Repeal, Replace, Regurgitate

After several attempts to start this post, I need to give up on trying to be clever or intellectually rigorous, disciplined, or even organized in presentation. I’m just too disgusted and need to get it out of my system. The ongoing spectacle to repeal Obamacare and replace it with We-don’t-care is reaching it’s absurdly noxious climax this week. We are being treated to one of the most nauseating demonstrations of legislative sausage-making I can imagine. Repeal, Replace, Regurgitate.

It looks very possible that an $8 billion ruse is going to persuade enough moderate (what the hell does that mean here?) Republicans to vote for the House bill to pass it.

How did we get here?

After sixty-some safe and symbolic votes over the years to repeal the Affordable Care Act, someone threw the House Republicans a curve in November and delivered all three Houses– Representatives, Senate, White– and a mandate to do it for real. Several problems presented themselves early on.

Republicans, including Trump, had done a smashing job of convincing their base that Obamacare was evil, awful, and a disaster. So much so that a large percentage of those voters entered 2017 not realizing that the health care they had and counted on actually is Obamacare. Once that began to sink in, views on health care became a little less partisan for real people. They liked and needed what it provided.

The new President had been promising for months that he was going to replace it with something better. He had a plan and it was great. Ready any day now. No such plan existed.

Republicans had been saying or implying the same thing for years. But, sorry, no such plan existed.

It turns out that the only thing that has been uniting Congressional Republicans on health care is the political strategy of opposing Obamacare. When it comes to providing health care, their enthusiasm wanes and is scattered all over the map.

Folks like Ryan and his cohort want mostly to get government out of health care and any other entitlement program ASAP. If they could privatize completely, they gladly would but see the need to proceed cautiously. The Freedom Caucus has similar goals but has little interest in compromising or being cautious, even within the party. The so-called moderates see some value in providing actual health care, whether they are motivated politically or sincerely.

So, when the House came up with their first bill, you’ll remember that the Congressional Budget Office scored it and determined 24 million Americans would lose insurance by 2027. Premiums would be 15-20% higher for the first couple years, then about 10% lower by 2026. Medicaid reductions would account for many of the people thrown off care. Tax cuts would result for wealthier people and businesses.

That wasn’t painful enough for the Freedom Caucus, so they voted against and scuttled it.

Recently, with both Trump and the House under extreme pressure to deliver on their promise to repeal Obamacare (or something sorta kinda like a repeal that they can sell), a deal was struck with the hard right members. Several of the popular features of Obamacare– e.g. no refusal or penalty for pre-existing conditions, a list of required provisions for all plans– can now be eliminated by states with a waiver. The states would be required to have a high-risk pool for people who have pre-existing conditions. It is widely understood that these high-risk pools almost always run out of subsidies, resulting in skyrocketing premiums and loss of insurance.

A particularly sensitive and touching explanation for the removal of the guarantee of affordable coverage for families with pre-existing conditions was given by Rep. Mo Brooks (R-AL), who said these people will “contribute more to the insurance pool that helps offset all these costs, thereby reducing the costs to those people who lead good lives, they’re healthy, they’ve done the things to keep their bodies healthy. Right now, those are the people have done things the right way that are seeing their costs skyrocket.”

Contrast that remarkable statement with the one made a couple nights ago by Jimmy Kimmel. If you haven’t watched it, you should.

So, today a couple of the so-called moderates came up with an amendment to the bill that would add $8 billion over 5 years to supplement the insurance of people with pre-existing conditions. That is vastly less than the amount that will be required if, no, when many Red states choose to exempt themselves from full coverage for their people, which is inevitable perhaps for most states since the bill also calls for cutting and then limiting (block granting) money for Medicaid and for subsidies.

Conjecture is that this bandaid could be enough to assuage the consciences of a handful of legislators, enough to pass the bill on to the Senate.

What a hollow victory that would be. What a repulsive accomplishment.