Health care reform

Republicans Are Rushing To Vote on a Health Care Bill They Haven't Read. They Learned Nothing From Obamacare.

The House is planning a vote today on a bill that still isn't finalized.

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We have to pass the bill to find out what, um
Cheriss May/ZUMA Press/Newscom

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.

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.

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  1. “”””They have leaned nothing from Obamacare”””

    No, they have leaned everything from Obamacare, that is how Obama care got passed, by voting before reading.

    1. I find it funny that two weeks ago the drums were beating in unison “The GOP is taking too long to pass their healthcare bill. Trump is failing”. Now they are passing it too fast – and Trump is failing.

      Ya know…. when you have the conclusion written before the events occur, it kinda distorts you interpretation of the events as they unfold.

    2. By trusting Obama to “fix” the bill in the implementation. That’s why it’s called Obamacare, because Obama had all the discretion in the world as to how to implement it – grant waivers and extensions and deal-sweeteners and creative interpretations of the language. Who gives a shit what the bill says if Trump can pick and choose how he interprets the law and which parts he’ll ignore and which parts he’ll expand upon? If a penalty can be a tax and a state exchange can be a federal exchange and January 1, 2014 can be January 1, 2016, why can’t anything mean anything?

      This clusterfuck isn’t a plan so much as it is a plan not to have a plan – pass the steaming pile of shit to Trump and see what he does with it and you can blame everything on Trump just as you blamed everything on Obama. The press will be on your side this time around.

    3. +1

      ObamaCare Lesson #1: This is how you herd cats.

    4. They have learned nothing about the problems in our health care system. For both parties, everything is now purely political and designed for purely political reasons. The GOP has nothing to offer. The Dems have only the last arrow in their quiver – single payer – that merely needs implementation in order to fail and prove they have nothing to offer either.

      At this point, I now think it will be easier to successfully reform a failed single-payer system than to reform the clusterf#$% we have now. Both parties need to be exposed as total failures and stupid and venal to boot. They each need to own a massive multi-trillion-dollar failure before there’s a chance of anything positive happening.

    5. Prediction:

      Republicans will eventually pass something, but no matter what they pass the Democrats will rightfully hang responsibility for whatever steaming pile of crap is passed around Republicans necks and they will use it as a ‘get out the vote’ tool in the next election or two.

      After Democrats win back the Presidency, House, and Senate on the back of replacing RINOCare Democrats will successfully implement a government takeover of the entire health industry. American’s will weakly object, but with their knowledge that there is no portion of the Political class who will do anything useful they will knuckle under and take it in order to ‘see how it goes’.

      Healthcare goes into a predictable decline, and access will also decline as Doctor’s shutter their doors.

      Lastly, you will see other levels of the healthcare industry take over all primary care with less training and, finally, loosened conditions on who can provide what service.

      So, ironically, the thing that should have happened first will in fact happen last but the entire system will be destroyed to the point where the necessary changes that should have happened will be ineffectual.

      1. I agree except that I don’t think ‘healthcare will decline’. It will grow like kudzu – 25%+ of GDP – and ‘health insurance’ will cost more than housing and the only thing in shortage will be the ability to actually go to a doctor.

        And if a free market ideologue actually heads down the reform of ‘loosening conditions’ for that primary care access at that point; then that will permanently kill free market ideology and won’t fix anything. If every other country on Earth can provide access to a doctor and the richest free market on Earth that spends the most on healthcare can’t figure out how to provide more than access to an orderly; then there is no value to a free market.

        Necessary changes will only happen over the dead corpses of ideologues from both sides.

        1. When I refer to Healthcare I refer to the ability to actually go to a doctor. The fact that someone could even misconstrue that to somehow indicate healthcare as a share of GDP as opposed to actual care itself is telling on how the debate has been entirely framed around things that have nothing to do with actual healthcare.

          The point here is that changing the regulations on who can provide what type of care is going to be loosened by necessity either way. The reason I can confidently assert this is because I try to pay attention to the number of primary care doctors who are currently practicing in the United States and that number has been on the decline for some time now. Why would the supply of doctors expand when all the incentives to become a doctor are evaporating as we speak?

          This is basic economics. Why anyone treats healthcare as if it’s immune to the laws of supply and demand I’ll never know, but you can’t distort a market in the ways the government is attempting. You simply can’t, and people should be smart enough to realize it.

          1. We basically agree on what is happening to generalist doctors and the ‘solution’ for healthcare. The disagreement is that generalist doctors can NEVER exist within an ‘insurance’ system because insurance is created to figure out how to pay for specialists/hospitals not generalists.

