Huge Dilemma Or Another Distraction

The Republicans wheeled out their long awaited repeal and replace health care plan last week. As expected it certainly didn’t live up to their rhetoric. Is there another aspect at play? Let’s explore.

Despite seven years of complaining about how bad Obamacare was the Republicans were totally unprepared (as well as not unified) when they gained control of the White House while retaining both chambers of Congress in November. While Trump wasn’t really their guy he had campaigned on repeal and replace and would be likely to sign anything they passed. If they were truly organized the Republicans would have had a bill on his desk to sign on Day One. The reality is that as of Day One they didn’t even have a draft bill yet.

Over the last week or so we heard rumors of a small handful of Republicans crafting a bill in private. At one point Kentucky Republican Senator Rand Paul rather theatrically went searching for said legislation with a copy machine in tow. It appears that when he found the “secret room” where the draft legislation was housed he was denied access and the bill was clandestinely moved.

Monday the bill was introduced. On Wednesday it was taken up in both the House Ways and Means and the House Energy and Commerce Committees. After all night, marathon sessions the bill advance out of both Republican controlled committees. Interestingly the “fiscally conservative” Republicans took up the committee phase of the legislation before the Congressional Budget Office (CBO) had a chance to score the bill. Scoring primarily gives a non-partisan and objective estimate of a bill’s financial impact. In other words, how much it will cost. The other germane question is how many people it will negatively impact. The Brookings Institute estimates the number to be 15 million. Health and Human Services (HHS) Secretary Tom Price (in the words of a panelist on the program) did a lot of tap dancing but no answering when asked that specific question multiple times on Friday’s Morning Joe program.

The Republicans pitch is that individuals will be free to choose the plan they want. Without getting into a lot of the details, the problem will be in many cases they will not be able to afford it. To follow parallel reasoning I have access to purchase a Rolls Royce. I’m certain that if I went into a Rolls dealership (I assume they exist) that I would be treated politely. I’m a well-spoken, educated, older, white male with an appropriate haircut. However I don’t truly have access to a Rolls because I can’t come close to affording one. (Not even if I sold my iPhone.)

Paul Ryan called the new proposal, “An act of mercy.” His reasoning is that Obamacare is a disaster that is about to collapse under its own weight. Employment has continually increased under Obamacare which when being voted on the Republicans all called, “This job killing bill.” Under Obamacare more Americans (by raw numbers and percentage) have health care coverage than ever before. The cost curve (while still too steep in my mind) has been bent downward under Obamacare. By what measure is this collapsing or a failure? Many of Obamacare’s problems, (and even President Obama admits they exist), have been caused by Republican obstruction at both the federal and state levels.

The GOP plan would be more expensive for all but affluent young Americans and make health insurance prohibitively expensive for almost everyone else especially those in their fifties and sixties but not yet Medicare eligible.

Trumpcare is being opposed by almost every professional medical group because it would disrupt the payment system to the point that it would close hospitals and practices. The refusal to accept the Medicaid expansion provision in Obamacare has either caused or greatly contributed to the closing of many rural hospitals including the one in the North Carolina county I lived in until recently. Trumpcare would exponentially increase that problem. That would not only kill jobs; it would kill people.

The Democratic reaction has been both predictable and rather humorous. Senate Majority Leader Chuck Schumer said, “Trumpcare gives you less for more.” Maine Independent Senator Angus King (who caucuses with the Democrats) had two of the best lines. “Repeal and wreck.” Along with: “Shift and shaft.”

It has been far from smooth sailing on the GOP side. In the House the radical right wing wants a clean repeal of Obamacare and if they are willing to entertain the possibility of a replacement (which is somewhat doubtful) they want it to have absolutely no resemblance to Obamacare. The dilemma in that position is that most of the provisions of Obamacare are hugely popular with the American people including a lot of GOP and Trump supporters.

With the above sentence in mind, four Republican Senators, (Shelley Moore Capito of West Virginia, Cory Gardner of Colorado, Lisa Murkowski of Alaska and Rob Portman of Ohio), are already on record as supporting repeal but very concerned about the content of the replacement portion of the bill. Not coincidentally that all four come from states that have accepted Medicaid expansion under Obamacare and that is how a lot of their constituents receive their health care coverage. These Senators knows that if the bill ever passed as currently written a lot of their constituents (who in many cases voted for them) will lose their health coverage. If normal projections hold true the GOP can only afford to lose the votes of two Republican Senators and still pass this bill.

Having unconscionably rushed the bill ahead sans CBO scoring what do you think Trump and his defenders did? They launched a pre-emptive attack on the CBO and its credibility. Next I think they will attack perfect hearing and 20/20 vision. Why would I believe what I hear with my own (less than prefect ears) or see with my (corrective lens aided) eyes when I have the benefit of the Trump administration and friends’ alternate facts?

Now the political operative/analyst part of me takes over. To me neither the bill nor methodology employed makes sense. However there is a theory going around that does. It maintains that the bill was designed to fail. It dovetails with the theory that the only Republican priority in this Congress is to substantially lower taxes on the wealthiest Americans. Putting both theories together the Republicans rush a silly repeal and replace bill to Congress and let it fail. This gives them cover. They can say they tried to repeal it but just couldn’t get it done without leaving too many of their voters unprotected. They can then go on to deliver a return on investment for their largest and most important financiers by lowering their taxes. Quietly they are already at work dismantling regulations (another ultra-rich agenda).

Despite being one of the longest posts ever, this is far from a complete discussion of this topic. However, it could explain a few things.

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