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.

NEXT: Republicans Didn't Lack a Plan to Replace Obamacare. They Lacked a Unified Theory.

Obamacare Health Care

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

Please to post comments

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

  1. Suck it, Team Red. You own this clusterfuck now.

    1. B-b-b-b-but Pelosi!

      1. I’m making over $7k a month working part time. I kept hearing other people tell me how much money they can make online so I decided to look into it. Well, it was all true and has totally changed my life.

        This is what I do..,.,.,.,.,. http://www.careerstoday100.com

  2. If the GOP can’t pass a bill because they’re worried about people’s reaction to eliminating the prohibition on denial for pre-existing conditions, they might as well implement full-on single payer for everyone. Because it’s no longer health insurance, it’s a health program.

    1. Yes, the meme the local progs shouted at our local GOP Congressman (who caved, of course) is that Medicare should be expanded to include everyone. To preserve some semblance of fiscal common sense, some of them now say it would just be for “catastropic pre-existing conditions” such as what happened with Fallon’s baby, but you and I know darned well that in twenty years it will cover everything from flu shots to band aids to Coppertone to condoms.

      1. you and I know darned well that in twenty years it will cover everything from flu shots to band aids to Coppertone to condoms.

        That’s what the propaganda says. In reality, it will cover only catastrophic, immediately life-threatening conditions, and only if your number gets called in time.

        1. It will cover life-threatening conditions if you can wait six months. It will cover flu-shots and condoms if you can wait six years for them.

          So yes, it will basically cover very little in actuality, but it will COST like it covers every goddamned thing someone can think of.

      2. Condoms are already free at local health departments.

    2. What people say about guaranteed issue: “everyone should be able to get insurance when they need it. I don’t want to live in a society that let’s people die in the streets.” Since it is impossible to truly insure uninsurable risks, call the pre-payment of their health expenses for pennies on the dollar what it is: charity. As such, the people who believe that forcing insurers to provide “health insurance” to people with pre-existing conditions should be made to pay for it. That means taxes and making the payments for health coverage of pre-existing conditions a government function, like all other public assistance. Don’t like it? Ask Suderman what he would do instead. I am still waiting for his health reform program.

      1. What about those of us who DO want to live in a society where the unproductive die in the streets?

    3. It hasn’t been health insurance for decades.

  3. Nothing could be less accountable or transparent than Obamacare.

    Obamacare was a mess when it was passed. They constantly changed it through regulations. The ACA costs a lot more than projected (and a large part of the costs were passed onto insurance carriers and policyholders) and covers millions less than projected. Nothing can be worse than Obamacare.

    1. Team Red: Hold my beer

    2. Whatever the problems, Obamacare did have CBO scores and took months to pass. The text of the bill was available for review. The text of the amendments to this POS weren’t even available until the wee hours of this morning. So, no, this bill is much worse.

      1. The CBO scores were absolute BS. Remember the CLASS Act (i.e., public LTC insurance)? Remember the 10 year horizon with up to ten years of taxes and only six years of spending on which the scoring was based? If you think the CBO scoring is anything other than a political tool, you are naive.

        One last point: who are the CBO? What expertise do they have in predicting health care costs? Where is their model for predicting who will sign up for insurance, at what cost, and paying what premium? I would love to see this fantasy model that all the health actuaries in the US could never develop.

        1. Remember the 10 year horizon with up to ten years of taxes and only six years of spending on which the scoring was based?

          You just said below it wasn’t paid for.

          You are a Trumptard! Lying and contradicting within seconds of each.

          1. It wasn’t paid for. The CLASS ACT was a fiction which was soon dropped (there goes a whole bunch of revenue to pay for Obamacare). And Obamacare is set to last longer than 10 years. Do you know what a lie is?

            Most importantly, a large portion of the cost of the program was pushed onto the backs of insurers and the insured. Insurers are leaving the markets and millions fewer than anticipated have purchased Individual ACA plans. The rate increases, which include the impacts of buy-downs, have been staggering.

            1. wrong – (Aug 2016)

              The CBO report said the Affordable Care Act reduces the budget deficit by $143 billion between 2010-2019. Many people were understandably skeptical that a $940 billion program that expands health care coverage also saves money. That’s because the ACA legislation has taxes and fees that more than offset the cost. Here’s a summary of the savings.


              1. I acknowledged the 10 year scoring horizon multiple posts ago. Are you intentionally ignoring that? The taxes come in for more years than the spending goes out. What happens after the ten years?

