The GOP-controlled House managed to pass its own slightly different version of Obamacare on Thursday by a narrow 217-213 vote, tweaking some regulatory provisions of the Affordable Care Act but largely leaving the law intact.
But that’s not what’s surprising about Thursday’s vote. House Republicans were never going to actually repeal Obamacare, despite what they promised repeatedly over the past seven years. Sure, they made some changes to the original version of their American Health Care Act, which they pulled in March for lack of support from conservative GOP lawmakers. But for the most part those changes won’t have much effect unless state legislatures actively request waivers to opt out of some (not all) of Obamacare’s health insurance regulations—then reapply for their waivers in ten years.
As passed, the bill does make some changes to Obamacare, the most significant of which is to Medicaid. The bill is designed to end Medicaid as an open-ended entitlement by putting per capita caps on federal funding, meaning the federal government would pay states a set amount for each enrollee. But the bill doesn’t freeze Obamacare’s Medicaid expansion until 2020, giving states a huge incentive to sign up as many people as possible in the meantime. (Medicaid, it should be noted, is the worse form of health coverage in America. Studies indicate it doesn’t improve health outcomes compared to the uninsured, but does incentivize patients to seek routine care in costly emergency rooms.)
The surprising thing about the Republican health care bill is that everyone, Right and Left, is treating it like it’s a big deal that changes everything. It’s not. It’s political theater, plain and simple. Republicans promised they would repeal and replace Obamacare, and now they’ve passed an anodyne bill, the bare minimum to be able to say that they repealed Obamacare, even though the ACHA does no such thing.
Yet on the Left, which shouldn’t have been surprised that House Republicans came back after their first stalled effort and managed to pass their bill, there was much wailing and rending of garments on Thursday—accusations that the GOP bill was a “death warrant for disabled children,” snap fundraising efforts to stop Republican lawmakers who “voted to destroy healthcare,” dark ruminations that the health care bill would become the GOP’s Iraq War, and of course promises from Democratic politicians to challenge the “disastrous and unconstitutional bill” in federal court.
House Democrats, laboring under the impression that the ACHA represents political suicide for House Republicans, idiotically sang “nah nah nah nah, nah nah nah nah, hey hey hey, goodbye” after the vote.
For their part, Republicans acted like they’d just saved America. At a big White House press conference after the vote, House Speaker Paul Ryan said there was still work to be done to get the bill signed into law, because “the issues are just too important. The stakes are just too high. The problems facing American families are real. And the problems facing American families as a result of Obamacare are just too dire and too urgent.”
He’s right about that, of course. Obamacare is driving up costs and many of the exchanges set up for individuals to purchase coverage are collapsing as insurers flee the individual market. So you’d think Ryan and the Republicans would have come up with a bill that did more than tweak Obamacare at the margins.
Of course, the fate of the House GOP’s reform effort is far from certain. President Trump, flanked by Vice President Mike Pence, Speaker Ryan, and a host of House Republicans, said he felt “so confident” that the bill would pass the Senate. Yet Senate Republicans said Thursday they won’t even vote on the House bill, but will write their own legislation instead. A 12-member working group has apparently been meeting for weeks and, according to Senate Majority Whip John Cornyn, there is “really no deadline” for the group to produce a bill. Even if the Senate Republicans pass their as-yet-unwritten bill, the two bills will have to go to conference committee, be reconciled, and then each chamber will have to vote again to pass the reconciliation bill.
Given all that, House Republicans would have been better off passing a one-page bill changing some random tax law then leaving it to the Senate to rewrite the shell bill and iron everything out in conference. It would’ve saved Republicans from unnecessary political pain and spared the American people all this political theater.