Thanks to three Republican heroes—and 48 Democratic ones—the health of the American people is a lot more secure than it looked like at a few minutes after midnight on Friday morning. Nevertheless, the past week has demonstrated something very important, albeit something not especially surprising. On health care, both in terms of the process they followed, and the outcome for which they aimed, most of the Republican Senate caucus should be ashamed of itself. They aren’t, but they should be.
Republicans spent years railing about the way Democrats passed the Affordable Care Act in 2009-10. The reality is that the year-long legislative path to Obamacare passage included multiple public hearings; a bill brought up through appropriate committees and through regular order; serious, if ultimately fruitless negotiations with members of the minority party—who, with hindsight, appear unlikely to have been willing to vote yes no matter what Democrats gave them; as well as not only consideration but adoption of GOP amendments: 188 Republican amendments were adopted into the ACA, as were another 17 amendments of bipartisan origin.
With Republicans in charge now, the count of amendments adopted that were offered by the minority party on health care is zero. Also, don’t forget that the core principle around which Obamacare is built is a conservative idea—working through private insurance and mandating coverage so that people cannot simply sign up after they get sick.
Finally, the American people elected 60 Democratic senators and a huge House majority in 2008, as well as a president who won an actual landslide and campaigned on passing national health care reform. Republicans today have no such mandate. Donald Trump lost the popular vote by three million.
This time, Mitch McConnell and his leadership team operated in a way that makes their complaints about what Democrats did seven years ago look ridiculous, at least to any objective, reality-based observer.
Let’s look at what McConnell & Co. did last week. They voted to begin debate on a measure—the Better Care Reconciliation Act (BCRA)—that was developed by a select, all-male group of senators, without conducting a single hearing and without going through the committee process. John McCain flew back from cancer treatment, spoke out against this process, but then cast a deciding vote in favor of moving forward with the process he condemned—and was called a hypocrite for doing so. I have to say that, at the time, I thought the same thing. He even subsequently voted for the BCRA, although at least he voted against a straight repeal of the ACA—and both measures failed.
Recently I wrote about another example where McCain resisted the trend in his party. I noted that I nonetheless disagreed with him most of the time. That’s still true, but if his ultimate legacy includes being one of the people who helped kill Obamacare repeal, that’s an awfully large plus mark on his ledger.
Back to the Senate floor. What came next? That's where it got even more sickening. The only measure left that kept alive McConnell’s chances of passing a law, any law, was the so-called “skinny repeal.” This proposal would have repealed the Obamacare mandate that requires individuals to purchase insurance or pay a penalty, and would have delayed for eight years the mandate that larger employers must provide coverage or face a penalty. It would have also defunded Planned Parenthood—shifting some funds to Community Health Centers—as well as cut funding to the Centers for Disease Control and Prevention (CDC), offered a tax break to upper-income households via expanded Health Savings Accounts, and let states weaken regulations that prevent insurance companies from offering junk insurance—the kind that doesn’t cover essential benefits and that doesn’t cap out-of-pocket spending by consumers.
The skinny on this proposal is that Republican senators never actually wanted it to become law. That’s how cynical and duplicitous they are. 49 out of 52 of them voted to pass it anyway. Mind you, their goal was not necessarily passing the right law, or even a law that will, for example, improve the health care of Americans. They just wanted something.
This skinny repeal would’ve been a disaster, as J.B. Silvers, a professor of health care finance, explained here. According to Congressional Budget Office estimates, this proposal would have resulted in 16 million fewer Americans having health insurance.
The problem for McConnell was that he needed the Senate to pass something in order to set up a House-Senate conference, at which point some kind of compromise was supposed to be hammered out between whatever the Senate passed and the truly awful House bill passed this spring. Such a compromise, called a “conference report,” must be voted on without amendments and, in cases where the report derived from a reconciliation bill—as it would’ve in this case—cannot be filibustered. In other words, it just needs 50 votes in the Senate, up or down.
However, on Thursday, the House GOP leadership told its members to keep their schedules flexible and be prepared for a quick vote at any point in the coming days. Majority Leader Kevin McCarthy (R-CA) wrote the following in an email to his fellow Republicans:
While last votes are currently scheduled to take place tomorrow, Members are advised that — pending Senate action on health care — the House schedule is subject to change. All Members should remain flexible in their travel plans over the next few days.
House Republicans were also reported to be planning the implementation of so-called “martial law” on the House floor, something that would have made it procedurally possible to ram something through very quickly. Furthermore, Rep. Chris Collins (R-NY), a noted Trump ally, called the Senate’s skinny bill “better than nothing,” and added: “It becomes a binary choice. If it’s this or nothing, who wants to go home and say I did nothing?” And if it came to that choice, Trump himself may well have put pressure on House Republicans to vote yes, in order to give him anything he could claim was a victory on Obamacare repeal.
In the end, despite the very real evidence that the House might just pass the skinny repeal, 48 Republican Senators voted for it anyway. Sen. Lindsay Graham voted yes even after he called it “terrible policy and horrible politics” as well as a “disaster” and a “fraud.” Graham apparently was satisfied after House Speaker Paul Ryan made a vague statement saying that the House would go to conference but which, crucially, refused to rule out ultimately passing the skinny bill if the conference report failed to pass the Senate. Ryan’s statement wasn’t enough for McCain and he, joining Collins and Murkowski—who faced down a disgusting threat from Trump’s henchman, Interior Secretary Ryan Zinke, regarding funding for her state—voted no. McCain walked up to the desk where the clerk was recording the vote, and gave the thumbs down sign like a Roman emperor condemning a defeated gladiator to death. If you haven’t seen it, watch the video below, the gasps are audible and, yes, wonderful to hear. They are the sound of victory.
What do the American people want? Support for single-payer, government-provided health insurance continues to rise, and both single-payer and Obamacare are much more popular than either the bill passed by the Republican House or the Senate’s failed BCRA proposal. The problems with Obamacare can be fixed, but not by repealing it, and not by a process that shuts out Democratic input.
To those of you who called and urged Senators McCain, Murkowski, and Collins to vote no, kudos to you. Same goes to those who made sure our Democratic senators knew where their constituents stood on Trumpcare.
We need to keep fighting as hard as we can, and to educate as many people as we can, so that we can get our message through, because Zombie Trumpcare could rise again. It has been prematurely declared dead many times before. Republican-only health care reform would be a disaster, it would ruin lives, make people sicker, and, yes, lead to deaths that could have been avoided. Would that, finally, make Republicans who voted for such a law ashamed? Despite last week’s victory, we must keep working to make sure we never have to find out.