Tags: Trump Administration | Healthcare Reform | Republican | Health | Plan | Death | Spiral

The Republican Health Plan's Quick Death Spiral

The Republican Health Plan's Quick Death Spiral
(Dollar Photo Club)

By    |   Saturday, 25 March 2017 09:05 AM

On Friday, in floor debate over the American Health Care Act, Democratic Representative Jim McGovern said: “I look at this bill … and I have to wonder ‘What are my colleagues thinking?'” It’s fair to say that he spoke for a lot of health-care wonks.

I certainly can't advance a rational explanation of why Republicans are so committed to pushing through a hastily drafted bill that no one likes. The initial draft was scored by the Congressional Budget Office as causing 24 million Americans to lose their health insurance -- which is more than would lose care if the Republicans simply repealed Obamacare without replacing it. Still, Republicans planned to vote on the bill on Thursday, the seventh anniversary of the passage of Obamacare.

That was the plan. The plan changed.

Only 17 percent of American voters approve of the bill, while 56 percent disapprove. The House postponed voting on the bill it when Republican leaders couldn’t get the votes to pass it. And yet for supporters of the bill, it seemed risky to wait -- because representatives who went home to their districts this weekend would be yelled at by 56 percent of their constituents. President Donald Trump’s budget director, Mick Mulvaney, issued an ultimatum to House Republicans: The president would accept no further changes, so take the vote. Three new amendments were added to those already negotiated Monday: the essential health benefits that all plans are required to have would be rolled back, some new money would be made available to provide for maternity and infant care, and the repeal of the Medicare surtax on high-income people would be delayed in order to pay for it.

Nicholas Bagley, a law professor at the University of Michigan, argues that it’s not actually clear how the repeal of the essential health benefits is going to work: whether it simply requires states to set the scope of the benefits in each of the 10 categories specified by the law, or whether they have carte blanche to start over and decide that, say, acupuncture is the only thing insurance must cover. And if states don’t specify the essential health benefits, would that mean that tax credits will be unavailable for voters in that state? Even if Republicans are on board with the amendment’s goals, Bagley argues, they should think hard about voting for this, because “its actual language is a train wreck.”

That lack of clarity is a big problem because the changes are scheduled to take effect in 2018. Insurers will start submitting their preliminary rates for 2018 in a few months. They can’t do that until they know what they have to cover. That means that after this bill passes and is signed into law -- if it does pass and is signed -- either states would have almost no time to decide what to cover, or insurers would have almost no time to figure out how to design and price their insurance plans. This creates a risk that they’ll fail to make the deadline -- meaning that Republicans will pass this bill, only to see the individual market collapse next year.

These things are happening because Republicans aren’t taking the time to think them through. Amendments seem to be made simply because they might appease one part of the coalition or the other, with no reference to building a coherent policy. And that, in turn, is happening because there is no overarching policy vision driving this bill; there are congressional Republicans, who want to be able to say they repealed Obamacare, and Donald Trump, who wants a quick win he can crow about before moving on. The result is a bill that can’t even seem to do what it was designed for: get enough votes to pass Congress and give everyone a win. When those contradictions became apparent, and the negotiating process bogged down, he tried to bulldoze through the objections by demanding that people stop arguing and just take the darn vote.

Trump’s position makes a certain amount of sense: He wants to move on to tax reform and other more fun topics, not muck around with the health-care system. ("Nobody knew health care could be so complicated.") And for Trump, the price of a failed vote on a hastily assembled bill is pretty low. During the campaign, he often ran as much against his own party as against the Democrats; if Republicans in Congress have an embarrassing failure, Trump can just say “That’s those guys over there, the bad politicians who don’t care about getting things done.” I’ve seen multiple people asking today why, if Trump is such a great dealmaker, he couldn’t get health-care reform done. Yet this outcome is a actually great deal -- for Trump. It’s everyone else in the Republican Party who loses.

If the Obamacare replacement fails to pass, it will be embarrassing for Speaker Paul Ryan, and worse, suggest that there is no health-care bill that can secure enough support within the party to pass. The cost won’t just be the loss of a bill no one much liked in the first place, but quite possibly, the opportunity to do a better health-care reform down the road. That will hurt quite a lot of Republicans who promised voters they’d get rid of Obamacare and replace it with something better if only voters would give them Congress and the White House. It will also hurt Americans stuck with Obamacare’s various problems.

By midday Friday, Paul Ryan was at the White House to tell Trump that they didn’t have the votes, and it looked as if we were starting to see the defections that inevitably occur when the fate of a doomed bill is sealed. Yet the White House seemed to be insisting that the vote go forward anyway. Just as the nation seems to be riven by an increasing partisan divide, the Republican Party looks riven by a similarly deep divorce: between the interests of the presidency, and those of the party over which he ostensibly presides. Health-care reform has been the first casualty of that divide. It will not be the last.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Megan McArdle is a Bloomberg View columnist. She wrote for the Daily Beast, Newsweek, the Atlantic and the Economist and founded the blog Asymmetrical Information. She is the author of "“The Up Side of Down: Why Failing Well Is the Key to Success.”

© Copyright 2021 Bloomberg L.P. All Rights Reserved.

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On Friday, in floor debate over the American Health Care Act, Democratic Representative Jim McGovern said: "I look at this bill … and I have to wonder 'What are my colleagues thinking?'" It's fair to say that he spoke for a lot of health-care wonks.I certainly can't...
Republican, Health, Plan, Death, Spiral
Saturday, 25 March 2017 09:05 AM
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