Senate Republicans are hurling themselves toward passing an incredibly unpopular set of health care reforms that even they don’t understand, haven’t seen and likely won’t see until just before it hits the floor.
This rightly has raised the hackles not only of Senate Democrats and the media, but anyone who values transparency in government or is anxious about the consequences of reordering the American health care system and taking away health coverage from millions of people.
But as important as the legislation’s details will turn out out to be, there’s a simple, fundamental, incontrovertible fact about whatever the Senate health care reform bill winds up looking like: The purpose of this bill is to dramatically scale back the safety net so wealthy people and health care companies can get a massive tax cut.
It’s the biggest open secret about the secret Senate health care bill.
That’s true of the House-passed version of the American Health Care Act, which the Congressional Budget Office projects would lead to 23 million fewer people being insured over the next decade, severely weaken protections for people with pre-existing conditions and put health coverage out of reach for older, sicker and poorer people who won’t be able to afford insurance or, in some cases, to even access it at any price.
Senate Majority Leader Mitch McConnell (R-Ky.) and his handpicked cohort of backroom negotiators are advancing a measure that will look pretty much like the House legislation and do pretty much the same thing. McConnell wants a vote before July 4, and he’ll probably get it if something doesn’t alter the trajectory. There’s little Democrats can do beyond try to slow Senate business to a crawl to draw out the process and keep health care in the public eye for as long as possible.
There’s been a lot of talk about the Senate “moderates” balking at the most regressive parts of the House bill and halfheartedly complaining about McConnell’s opaque process as though they’re powerless to influence it. But if the past behavior of so-called moderates can inform predictions about what they’ll do this time, the smart money’s on them giving in when push comes to shove.
Yes, the details are important, especially to anyone anxious about how this bill would affect their lives. But it’s not as though the Senate is proposing to increase assistance for people who don’t have the money to buy health insurance, or to provide targeted help for those whose premiums have risen beyond their means under the Affordable Care Act.
There’s no way McConnell unveils a bill that fixes what’s wrong with the health care system, a scenario that might prompt Senate Minority Leader Chuck Schumer (D-N.Y.) to join him in a duet of “I Got You Babe” on the Senate floor. There’s no way this ends with a new law that ensures people have access to decent, affordable health insurance and a safety net to catch them during hard times.
Whatever else the bill might be, it’s still an effort to repeal the Affordable Care Act because Republicans don’t believe rich people and corporations should have to pay so that poor, middle-income or sick people can go to the doctor.
The Affordable Care Act is an assertion of the opposite, that society has a collective responsibility for, and derives a mutual benefit from, promoting access to health care and providing the mechanism and the money to do so. The law hasn’t done everything it set out to do, and didn’t even attempt to achieve truly universal health care, but it still extended health coverage to about 20 million previously uninsured people and drove down to a historic low the share of the population without health coverage.
Whenever senators finish their secret dealmaking and the public has a bill to review ― if not stop it before Congress and President Donald Trump rush to make it law and have another party in the Rose Garden ― there’s not going to be much difference from the unloved House-passed bill no one seems to like. That includes Trump, who reportedly told senators he believes it to be “mean.”
The question isn’t whether GOP senators choose to preserve gains in coverage, but just how much of it they’re willing to take away.
We won’t be talking about senators from states that expanded Medicaid under the Affordable Care Act fighting to save it, but about how many years they want to wait before the Medicaid expansion disappears.
The senators aren’t going to retain the guarantee of coverage for people with pre-existing conditions, because they’ll relax other insurance regulations in a way making that moot. A promise that insurers have to offer coverage to, for example, a cancer patient is worthless if the insurance doesn’t have to cover cancer treatments or if there are annual and lifetime limits to an insurance policy’s benefits.
There may be Republican senators who aren’t ready to commit in public to supporting the health care bill, citing the opacity of McConnell’s process. But the rest of us already have enough information to make up our minds about it.