I’ve always hated the name “American Health Care Act.” What is its purpose exactly? To imply that only GOP efforts at enriching big insurance companies are patriotic, while Democrats are after something more Guatemalan or Bulgarian? “American Health Care Act”—it calls to mind Jim Dixon’s contempt for the title of his academic paper in Kingsley Amis’s novel “Lucky Jim”: “His thinking all this without having defiled and set fire to the typescript only made him appear to himself as more of a hypocrite and fool.”
Yet that four-word euphemism is all we’ve had to go on over the last month, as Senate Republicans announced that everything else in the House bill was up for strip-mining and began crafting their own version in hermetic secrecy. Those who were snubbed, like Rand Paul, set about playing Washington’s favorite new game “Where in the World is the Republican Health Care Bill?” and at one point their gumshoeing took them all the way to Moscow. “I’m sure the Russians have been able to hack in and gotten most of it,” said one lawmaker of the Senate draft, and because that lawmaker was John McCain, no one was sure whether he was joking.
At any rate, the chase is now over. Senate Republicans on Thursday unveiled their creation, the Better Care Reconciliation Act, from the vaguely patriotic to the vaguely clinical. As with the House version, it rolls back the individual mandates but doesn’t compensate with other cost-cutting measures. So the threat of a death spiral still beckons. Without the mandates, younger and healthier consumers will turn their backs on the exchanges, while the old and sick remain trapped within as insurers depart and premiums continue to go up. The law does dedicate $50 billion for a “stabilization fund” to steady the exchanges but that dries up after four years and it’s unclear what happens next.
The GOP bill also halts the Medicaid expansion in 2021, repeals the employer mandate, and severs funding for Planned Parenthood. But the main innovation, as my co-worker Pat McMahon pointed out in a newsroom conversation earlier today, seems to be effectively turning the exchanges into high-risk pools and shifting some of the authority over them to the states. In other words, it both maintains the skeleton of Obamacare and seriously rearranges it.
Or at least that’s what I was able to glean after an hour of skimming over the language and perusing a couple explainers (still makes me more up to speed than Chuck Schumer). Realistically, it will take days for even the sharpest experts to read the 146 pages, cross-reference the changes with Obamacare and existing legislation, extrapolate the effects and recommend modifications. Mitch McConnell is giving them…until next Friday. That’s so lawmakers can skedaddle out of Washington before the tourists descend for the Fourth of July holiday. It’s also to truncate further criticism that could send the approval ratings of this project, currently at swine flu levels, plummeting to whatever is below that.
After years of complaining about how Obamacare was hatched with no transparency, Republicans have now produced a bill that was devised in secret, released in haste, and will be voted on before it can be digested. It calls to mind the Hillarycare efforts in 1993, conjured up behind closed doors by a clutch of shadowy technocrats with Vonnegut-esque names like “Ira Magaziner” who ultimately forfeited the support of the public. The GOP rightly complained back then, so why the secrecy-cum-urgency now? Given how royally Obamacare mucked up the health care market and how determined Republicans now seem to play a shell game with its mistakes rather than correct them, this deserves at least a little more time on the cooling saucer, doesn’t it?
As Autumn Price reported here at Rare, Senator Rand Paul recently introduced legislation aimed at allowing lawmakers to actually read bills before they’re voted on. Under its formula, a bill would have to gestate for one day per every 20 pages. That would have meant a glorious three months of delay for the 2016 NDAA; only a week for the Senate health legislation, but Paul does have another option here. If he can marshal two other Republican senators in opposition, he can snatch away McConnell’s majority and at the very least stall. And as we go to print he’s announcing that he already has the dissenters lined up. Do it Rockapella.