Republicans Aren't Even Bothering to Defend Their Health Care Bill on the Merits

That's why it might go down.



The main thing that the House GOP health care bill accomplished was to give Republicans a way to say they had a plan to repeal and replace Obamacare. The main thing the manager's amendment—a series of changes to the original bill released this week—does is to attempt to placate House Republicans opposed to the original bill, in hopes of creating a bill that can actually pass.

But the original bill doesn't really repeal and replace Obamacare. Similarly, the manager's amendment may not win over enough skeptical Republicans to pass in the House. The American Health Care Act (AHCA) is a bill that so far does not appear to accomplish its most basic political and policy goals.

Currently, there's a vote set for tomorrow, and both the White House and Republican leadership are making an all out push to get the bill over the finish line. But it remains an open question whether or not the bill will win majority support, and one of the reasons why is that its backers aren't really doing much to defend the bill on its merits. In the meantime, the vote looks like a major test of Donald Trump's ability to move legislative—and a potential moment of power for determined House conservatives.

The manager's amendment was loaded with provisions designed to win over the support of skeptical Republicans. The revision added incentives for states to implement Medicaid work requirements (which are structured in a way that provides little benefit to states), allowed states to apply for a flat Medicaid block grant, and pushed forward the elimination of Obamacare's taxes to repeal them retroactively for this year, among other things.

It even included a special provision designed to appeal to New York legislators by blocking the federal government from providing matching funds for dollars collected from New York county governments, which would effectively end a complicated and longstanding Medicaid payment game played by the New York's state government at the expense of county budgets. This was less a systemic reform and more a targeted provision focused on winning the support of a specific group of legislators—the sort of last-minute deal sweetener that gets thrown into a bill that might not survive a vote.

But right now, it looks like it might not be enough.

After the manager's amendment came out on Monday night, Rep. Justin Amash (R-Michigan) said that the Freedom Caucus, a group of conservative House legislators, had enough votes to stop the bill from passing. Rep. Mark Meadows (R-North Carolina), who leads the Freedom Caucus, concurred.

On Tuesday, Trump addressed House Republicans, urging them to support the bill and warning that those who refused risked losing their seats in 2018. Reports indicate he specifically called out Meadows for serving as the point person for Freedom Caucus opposition. ""I'm gonna come after you," Trump said to Meadows in the closed-door meeting, according to The Washington Post.

Yet despite Trump's direct appeal, Republicans still don't appear to have the 216 votes needed to pass the bill in the House. According to Politico, Meadows and others in the know say that there are still enough Freedom Caucus members opposed to the bill to sink it. A count from NBC News this morning confirms that House Republicans do not currently have enough votes to pass the bill.

It's always possible that the bill will pass on a tight vote, with a few no votes flipping to yes at the last minute. But part of what is remarkable about this situation is how uncertain it is with just a day to go. That a bill that supposedly fulfills the GOP's number one domestic policy priority—repealing and replacing Obamacare—for the last seven years might well not pass at all reveals just how little consensus there is around this legislation. (And, of course, even if the bill passes in the House, there is no guarantee it will pass in the Senate, where it can survive just three GOP defections, and where many of the worries about the bill come from the opposite direction of the House Freedom Caucus.)

Even more telling still is that Republican leadership is barely attempting to defend the legislation on its merits. There are basically three arguments for it at this point.

The first is that no Republican should want to block a rare opportunity to pass a bill that would repeal Obamacare. This is more or less the argument being made by House GOP leadership, and by people like Rep. Mo Brooks (R-Alabama), who says that the AHCA vote is a test that will demonstrate who is a true conservative. The problem with this argument is that it assumes that this is an effective repeal bill rather than actually making a case on its policy merits. (Among the reasons to be skeptical of this claim is that, at least according to the Congressional Budget Office, more Americans would be uninsured under this bill than under a straightforward, no-frills repeal.)

The second argument made for the House Republican bill is that Republicans who defect risk losing their seats. This is the argument made by President Trump. It is a purely political argument, one that says nothing about the merits of the policy itself. Indeed, it is unclear if Trump, who has never once described or even attempted to summarize the bill's main policy mechanisms, knows enough about how the bill works to make a policy argument in its favor.

Finally, there is the argument, made by Speaker of the House Paul Ryan, that the bill is a prerequisite for some hypothetical future tax reform legislation. (Last night, Trump made a version of this argument as well.) It is true that passing the health care bill through the reconciliation process now would make certain aspects of the tax reform process—namely permanent large tax cuts—easier later. But that is an argument for tax reform, not for the GOP health care plan.

It is no wonder, then, that the bulk of the Freedom Caucus is, at least for the moment, still holding out. They are being told they must vote for the bill, but they are being given no good policy reason to do so.

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  1. They need to just go with Rand. This is what they were elected to do. I realize Paul never expected in a hundred years to have control of all three branches this election, but he should have had a plan.

