Speaker Paul Ryan has scheduled the American Health Care Act (AHCA) for a vote in the full House on Thursday. Passing the bill through the House will be difficult, and through the Senate even more so.
The AHCA does not repeal Obamacare, which Congress voted to do only 14 months ago and Republicans spent the last seven years promising. The present bill, offered a mere two weeks ago and hustled through committees without time to fully consider its implications, is typical of the top-down, take-it-or-leave-it legislative blackmail characteristic of so many ill-considered attempts at lawmaking. In the unlikely event it is signed into law, it may well become a new “read-my-lips” broken pledge, an anchor around the president’s and Congress’s hold on power.
Donald Trump’s presidential nomination was as much a rebuke to the Republican Party as his general election was to the Washington establishment, yet Ryan and the legislative leadership of the party seem to have taken no notice.
They still believe the proper method of governing is to huddle in a back room with a handful of lobbyists and craft complex legislation in secret before springing it on their members in a hail of empty promises and naked threats. This type of “pass-it-to-find-out-what’s-in-it” mentality birthed Obamacare, and almost passed comprehensive immigration reform. It is the reason the conservative base increasingly despises their party.
Ryan’s AHCA retains 10 of 12 major mandates Obamacare placed on insurance companies. The primary mandate is requiring that insurance companies not penalize people for pre-existing conditions. While that sounds like a lovely idea, it enables people to put off buying insurance until they get sick, thereby destroying the whole idea of insurance and driving prices through the roof. To help pay for the costs Obamacare created and the AHCA continues, the bill changes Obamacare subsidies into tax credits, which are available even if one doesn’t pay income taxes.
The Death Spiral Under New Management
The AHCA eliminates the individual mandate to buy insurance, but allows insurance companies to charge an extra 30 percent to people who allow coverage to lapse. This 30 percent is an implicit penalty for pre-existing conditions, but it is a pittance compared with what the coverage will actually cost, which will be made up by charging others more, causing them to drop their coverage.
At least requiring everyone to sign up, while constitutionally loathsome, made sense given the mandate to cover pre-existing conditions, but the AHCA doesn’t do that and thus is likely to accelerate the death spiral of healthy people dropping coverage. If this argument seems familiar, it is because the Republican Party has been making it for the past seven years, but now seems inexplicably eager to switch sides on a winning issue.
The bill does a few admirable things like eliminating most of the Obamacare taxes, although where the GOP will find the money for their new tax-credit entitlement remains a mystery. The president and Republican leaders of Congress maintain that the real reform will take place in phases two and three, but they will suffer the same problem they face in repealing Obamacare in toto, namely an almost certain filibuster by Democrats in the Senate.
Subsequent phases of reform may be politically advantageous by highlighting Democrat intransigence, but they will not become law. Besides, what difference would buying insurance across state lines make if every state held onerous Obamacare—now GOP-approved—mandates? The entire idea of interstate competition is to avoid mandate-heavy states like New York and California.
Obamacare requires insurance companies to charge older people no more than three times what they charge younger people. The GOP plan allows them to charge five times more, which may be an improvement, but is still a loser for the young and healthy, who will have to pay more in transfer payments to the elderly, the richest and most entitlement-fattened age cohort.
President Trump appears less than enthusiastic about Ryan-care, although he is actively fighting for it. He understands that defeat on this issue would cause his ratings to plunge in the short term. The president has said that “everybody’s got to be covered” while exhausting the thesaurus for words to denounce Obamacare. Does the president, and do members of Congress, understand that Ryan has drawn up the adoption papers for this socialist monstrosity?
It Is Not As Though Other Options Don’t Exist
While the Senate is aghast at the idea of eliminating the filibuster, Democrats just changed the rules to exclude judicial nominees. The filibuster has prevented passage of horrendous legislation, but the type of laws needed to save the country from the coming financial implosion from entitlements will not be passed with Democrat votes, nor with the assistance of the likes of Susan Collins, et al. Retaining the filibuster equals keeping our socialist entitlement state unchanged until death do us part.
The Affordable Care Act, a.k.a. Obamacare, is itself a budgetary disaster, worthy of repeal in full under the present rules of reconciliation. There is no particular reason to dissect its various tumors into what is and is not impactful on the budget whilst the cancer spreads. If Democrats can make an argument that not purchasing insurance is itself an economic act, surely the Republicans can legitimately argue that not repealing Obamacare is harmful to the budget.
Republicans Already Passed Obamacare’s Repeal
On January 8, 2016, President Obama vetoed a repeal of Obamacare’s budgetary provisions passed under reconciliation. Ryan said at the time, “Next year, if we’re sending this bill to a Republican president, it will get signed into law.” Presumably Ryan said “if” to mean “if I had a Republican president,” not “if I feel like holding another vote,” which apparently now he doesn’t.
Trump has indicated that he wants repeal and replace done simultaneously, but if replace is subject to filibuster and repeal is not, then you get what you can get. As a legislative matter, it would be a lot easier to pry off a few Democrat votes for a GOP bill with sweeteners from the old Obamacare legislation than without any Democrat ideas at all, while at the same time never removing them to begin with.
They don’t call Republicans the “Stupid Party” for nothing, and at no time has that ever been on better display than in the grotesque betrayal of their multi-year campaign promises presently under consideration. When George H. W. Bush broke his “read-my-lips-no-new-taxes” pledge, it cost him his re-election. What Trump, Ryan, and their lemmings in Congress are considering would be a thousand times worse.
Despite seven years, Republicans have not agreed on a proper replacement for Obamacare; perhaps they believed they’d never need to. It’s not as though Ryan actually helped get Trump elected. Republicans need to vote on full replacement in whatever form. Let the Democrats filibuster it, let the RINOs squeal and vote against it. Take another year, hold hearings—in public, please!—and get it right. The conservative base will understand. They’ve waited seven years. They can wait eight.
If Republicans pass this bill and take ownership of Obamacare, they will be annihilated.
