help frame the issue for the media and for her colleagues, making it more about policy outcomes and CBO estimates than about simply winning 50 votes.
Health care coverage is a matter of life and death for many. We need to demand that our elected officials treat it that way.
Thanks for all you do,