            Personally I think the solution is probably in ordoliberal stuff like R?pke – http://bit.ly/2nhw71ethe vital things are beyond the realm of supply and demand and property. It is they which give meaning and dignity…the market economy is not everything. Take primary access out of insurance altogether. That is paid for by a combo of taxes (mostly to make sure that they are geographically distributed) and out-of-pocket. 3% or so of GDP. That is the sole thing that is universal and ‘mandated’ – and the sole thing that is primarily funded by fedl govt – and yeah if people themselves want a nurse practitioner instead then thats ok too.

            Beyond that its insurance and free market – and they will have to compete for the business of the 80% of the population that doesn’t daily ‘need’ them. That’s a free market – where the customer can reasonably just walk away and not buy.

            1. From a purely economic/local perspective – generalists are fixed cost, income inelastic, price elastic. Hospitals are fixed cost, income elastic, price inelastic. Specialists/labs are variable cost, income elastic, price inelastic. Market producers can easily manage the latter two together – with ‘insurance’ being the way customers pay for the product. They don’t do the fixed cost elements well at all. They don’t construct new hospitals – fewer hospitals/beds now than in 1960. Munis themselves (we have prob moved beyond churches doing that) need to build that supply via muni debt and local prop taxes – and rent the space to providers to drive hospital dayrates down. But that’s their problem.

              And providers squeeze generalists out of the insurance pie altogether because generalists end up bearing 100% of the deductible/copay ‘features’. They need to be outside the entire ‘insurance as a product’ mindset.

  2. But all the major components were available for public scrutiny before the key votes.

    ACA got the Sunlight Before Signing treatment? Posted online for five days of public comment prior to getting the president’s signature? So we didn’t need to pass it to find out what’s in it? I guess I’ll take your word for it.

    1. Tu quoque for the fail, again.

      1. Looks like you’ve got your own little personal troll now, FoE.

        1. As always, I’m just happy to get the attention.

          1. Well if you could house train him, that would be great. The little scamp has a bad habit of pooping all over the comments section.

      2. I agree. Suderman shouldn’t be making those arguments.

    2. Do you idiots ever consider filling your brains with something other than discredited right-wing horseshit talking points?

      Obamacare was debated in public for months to within an inch of everyone’s sanity. As someone once said, “nobody thought healthcare was this hard.” And that someone is fucking stupid.

      1. Another brilliant piece of satire Tony! Without you, who would subtly remind us that the ACA was a product of the Heritage foundation?

  3. They can’t finalize it before they vote on it….. you have to pass a bill to see what is in it. Everybody knows that. C’mon man, that ain’t new!

  4. I hope* the complete clusterfuck occurring in NYS (my GOP Rep is against the provision because it “hurts the city” – does it? who the hell knows? I’ve read four reports on the thing and I’m no nearer to understanding WTF it does) will blow up in their faces and the people revolt against this chicanery.

    *Absolutely no chance of this happening goes without saying

  5. I wasn’t for taking this tack, but I think it’s important to pass something now to establish that federal health insurance policy is still in play, unsettled. Keep the pot stirred.

  6. I would bet my life savings that nothing will pass and Obamacare is here to stay-people are hooked on free shit and the GOP knows this. They also know that the dems will have a field day if voters start losing their insurance or have to suddenly pay 10x more. Trump might look like an idiot, but it has served him well so far.

    1. Of course. Those favoring Obamacare can trot out numerous individuals to claim they will die if they lose their care. And those opposing it, or favoring a free market in health care, have no sob-stories to tell that lead to the death of themselves or their children or grannie.

    2. Even if something does pass, the free shit provisions are staying. That much is incredibly clear. Many people still haven’t realized that Republicans are now the Democrats and the Democrats are now Progressive Socialists. Thus, there is no ‘conservative’ party at all, merely different shades of expanding statists.

      1. Conservatives have been statists for a very long time. They only pick different areas for the government to control.

    3. The interesting thing about this particular free shit is that if you are not a part of the medicaid expansion, there is a high likelihood that even with the hundreds of dollars per month in subsidies, most folks are actually spending more than they were before.

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  8. Republicans Are Rushing To Vote on a Health Care Bill They Haven’t Read. They Learned Nothing From Obamacare.

    interesting headline. I take the exact opposite view. I would say they learned PLENTY from Obamacare. It may not be the lesson WE want them to to learn, but in the scope of politics, they learned a very valuable lesson.

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