House Republican leaders feel so good about their bill to repeal and replace the Affordable Care Act that they’re trying to hide it from public scrutiny until the last possible minute.
Bloomberg Politics and the Washington Examiner on Wednesday reported that GOP leaders are putting the finishing touches on the legislation, and are ready to show their colleagues what it’s going to look like. Nothing is quite final, but the tentative plan is to have the House Energy and Commerce Committee, one of three House panels with jurisdiction, consider the proposal next Wednesday. If the committee signs off, it would be a major step toward legislation passing in the full House ― and, eventually, enactment of a law wiping the 2010 health care law off the books.
For now, according to Bloomberg, leaders are planning to make the bill available only to committee members, who will have to view a printout in a dedicated reading room. No copies will be allowed out of the room.
Committee rules call for making legislation public no less than three calendar days before hearings, which means that Republicans will have to post a version by 11:59 p.m. on Monday if they want markup to start sometime on Wednesday. But Rep. Chris Collins (R-N.Y.), who sits on the committee, told Bloomberg that the vote might take place before the Congressional Budget Office and Joint Committee on Taxation get a chance to produce formal estimates of the bill’s effects on insurance coverage and the federal budget.
“It looks like, unfortunately, based on the delays, we may be marking it up and voting on it before we have a score,” Collins said.
“Unfortunate” ― that’s one way to put it. More than 20 million people now depend on the Affordable Care Act for coverage. Many more people are affected by regulations or taxes that the law introduced. “It seems unconscionable to vote to strip away health care insurance for twenty million people without knowing how many would (or wouldn’t) be covered under a new GOP plan,” Sarah Binder, a George Washington University professor and expert on Congress, told The Huffington Post in an email. Norm Ornstein, a political scientist at the American Enterprise Institute, suggested that marking up legislation without those formal assessments would be “reckless, dangerous, and irresponsible.”
Not to mention ironic. Conservative mythology holds that Democrats wrote the Affordable Care Act in secret, ramming it through Congress before anybody understood what was in it ― even though in reality, Democrats spent over a year litigating their proposal through committee hearings and floor debates, with CBO and JCT analyzing proposals every step of the way. Just this week, House Speaker Paul Ryan (R-Wis.) said, while appearing on NBC’s “Today” show, that “we’re not writing some bill in the back room... like Obamacare was written.”
Republicans may have good reason to keep their plans under wraps for as long as possible. For seven years, they’ve been saying they could come up with an alternative to the law that would cover as many or more people, with better insurance, all at lower cost. But an earlier, draft version of the legislation that leaked to Politico a week ago offered a glimpse of what they actually have in mind.
That bill called for rescinding the law’s expansion of Medicaid eligibility, and then transforming the whole program so that the federal government would no longer guarantee a level of insurance benefits for every person who qualifies. The proposal would have continued to make financial assistance available to people who buy private coverage on their own ― but, critically, it would have delivered the assistance in a different way, with aid shifting away from the poor and the old and toward the rich and the young. Amid all of this, the bill would have rolled back regulations designed to make insurance plans more comprehensive and more widely available.
A series of assessments of the proposal and its predecessors all yielded the same conclusion. Some people would be better off, primarily because they’d get new tax breaks or lower insurance premiums ― assuming they were healthy enough not to worry about medical bills. But many millions who now have coverage would lose it, and even many of the people whose premiums would fall would end up facing substantially higher out-of-pocket expenses.
An argument between conservatives and extreme conservatives, over whether a bill stripping health insurance from millions of people goes far enough.
One finding in particular might help clarify what exactly Republicans are proposing to do. It comes from a study by economist Linda Blumberg, a senior fellow at the Urban Institute. Using an earlier version of Republican legislation, Blumberg decided to figure out what kind of insurance a low-income person using the new Republican tax credits could actually buy on the market, assuming that person had no extra money for premiums. She found that, among the oldest consumers buying plans, the tax credits in the bill could pay for only a very skimpy policy ― one that, for a single person, came with a deductible of $25,000, covered only generic drugs and excluded such services as mental health and rehabilitative services.
It’s an extreme example, and the bill that Blumberg analyzed was less generous than the one that got all the attention last week. But, tellingly, that new bill provoked protests from leaders of the House Freedom Caucus and Republican Study Committee ― not because its assistance was inadequate but because, in their view, it was too generous. In particular, these Republicans were upset that the financial aid in the proposal came in the form of refundable credits, which means people too poor to pay income taxes still would get the money.
Several of these House Republicans, along with some allies in the Senate, vowed to vote against any bill with refundable credits. This has been the major legislative drama of the past few days, and it’s anybody’s guess whether the hard-liners are serious about blocking leadership’s bill ― even if that means blowing up the whole repeal effort ― or whether they’re merely posturing in order to please their supporters, and perhaps gain leverage for future negotiations. The new bill presumably takes into account the conservative objections, one way or another.
Regardless, it’s worth recognizing just where on the political spectrum this debate is now happening. It’s an argument between between conservatives and extreme conservatives, over whether a proposal that would strip health insurance from millions of Americans goes far enough.
But neither side’s vision sounds a lot like “better health care,” which is what President Donald Trump and many GOP leaders have been promising they would deliver.
Clarification: Language has been amended to more accurately reflect Bloomberg’s report on plans for legislators to view the bill.
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