  2. Typical Congress. They need to pass it to find out what’s in it.

    Anything but a repeal is a political mistake. Mark my words.

    1. Anything but a repeal would be an economic, ethical, and mathematical mistake, yes, but not a political mistake. Really, making sure that people continue thinking they’re getting free shit is the opposite of a political mistake.

      1. I think this is sadly true. What Trump supporters really want is to feel like they stuck it to the left and got rid of Obamacare. It doesn’t matter if it is being replaced by a different flavor of the same thing. The important thing is that they can say they got rid of something their enemies wanted to keep. In that sense keeping the free shit and saying you got rid of the ACA is possibly a political winner in the short term at least for Trump’s base. Where it bites them is when the whole thing implodes and it is now Paul Ryan’s plan instead of Nancy Pelosi’s,

        1. Democrats have already won with ObamaCare. Republicans are too thick-headed to notice. The ACA will be wholly “repealed and replaced” just as soon as Social Security and Medicare are repealed and replaced.

        2. ^This^ x1000

      2. It’s a political mistake because anything but a repeal of ObamaCare will allow the lefties to flip the issue back on Republicans as they are already doing with calling it TrumpCare.

        Republicans know that repealing ObamaCare would make it harder to later add the gimme features like keep kids on until 26 and cannot reject customers with previous illnesses.

        Republicans were voted in a majority because they were told ObamaCare would be repealed. Republicans ignore this at their own peril. Might be good for Libertarians though, since people don’t like Democrats and Republicans will probably go against their promise.

        1. nope dumbasses will still vote party lines again. I won’t but 90% of the US is an idiot and will still vote party lines.

          1. Yeah, you’re probably right.

  3. I think the gop play here is it doesnt go somewhere. Obamacare continues to crater and dems get blamed making get rid of it easier politically. Problem would be if dems took over again.

    My concern is why is healthcare needed and tied to tax reform?

    1. Because of budget reconciliation. If the Republicans pass tax cuts as part of a huge healthcare cut, they can plausibly claim it’s “budget neutral,” which is required to pass the bill through reconciliation. Otherwise, they’d have to convince 8 Democrats to go along with massive tax cuts for the rich, which is extremely unlikely.

  4. When Obamacare was passed, the Dem leadership twisted arms and kissed asses – whatever it took to get the bill passed. The GOP doesn’t have that leverage because there’s a handful of legislators that can’t be bullied or bribed into lying back and thinking of Reagan. When it gets down to it, Dems to a man believe all your great ideas don’t mean a thing if you can’t get elected, there’s a few Republicans who think getting elected doesn’t mean a thing if you have to abandon your principles to get elected.

    1. Either that or they think that their principles are what keep getting them elected.

      1. It sure ain’t their good looks.

        1. Hey! Rand is a handsome man with a unique sense of style.

    2. I forget which jackass pundit it was I saw on CNN the other day claiming that Rand’s objection to the bill was purely opportunistic. He claimed that since so many of Rand’s constituents are welfare cases they need Obamacare and Rand knows a vote to repeal it would be political suicide, so by opposing repeal because it (supposedly) doesn’t go far enough he can make sure his people keep suckling at the government teat while pretending to be a principled opponent of government teat-suckling. Pure projection or vicious smear? I don’t know, but just casually tossing out there that obviously Rand is just posing is pretty low for political analysis, even for CNN.

  5. Even more telling still is that Republican leadership is barely attempting to defend the legislation on its merits.

    Wouldn’t the bill have to have some actual merits for that to even be possible?

    1. Next thing you know they’ll be unwilling to defend the President on his merits.

      1. Wouldn’t the president have to have some actual… oh, never mind.

        1. You know who else had to have some actual….

  6. “I’m gonna come after you,” Trump said to Meadows in the closed-door meeting, according to The Washington Post.”

    Is the moron vote really so large in Meadow’s district that the talking yam poses an electoral threat?

    1. Yup. They
      Ove Cheetos

    2. Trump’s brilliant skill as a negotiator on display there. Thuggish threats.

      1. So ObamaCare threatening congressmen to do his bidding was thuggish too?

        It politics! If you don’t toe the party line then you get hard time and little GOP money when your re-election time comes around.

  7. Translation: Rep. Collins is proposing a tax increase on New Yorkers to the tune of $4.7 billion.


  8. This bill is an absolute joke. It doesn’t even begin to touch the core poison of Obamacare.

    1. Guaranteed issue – forcing insurers to take all comers for every pre-existing condition….without even having waiting periods. They can’t even charge the sickest anything close to what it cost to pay for their medical care

    2. “Essential Health Benefits” – the one size fits all mandates

    Those two must go or we still have Obamacare.

    1. It doesn’t even slightly tweak the system away from employer-based care by removing or neutralizing the tax incentives in favor of it. Which they CAN DO in reconcilliation.

