Republicans Have to Pass Their Health Care Bill to Find Out What's In It

The House will vote today on a bill without knowing the cost or what it will do.


Jeff Malet Photography/Newscom

In March 2010, in the hours before the final vote to pass Obamacare, John Boehner, then the top Republican in the House, gave a fiery speech denouncing not only the soon-to-be-law, but the process that had led to the vote.

"Look at how this bill was written," he said. "Can you say it was done openly? With transparency and accountability? Without backroom deals struck behind closed doors hidden from the people? Hell no you can't."

All of these questions could now be asked of the GOP's bill to rewrite Obamacare. And the answer to every one of them would be the same as the one Boehner gave seven years ago: Hell no.

Republicans are preparing to vote on a health care bill today that is even less transparent and accountable than Obamacare, on a rushed vote that was negotiated almost entirely via backroom deals.

The House is expected to vote on the American Health Care Act (AHCA), sometime today. But Republicans, by their own accounts, have no idea what it will do.

The bill itself was only finalized last night, with the addition of an amendment by Fred Upton that would provide an additional $8 billion to fund state high risk pools.

The inclusion of that amendment won over Upton and a few other lawmakers who had complained that the bill didn't do enough for people with preexisting conditions. But just the day before, when Upton was still opposed to the law, he had said that more money wouldn't solve the problem.

Upton's amendment is just one of many backroom deals included in the bill entirely to win over holdout votes. The bill also includes legislative kickbacks for the New York delegation and other House members.

Meanwhile, Upton admits he doesn't even know if the money he secured in exchange for his vote is enough to solve the problem he wanted to fix. "Is it enough? I don't know. That's the question I was asked. I was led to believe that $5 billion was enough, which is why it's $8 billion," he told Dylan Scott of Vox.

Upton is simply taking House leadership's word, on a provision that he previously said wouldn't be sufficient to win him over. (There is reason to believe that leadership is wrong. As Robert Graboyes, a health policy scholar at the Mercatus Center, said yesterday, high risk pools are typically underfunded, and $8 billion in extra money is a "pittance.")

One reason Upton can't say what his amendment will do is that the bill, in its current form, has not been scored by the Congressional Budget Office (CBO).

That is highly unusual for a bill of this magnitude. And it goes against the sort of policy process that Republicans have typically insisted on for other legislation, including Obamacare. For example, back in 2009, when Congress was debating Obamacare, Paul Ryan, now the GOP Speaker of the House, repeatedly criticized Democrats who voted for the legislation that would become Obamacare without a CBO score during the committee process. "I don't think we should pass bills that we haven't read, that we don't know what they cost," he said at the time.

Ryan is now about to preside over a full House vote on a health care bill that has not been scored by the Congressional Budget Office. The Republicans who vote to pass it today will not know what it costs.

Indeed, it's notable how little independent analysis of this bill we have seen. Republicans not only do not have an estimate from the Congressional Budget Office, they have not been able to point to any cost or impact estimate by outside organizations, even conservative groups friendly to the GOP. Earlier this week, Speaker of the House Paul Ryan posted a bullet-pointed list of effects he claimed the bill would have with the word "VERIFIED." The document cited no outside sources for its claims. It had not been verified by anyone.

The Trump administration, which over the last month has aggressively pushed House Republicans to vote on the bill, has also dismissed worries about cost estimates and analysis entirely.

"It is literally impossible at this point" to predict the effects of the GOP health care bill, White House Press Secretary Sean Spicer said yesterday. So we have to pass the bill to find out what's in it?

There is some trivial truth to the notion that legislative analysts cannot perfectly predict the future. But that's a reason to understand the limitations of legislative analysis rather than to avoid it entirely. A CBO score, or any competent independent analysis, would give us a better idea of the likely cost and results of the bill. Right now, on the day that House Republicans are set to vote, no such analysis exists. It is hard to avoid the conclusion that Republicans are rushing to hold a vote now because they do not want GOP legislators to know what it costs, and what it is likely to do.

Spicer's argument that it's impossible to know what the bill will do is especially galling given all of the evidence that his boss, President Donald Trump, has no idea what is in the bill. The White House is effectively making the case for ignorance about a bill that will affect health coverage for millions, and will reorganize a sixth of the U.S. economy.

To summarize: Republicans don't know what's in the bill. They don't know what it will cost. And they don't know what it will do. But they must pass it immediately.

The process leading to today's AHCA vote is worse in every way than the process that led to Obamacare, which, when Boehner delivered his speech, had a CBO score, and had been debated for an entire year. It was a bad idea then. It's worse now.