When the House Republican Conference gathered in Washington, D.C., on Thursday morning, it was greeted by a couple of motivational songs: “Eye of the Tiger” and “Taking Care of Business.” On Twitter, the A.P.’s Erica Werner also relayed the message that the Party’s leadership sent to the rank and file, which was equally lacking in subtlety: “It’s time to live or die by this day.”
A number of House Republicans, especially those from competitive districts, weren’t overly enthusiastic about fulfilling the health-care suicide pact that Paul Ryan, the House Speaker, was forcing on them. Ultimately, though, a number of countervailing factors won out: loyalty to the Party, eagerness to score a legislative win, hostility toward Barack Obama, free-market ideology, and a reluctance to antagonize wealthy G.O.P. donors. On Thursday afternoon, when it came time to vote on the American Health Care Act of 2017, only twenty Republicans broke ranks, allowing the bill to pass by the slightest of margins.
In the most immediate of terms—congressional whip counts—that was a victory for Ryan and his ally in the White House, Donald Trump. On their third attempt at passing an Obamacare-repeal measure, and after much drama and humiliation, the House Republicans had assembled a majority. But at what cost? The vote represented a moral travesty, a betrayal of millions of vulnerable Americans, and a political gift to the Democrats. And if it ultimately costs the House G.O.P. its majority in next year’s midterms, that would be a richly deserved outcome.
Ryan and his sidekick, the House Majority Leader Kevin McCarthy, pushed through a bill that, if it ever goes into effect, could upend one-sixth of the American economy and result in tens of millions of Americans losing their health coverage. Since the Republicans failed to give the Congressional Budget Office time to “score” the bill before voting on it, we don’t have any official estimates of its likely effects. But the bill that was passed on Thursday was an amended version of a bill that the C.B.O. had previously determined would raise the number of uninsured people by twenty-four million over ten years, and increase premiums for many others, particularly the old and the sick, as well.
In recent days, a lot of the media coverage was focussed on an amendment to the revised bill that allows individual states to seek a waiver from the Affordable Care Act stipulation that insurers have to cover people with preëxisting conditions. This is a truly hideous feature of the legislation, and a last-minute amendment addressing this issue—intended to convince the Republican congressman Fred Upton to support the legislation—was merely a fig leaf to cover it.
Upton secured eight billion dollars in additional funding for “high-risk pools” at the state level, which would cover people with serious illnesses. But, even with the extra Upton money, these pools would be grossly underfunded, and would leave many sick people without coverage—more than eight hundred thousand, according to one analysis. And that wouldn’t be all. If a seriously ill person did find an insurer, he or she could well face prohibitively high premiums. Many states operated high-risk pools before Obamacare went into effect, and the premiums were often set at fifty or a hundred per cent above the going market rate.
In jettisoning the principle that everybody, regardless of age or health, should be legally entitled to purchase insurance coverage, the House Republicans did something truly awful. The bill would give insurers a lot more leeway to charge higher premiums to old people. Many people in their sixties would see their premiums rise by thousands of dollars; some could see their premiums double. And, even then, they wouldn’t necessarily be getting the same level of coverage that they currently receive. The bill would allow states to opt out of providing all the benefits and treatments that were listed as “essential” under the Affordable Care Act.
On top of all this is another huge issue, which I’ve pointed to before. The bill passed on Thursday includes a substantial tax cut for the rich, financed by big cuts in Medicaid, the federal program that provides health care to the poor and indigent. Obamacare expanded Medicaid and CHIP, the children’s version of the program, and, to pay for these and other provisions, the law imposed a tax of 3.8 per cent on the investment incomes of wealthy households and a 0.9-per-cent surtax on their ordinary incomes. That money has helped sixteen million struggling Americans, many of them kids, obtain health coverage since the start of 2014.
The House bill eliminates the Obamacare taxes, reverses the Medicaid expansion, and converts the financing of the program from a per-capita subsidy to a block-grant system. What impact would this have? Since the treatment of Medicaid in the bill that passed is basically unchanged from the original version, we can rely on the C.B.O.’s analysis, which showed that, over ten years, spending on Medicaid would be reduced by almost nine hundred billion dollars. Of the roughly twenty-four million people the C.B.O. estimated would lose their health coverage under the original version of the bill, fourteen million were Medicaid recipients.
In short, the bill the House just passed is one of the most regressive pieces of legislation in living memory. When Republicans cut taxes on the rich and slash funding for programs aimed at the poor, they usually go to great lengths to argue that the two things are unconnected. But in this instance they have done away with the subterfuge. It’s reverse Robin Hood, in plain view.
Speaking on the House floor just before the bill passed, Ryan thanked Trump for his “steadfast leadership” in supporting the legislation. He also said, “This bill delivers on the promises that we have made to the American people.” It does nothing of the sort, of course; it merely passes the buck to the Senate, where the bill faces an uncertain future.
It’s fair to assume that even some of the Republicans who voted for Ryan’s legislation on Thursday will be fervently hoping that their colleagues in the Senate take the bill and bury it in a very deep hole. Should that happen, though, the Democrats will be sure to dig it up in time for next year’s midterm elections. Speaking shortly before Thursday’s vote, Nancy Pelosi, the House Minority Leader, singled out Republicans from swing districts and said, “They have this vote tattooed on them. This is a scar they will carry.” And a horrible, ugly scar it is, too.