                Also, you have zero answer for the fact that the ACA shifts, through mandates and regulations, the cost of the law to insurers and policyholders. Please address asshole, or go away. Thanks!

                1. Insurers and policy holders would pay for 100% of the cost in a free market system.

                  You are saying nothing.

      2. “The text of the bill was available for review.”

        Good one. I LOL’ed.

      3. This bill has nothing to do with getting it right and everything to do with “See, we repealed! Like we said! Now, please vote for us again! We’re the party of gettin’ shit done!”

    3. Nothing can be worse than Obamacare.

      You’re an idiot.

      Single-Payer would be a lot worse. Medicare is worse right now. Bush’s Medicare Part D was worse because it was not paid for.

      At least Obamacare was paid for (via capital gains taxes) and reduced the deficit.

      1. Lightbringer boot status: Licked

        1. Refute a word of it – with logic.

          Oh, you’re just a party hack. Got it.

          GE TEAM RED! GO GO GO!

      2. PB: Do you buy your medical insurance on an ObamaCare exchange?

        I do, and it’s about 80% more expensive than the insurance I had before ObamaCare, and the new ObamaCare policy has far worse benefits.

        ObamaCare sucks.

        But you are right that government involvement in health care is generally a disaster. VA and Indian Health Service are as bad as Medicare in their own ways.

        1. No, I don’t. Why do you buy on an exchange? The only reason to is to receive the subsidy. And if you do get a subsidy your premium should not be higher after subtracting said subsidy.

        2. “I do, and it’s about 80% more expensive than the insurance I had before ObamaCare”

          Mine’s close to 400% more expensive. I buy it on the exchange, because it’s literally the only insurance choice I have in my state. Individual private insurance policies are on the verge of extinction, and none are available in my state.

          All of which wouldn’t be so bad if I had the option of not buying insurance.

          1. Absolutely – if enough people stopped buying insurance, the insurance companies would have some incentive to offer products people want to buy.

            The whole win-win nature of the free market seems to have been forgotten. It’s all about force now…

        3. I tried it once. A plan I used to pay $143 per month for (less than a year before) was $376 on the exchange. Exact same coverage. Exact same co-pays. The difference? The government got more involved and did whatever in the hell they did.
          Still, though, it took the Democrats something like fifteen years to get the ACA to where it was. A year to debate and chop up. If the Republicans are dumb enough to think whatever this slipshod, slapped together, bill they’re introducing is going to anything but turn a bad situation into a catastrophe, they’re way dumber than people like Bill Maher make them out to be.

          And this will be what costs them Congress and the Presidency for decades to come. All it’ll take is for someone like Elizabeth Warren (who is wrong on a lot, but talks one helluva game) to run against Trump and the Rs are SCREWED.

      3. Single-payer would be worse. But there will never be single-payer in the US.

        Obamacare was never paid for. Why do you think insurers and consumers are leaving the market? It is too expensive. A large part of the cost of the ACA was put on the backs of insurers and their customers. They balked. The Individual ACA market is now basically a pool of subsidized and really sick people (who are really the ones being subsidized). It is an unsustainable market.

        1. Wrong. From a federal government perspective Obamacare was paid for. Remember how the taxes kicked in before the exchanges began operating? The ACA has actually reduced the deficit by controlling cost and raising taxes.

          The law is not very libertarian but is fiscally responsible.

          1. why do you keep repeating the same bs? NO, the failed Obozocare was NEVER paid for.

          2. why do you keep repeating the same bs? NO, the failed Obozocare was NEVER paid for.

        2. I wouldn’t say “never”. There were those who said there’d never be anything like ACA in the US.

    4. Nothing can be worse than Obamacare.

      I suppose that’s true, but as somebody leaning toward an-cap as the least-worst option I sure would like to see Obamacare repealed completely and replaced with nothing. Nothing could be far better than Obamacare; it’d definitely be cheaper and less intrusive.

      1. That’s why this bill is indeed worse than Obamacare. For team red at least. It’s basically just adding a slice of tomato to a crap sandwich, and calling it your own. Good luck trying to disown its future failures by claiming the failure was already inevitable.

        Should this become law, all the GOP will have done is remove the electoral albatross from the Dems and place it on their own neck.

        And serious question: what exactly were the health care horror stories prior to 2009 that make Obamacare impossible to repeal in full?