    2. As I posted on an earlier thread, catastrophic coverage needs to be “guaranteed issue” by the government itself, in an entitlement assigned at birth. As so ably described by Sheldon Richman in a nearby article, insurance works better the bigger the pool. Rational people, before they knew exactly what body they’d be born into, would agree to split the costs for catastrophic coverage as widely as possible. As also pointed out by Richman, it’s stupid to insist on competition between “insurance companies” that are all selling the same government mandated product.

      This, combined with mandated price transparency for all medical services (catastrophic care, and non-) and a free market in provision of same would be all you need for a reasonable solution. Some day, when we figure out how, we can replace the catastrophic care entitlement. But it shouldn’t be a concern on day one.

      1. What an argument. Gee, if everyone had a guaranteed comfortable income and they didn’t know what group they’d be born into, I’d bet they would want that as well.

  9. You know that in December 2015, the GOP passed a bill that would have repealed Obamacare

    Why won’t they pass that exact bill? It was acceptable then, and they have a president who will sign it?

    So why won’t they give him a bill they gave the black guy?


  10. Ah, yes. The party that libertarians are supposed to vote for is working its magic again.

    1. I didn’t vote for them.

    2. I didn’t vote for them either.

  11. Healthcare, insurance, whatever you want to call it has been subsidized or regulated for some time. While a purely free market system where people pay out of their pockets for everything would certainly lower costs and encourage innovation, I know that will never happen. At this point, I don’t think a single payer system where basic care and prescriptions are paid for, but you have to pay for extras like cosmetic surgery and birth control yourself, would be a bad idea, but I do not trust anything that politicians are in charge of.

    1. This is my opinion. The problem with a market for health care, unlike, say, food, is that health care involves several different levels of ‘goods’ that provide vastly different results to consumers. Cosmetic surgery or lasik will provide a large benefit to the purchaser but there’s almost never any significant harm in delaying or avoiding it. Thus, providers have an incentive to make their services cheaper to attract more customers, and offering different levels of service. (To use an example with which I am familiar, removing acne scars can be accomplished in several different ways, some more or less thorough or requiring longer or shorter recovery periods. Acne scars are kinda gross, but not life threatening, so there’s a reason to consider greater or lesser versions.) Cancer treatment is at the other end — patients need it quickly, it needs to be completely effective quickly, and there isn’t a margin for error. Finally, I know from personal experience that the pressure of “if you don’t do this, you child will die” does not lead to the kind of careful examination of options that, say, an investment counselor would make.

      That’s not to say that there isn’t a lot of room for market solutions, or that everything has to be provided by the government, or even that the government won’t completely foul up the system. My point is that any policy regarding health care needs to be analyzed with a lot more care and with a lot less theory than it’s been given in the past.

      1. Medical is just like any other market. You determine what hospital you will go to, how much things cost and whether it’s smart to have insurance to cover “holy shit that’s expensive events”.

        Catastrophic insurance covers those costly major medical events but to get good rates, you need get the insurance young and maintain it. As with life insurance, the best rates are when you are young and not when you are old or having medical problems.

        Contracts would also be important with free market health care, so you set up arranged deals with doctors if “x” happens.

        Plumbers work mostly free market yet, when people need help and will pay almost anything when have you poop backing up in your home. Yet people set up deals with local plumbers (insurance), shop around for plumbers or pay the market price.

  12. There were two tests for Trump’s first 100 days: (1) Using an executive order to withdraw the US from the Paris Climate Accord, and (2) initiating legislation to repeal ObamaCare, totally, ASAP. He has, in my view, wholly failed.

    And what the Rs are doing in Congress seems insane. A Border Adjustment Tax? Get out of town! Lunacy! And a replacement for ObamaCare? You don’t replace one obscenity with another one. No guts. No expository skills. No principles.

  13. Tax cuts? Where are they? Entitlement curbs? Where are they?

  14. Trade and Immigration? He can cause a Depression with this nonsense.

  15. Can’t be fixed because no one dares consider actually reducing the cost of US health care. This would mean that some people now involved in one way or another with health care would suffer a loss of income! Can’t have that, can we?

    This is really the problem and there is simply no way it can be fixed by either party. Libertarians on the other hand wouldn’t have any trouble since we don’t believe anyone is “entitled” to a certain level of income, especially as it comes from working inside a legal monopoly where people don’t have any effective “choice” in the matter.

  16. I think it passes, but by the thinnest of margins. There are too many goodies at the disposal of the leadership for it to fail, especially when you realize the cost of not doing so. It wouldn’t be a political mistake for Amash and a handful of others, but it would be for many Republicans and would embolden the Democrats, which is just as bad. Personally, I want it to fail, because I have other priorities, but politicians are weak minded prostitutes and they can’t help themselves but to pass a bill that is designed to be able to say they did something, without having actually done anything. If/when it does pass, that will make it easier to pass in the Senate, because they would look even worse if they were the thing standing in the way of what has been the basis of GOP politics for almost a decade now.

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