On the eve of a major vote on the House health care plan, Republicans, fearing that the bill lacks enough support to pass, have apparently settled on a new plan: Rewrite the bill overnight, and then vote on it the next day, without time to read and debate it.
It was a sign of how determined House Republicans are to pass a bill, any bill, that they can claim repeals and replaces Obamacare, regardless of what is actually in it. It's a reckless plan that shows that Republicans have learned nothing from the follies of the law they spent the last seven years criticizing—even the lessons they repeatedly said they had learned.
Republicans scheduled a Thursday vote on the bill to partially repeal and replace Obamacare, but throughout the day on Wednesday, it looked increasingly unlikely that the bill would pass. Late in the evening, however, word circulated that the bill would be substantially rewritten overnight, with the vote to proceed on Thursday.
No official legislative language was released, but reports indicated that the primary change would be the elimination of Obamacare's essential health benefits rules—a list of mandates requiring insurers to offer particular categories of coverage.
Those changes are intended to curry favor with House conservatives, in particular, members of the Freedom Caucus, who were among the most vocal GOP holdouts. Freedom Caucus members have complained that the bill leaves Obamacare's essential structure in place, including its insurance regulations and its subsidies.
If the reports are accurate, the elimination of Obamacare's essential health benefits rules, would get rid of some of the health law's insurance regulations. But it would leave in place the preexisting conditions rules, known as guaranteed issue and community rating, which are central to Obamacare's health policy scheme. The revised GOP plan, in other words, would still revolve around Obamacare's key insurance regulations and a system of subsidies for individual market insurance, with a penalty (assessed by insurers on those re-entering the market) for those who don't maintain coverage.
At least one prominent Freedom Caucus member expressed cautious optimism about the development. "We're encouraged just based on the real willingness of not only the White House but our leadership to make this bill better," Freedom Caucus Chairman Mark Meadows (R-North Carolina) said Wednesday night.
But eliminating Obamacare's essential benefits regulations wouldn't be enough for others. "We've said many times that essential health benefits by themselves would not be enough," said Rep. Justin Amash (R-Michigan), according to The Hill. In a late night tweet, Amash went further.
Repealing EHB, w/out making other substantial changes, would make the bill worse, not better. It would hurt the sickest people on exchanges.
— Justin Amash (@justinamash) March 23, 2017
And that's presuming the early reports are essentially correct. As of this morning, no new legislative language existed. No deal had been struck. No Congressional Budget Office score had been released. Meadows told reporters that the plan was to work through the night, in hopes of coming up with new language by Thursday afternoon.
There are numerous problems with this plan, not least that, as Rep. Amash said, the reported changes would still leave the essential architecture of Obamacare in place. And by repealing some of the regulations but leaving the core preexisting conditions rules in place, it might well make it worse, driving up the cost of insurance for those who need it most.
The proposed changes would also pose challenges once it advances to the Senate, for two main reasons.
First, moderate Republicans in both the House and the Senate might oppose the elimination of the essential benefits rules. One influential centrist Republican, Pennsylvania's Charlie Dent, has flipped his vote to "no" following reports that a new draft of the bill will eliminate essential benefits rules.
Second, the rules surrounding the reconciliation process—a procedural maneuver Republicans are relying on in order to pass the bill with 51 Senate votes—might prohibit the change. Reconciliation rules only allow for provisions with direct budgetary relevance, which typically means tax and spending provisions. The essential health benefits requirements are regulations that might not pass muster.
Finally, and perhaps most importantly, is that there is no actual plan in place. Republicans are moving towards passage on a bill that has not been written yet, and that may include major changes from previous version. The CBO still hasn't scored the changes made in the manager's amendment that was released earlier this week. If Republicans vote on the bill today after releasing a heavily modified version, they will have no idea what they are voting on.
The rush to quickly alter and pass the bill would make a mockery of the GOP's criticisms of the process that led to the passage of Obamacare.
Republicans have spent years criticizing the health law for being sloppily drafted and moved through Congress without sufficient time to understand the bill. That was one of the main criticisms when it finally passed.
On the night that Obamacare was up for a final vote in the House, John Boehner, then House Minority Leader, gave an extended speech criticizing the bill not only on its merits, but on the process by which it was passed.
"Look at how this bill was written," he said in the speech. "Can you say it was done openly? With transparency and accountability? Without backroom deals and struck behind closed doors? Hidden from the people? Hell no you can't! Have you read the bill? Have you read the reconciliation bill? Have you read the manager's amendment? Hell no you haven't!"
Obamacare, for all its flaws, went through a months long process of debate and revision in both chambers of Congress. The bill was drawn up starting early in 2009, but the final vote wasn't until March of 2010. The bill was long and complex enough that not everyone understood every aspect of it, and some of the analysis of its provisions turned out to be wrong. But all the major components were available for public scrutiny before the key votes.
If House Republicans pass a bill that was substantially rewritten the night before the vote, that won't be true of the AHCA.
House Republicans won't have read it, and neither will most of their staffers, or knowledgeable outside analysts. The manager's amendment, meanwhile, which was released after work hours on Monday evening, included a provision specifically targeted at New York state legislators, in hopes of bringing their votes on board, that was never debated before being tacked on to the amendment.
Senate Majority Leader Mitch Mcconnell has stated his intention to vote on the upper chamber version of the plan next week. If that happens, will legislators have had sufficient opportunity to read, analyze, and debate the bill? As Boehner would say, hell no.
The rush to vote on the bill is itself a reason to be deeply skeptical of its merits, especially given the problems we have seen with drafts so far. It is a deeply irresponsible way to treat any legislation, and that irresponsibility is magnified by the scale and importance of this bill. Republicans would be passing Obamacare's replacement using a process that is even more hurried and less transparent than they complained about Democrats using on Obamacare.
Indeed, the fact that GOP leadership is so eager to move the bill through the system without taking the time to make the case for its policy scheme, even to their own members, is a sign that their only real aim is to pass a bill and move on, regardless of its policy content. The policy itself has become secondary to the political objective of passage. They just want to pass the bill, and they don't even care to find out what's in it.