    5. Oh yes, and I’m hoping it crosses the first hurdle today.

  4. Suderman, do you know how much would be enough to fund the high risk pools? Can anyone?

    1. Actually its pretty easy to calculate.

      If 10% of the population is going to be in those pools, then those pools will cost 66% of TOTAL ($2 trillion) medical spending in the US
      If 5% of the population is going to be in those pools, those pools will cost 50% of TOTAL ($1.6 trillion) medical spending in the US
      If 1% of the population is going to be in those pools, those pool will cost 23% of TOTAL ($700 billion) medical spending in the US

      Minus whatever is already being spent by those who are already on Medicare and Medicaid disabled.

      High risk pools are absolutely the worst idea out there. If govt is going to cover the sickest people; then govt should play a role beyond Daddy Warbucks.

      1. Where do you get the $2 trillion? Where did you get your claims probability distribution of costs by risk class/band? When were those risk classes defined? Do those risk classes assume that every individual (and more importantly their healthcare providers) have access to the deep pockets of insurers and/or government? The $2 trillion number is a number I remember using when we were pricing the impact of the ACA in 2010. Certainly costs have gone up, and the number and types of people participating in the healthcare system have changed significantly since 2010.

        1. The broad distribution/concentration of medical spending – in the absence of overt rationing – is very predictable. Kaiser Foundation has data -http://kaiserf.am/2aK8b2e . “High-risk pool” is simply where you put the spending on the sickest. My $2 trillion was just 2/3 of $3 trillion which is roughly the total medical spending.

          If we want to ration or manage care for that group, then that’s a different discussion – that has to link the delivery of care and the structure of the medical system and the financing of it – for both healthy people AND for sick people. It’s a worthwhile discussion – but Americans are clearly incapable of that. There are a slew of ways we can reduce costs – and fairly too – but we are 30 years late to be fucking around with ‘insurance’ as a substitute for that discussion/restructuring.

          1. Whoops heres the link again – http://kaiserf.am/2aK8b2e

            1. Total health care spending is not predictable. That is because, as the article you linked points out, there has been a significant part of the population that has been excluded from the experience data due to Underwriting. Now underwriting is illegal and those previously uninsured and their providers are cashing in. How much “pent up demand” is there? We still don’t know because people buy insurance, get a huge amount of care, then drop their plan. They don’t even hang around for a full year. They, and their providers, just game the system and move on.

              Spending is predictable when you have a relatively static population under the same rules and financing regimes over multiple years. The ACA ruined that. We still don’t have a good handle on what is going on, though we are in much better shape than in 2014 and 2015 (when we had no data).

            2. Thought experiment for you. If costs are so predictable, why did insurers do so badly in 2014 and 2015 especially? The reason is simple, they had no idea how many uninsured would sign up and how sick they would be. The answer, at least for 2014 and 2015 was not as many as we thought and they are much, much sicker on average than we predicted. A perfect storm. Oh yeah, and the feds lied to insurers and said they would offset a good majority of the losses through risk mitigation. Risk adjustment is rearranging the deck chairs since it is a zero-sum program. Reinsurance worked decently well but is now over. And risk corridors was a fraudulent program that has only paid out 12.5% of what was promised for 2014, and nothing after that. When insurers priced, selected product offerings, etc., they assumed that those programs would be fully funded. They weren’t, and insurers took huge losses (which that asshole Obama’s Cum Receptacle won’t acknowledge) . As a result, rates needed to rise greatly and many insurers left the Individual ACA markets.

              1. The predictability that I am talking about is the medical needs/spending of the entire system – the entire population of Americans. It truly is highly highly predictable.

                You are simply talking about the unpredictability of small sample sizes when the pool is chopped up into pieces where adverse selection is ENCOURAGED – and where each year’s medical spending for each person is also its own subsample. That is our current system and it stopped working about 30 years ago.

    2. Nah,which is why Drumpfcare will have death panels. For real.

      States won’t have enough money so such patients will be wait listed, and picked by a Kim Davis.

      Love it! There is no need for Owseley county to have many toothless fucks.

    3. Wouldn’t it be cheaper to pay people to move to states that don’t opt out of the pre-existing conditions mandates?

  5. We need a Congress of randomly selected citizens – not this elected corruption crap

    1. To be stampeded by the several randomly chosen community organizers and bleeding hearts who find their way into Congress?

      1. And how is that worse than the stampeding by lobbyists and backroom deals in order to produce crappy cronyist legislation that no one has read?

  6. 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).

    The CBO will show that the deficit will jump much higher.


    Fiscally responsible party my ass.

    1. The Republicans were never fiscally responsible. They complained about the Democrats tax and spend, where as they always borrowed and spent

  7. The GOP is utterly insane to enact anything other than blanket repeal of ObamaCare. They will own every failure in the nation’s entire health care economy from now on. And multiple failures are a certainty. The GOP will get exactly zero credit for any success, if any, because the Dems and their propaganda ministry in the mainstream media will consistently observe that all success derives from Obama/Pelosi/Reid’s PPACA.

    It would have been better for the GOP to do nothing and let PPACA collapse. In the meantime, the GOP could issue “sincere” appeals to Democrats to put forward their own proposals to avert the collapse of their PPACA.

    1. It would have been better for the GOP to do nothing and let PPACA collapse.

      But the Stupid Party actually knows the ACA won’t collapse – that is just a political talking point.

      A “collapse” is a sudden failure. And that won’t happen. Now will it die slowly as insurers exit rural markets? Yes, it will.

      1. Rural markets don’t need insurance. They need primary care doctors. The US has fewer PCP’s/peep than many third world countries – and the ones who do exist are almost completely concentrated in cities


        1. I agree. Let the thing die or find its lowest common denominator.

          The rush on this vote is to give the Trump/GOP assholes a political victory.

      2. Yes it is. Insurers are leaving the markets. Rate increases are huge. Member cost-sharing has sky-rocketed.

        The collapse will be a plan year with no insurers to sell policies. So one day people have insurance, and literally the next day they won’t. Pretty big deal don’t you think? What do you want, pestilence and everyone’s first born dying on Passover?

        1. Of the 20 million on Obamacare half are Medicaid.

          This fictional “collapse” you speak of is just a slow return to the pre-2014 status quo where the other 10 million had no insurance.

          That is no collapse.

          The fucking GOP wants to do that RIGHT NOW. The GOP is for collapse.

          1. “This fictional “collapse” you speak of is just a slow return to the pre-2014 status quo where the other 10 million had no insurance.”

            So your argument is that Obamacare will not collapse, instead it will have accomplished nothing.

            At least nothing positive.

            Bravo. You ‘win.’

            1. you can’t have a discussion with PB…he is a stupid low IQ progtard puppet

              1. You forgot the part where he steps on his own dick.

  8. I don’t think it should get lost that maybe the reason ObamaCare passed was because no one knew what was in it. If people knew what was in it, it might not have passed.

    If that’s the case, it may be that the only reason its reform or repeal will pass is because people don’t know what’s in it, too. If that’s the only way to get rid of the Medicaid expansion and the individual mandate, then I wouldn’t necessarily call that a lack of transparency.

    I’d call that good leadership.

    Congress will be held accountable for what they pass–or the voters may reward them. That’s what happened to Nancy Pelosi and Harry Reid when they passed ObamaCare. Nancy Pelosi can hardly get arrested anymore, and Harry Reid is playing golf somewhere. Representatives are like a box of chocolates.

    The best thing about democracy isn’t that you get what you want. You don’t get what you want from politicians. You get what you want from shopping at Amazon. The best thing about democracy is that you get a chance to throw the bums out every once in a while. Maybe these bums will be better. We’ll have to wait and see.

    And they’ll find out what we think of them come November 2018.

    1. I don’t think it should get lost that maybe the reason ObamaCare passed was because no one knew what was in it.

      Don’t be an idiot. The actual legislation was debated for months.

      Wingnuts even made up DEATH PANELS out of cost-saving legislation.

      1. The actual legislation was debated for months.


        1. You and your alternative facts.

          I can speak wingnut too.

        2. I thought the trademarked phrase was, “THEY RAMMED IT DOWN OUR THROATS?”?

          1. Yes, RAMMED IT DOWN OUR THROATS = democratic process.

            (amazing TEAM RED! idiocy no question)

  9. Why in the world would they want to read it. One they don’t have to pay for it and two they don’t have to use it. The insurance lobby already told them which way to vote anyways.

  10. In related news some reason.com Republicans posing as libertarians grudgingly discover that the Republicans are hypocritical shitheads.

    So, surely there was one Democrat who did something today. Like criticized Drumpf for pussy grabbing then but gave Colbert a free pass.

    Let us discuss that.

  11. Leftitarians out in force today.

    You’d think they’d be happy that the GOP is caving and largely retaining the heavy statist elements of Obamacare.

    But I guess they are more about ‘team’ than anything else.

  12. What difference does it make what’s in it? The Senate will change it beyond recognition anyway if there is any chance that it will pass that body.

  13. The party of principal, integrity, and fiscal restraint fails, again, to demonstrate that it has any of those qualities.

    Nobody should act surprised. Everybody knew this would happen. If we can just get back to pointing fingers at esch other for a few years, we’ll be ok.

Comments are closed.