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The bill that won’t die / May 04, 2017
So what’s up these days with Zombie Trumpcare? That would be the repeal-and-replace Obamacare bill that’s been kicking around for weeks in the U.S. House of Representatives but has yet to come up for a vote because Republicans in Washington can’t reach a consensus on which is more important, cutting taxes for wealthy people or taking away health insurance from sick people. Yes, you read that sentence correctly. All hail the current state of play in Washington, D.C.

It speaks well of the pushback effort that Congress — up till now — has sided with the angels and with sick people, or at least not taken a meaningful vote to doom them to shortened lives of misery and penury. It’s not so heartening to know that it’s been a close-run affair. The American Health Care Act, the name of the bill that the Republican House leadership has put forward to replace the Affordable Care Act (i.e., Obamacare), is truly a sadistic piece of legislation. According to the non-partisan Congressional Budget Office, it would reduce the ranks of the medically insured by 24 million people within ten years. The Trump White House has estimated the number at more like 26 million people. Yes, you read that right, too. Donald Trump is going all-in for a big legislative win (which would happen to be his first) on behalf of a bill that his own administration says will deprive 26 million people of access to health care. Are you tired of winning yet?

Sadly and in bigly fashion for President Trump, the AHCA hasn’t received positive reviews ever since it sprung from the cold recesses of House Speaker Paul Ryan’s brain. One opinion poll put public approval at 17 percent, which is a pretty spectacular result even for Congress. The first time Speaker Ryan tried to get a vote in the House, he was forced to back off because the AHCA was clearly headed for a fall. Just so we don’t omit important context, all this happened after seven years of Republican promises to do away with the Affordable Care Act at the first opportunity. The GOP-controlled Congress voted dozens of times to repeal Obamacare, but when the moment arrived to come up with something better, they face-planted.

So that would appear to be that … except there’s one more thing to consider: whether it’s because they feel politically vulnerable after promising their base to get rid of evil Obamacare and failing, or because they believe their own bullhockey, Republicans in the House, egged on by the Toddler-in-Chief, have kept at the entire repeal-and-replace thing. This has led to a strange outcome wherein Republicans — who control the White House and both houses of Congress — are stuck with a Dead Bill Walking that they can’t bring themselves to kill. Hence the Zombie Trumpcare theme. It should be added that zombies are a lot more fun in the movies.

This week, however, Paul Ryan and his band of zealots in the House of Representatives appear poised to round up enough votes to pass the AHCA on a second try and send it over to the Senate, where it is widely believed to be in for a rude reception. How have Ryan & Company cracked the mystery of how to reanimate a corpse? Apparently the formula works like this: first, you amend the original legislation to placate the radical conservatives who helped to kill it the first time around (more about these folks in a minute). Second: You lie about what you’ve done! Plainly it’s going to take more than sawed-off shotguns to put this zombie to rest.

“VERIFIED: MacArthur Amendment strengthens AHCA, protects people with pre-existing conditions,” tweeted House Speaker Ryan on Tuesday. Ryan doesn’t say who “verified” this “fact” — because no independent party has done so — but if you think Republicans have sufficient confidence in their arguments that they’ll wait around for the Congressional Budget Office to score their amended bill, you must’ve already bought the bridge and probably live under it, too. Imagine if the Democrats had pulled a stunt like this (which they didn’t) when they passed the original Obamacare act. I suppose it wouldn’t matter because people like Donald Trump and Paul Ryan would lie about what happened then, too.

What the Speaker was referring to in his Tweet are changes in the bill negotiated by the Freedom Caucus and a New Jersey congressman, Tom MacArthur, one of the leaders of the Tuesday Group, the caucus of so-called moderate House Republicans. The tweaks by MacArthur and Freedom Caucus ideologues would allow states to opt out of two major regulatory provisions of the Affordable Care Act: the requirement that insurance policies pay for a list of ten “essential health benefits” (stuff like hospital care, physician care, maternity benefits, medications, mental health services, no real biggies) and another that bars insurance companies from charging more for people with pre-existing medical conditions. The high cost of Obamacare policies (which for many people is offset satisfactorily by the law’s tax credits for buying insurance) is primarly due to the fact that ACA-policies must actually pay for medical services, and cannot dump and run when expenses soar. This protection extends to the costliest members of the population to insure, i.e., those with pre-existing conditions, who also cannot be charged higher premiums than their healthy peers. (The public policy term of art is “community rating.” And yes, I promise not to type those words again). If you’re still with me, we have finally arrived at the point where it becomes plain what Obamacare is good for: it covers the bulk of medical bills for the sick and injured, and protects people from utter ruination when bad outcomes occur.

The Republican repeal-and-replace bill is intended to serve different priorities. First, it gets rid of the taxes on upper-income earners that fund most of the costs of Obamacare. Second, the AHCA is a ginormous gift to the insurance industry, packaged as a victory for “deregulation” or “empowering the states” or “advancing freedom,” whatever that’s supposed to mean. (“Freedom is just another word for nothing left to lose”: Janis Joplin.) The newly-revised AHCA allows states to set new rules that would enable insurance companies to sell junk policies that don’t cover the biggest bills, and insurers also could gain the right to shed customers with pre-existing conditions, who would be shuffled off into “high-risk pools.” By removing the sick and unwell from the picture, insurance companies would be able, in theory, to offer less costly policies to everyone else. As for those in the pre-existing category, they would end up in a pool that would be dependent on ongoing appropriations from federal and state governments. If this sounds like a good idea to you, perhaps a visit to the doctor would also be a good idea.

The new Republican bill provides $130 billion over ten years to fund these state-level high-risk pools. That’s $13 billion a year. Just to continue with the math (brace yourselves), let’s make note of the 2012 average cost for enrolling Americans in a temporary, federally-run high risk pool that served as a bridge to full implementation of Obamacare: that per-person cost was $32,108. Divide this number into $13 billion that Congress is now throwing out and you come up with some 405,000 people who would fit into these high-risk pools. Care to guess the number of people right now in the U.S. who are living with cancer? It was roughly 14.5 million in 2012; the figure is expected to rise to 19 million by 2024. True, many cancer sufferers receive insurance through work or other means. But Obamacare is responsible for covering some 30 million people on the individual and small group markets. Does anyone seriously believe that setting aside money to cover 400,000 people and leaving the rest to fend for themselves is a defensible plan?

Apparently, somewhere around 216 Republicans in the U.S. House of Representatives believe it’s just swell. (That is how many votes it’ll take to pass the bill and send it over to the Senate). The prospects for passage have improved dramatically with every fresh effort to make the American Health Care Act even more hideous than it was before. The right-wing Freedom Caucus guys have been coming on board all week after mostly offering “no’s” the first time a vote was planned (then aborted). One of these members is our own 5th District Congressman, Tom Garrett, who confirmed this week that he’s a “yes” vote for Zombie Trumpcare 2.0. Bearing Drift, a conservative website on Virginia politics, conducted an interview with Garrett on Tuesday in which he revealed his support for the amended legislation. “They’ve sort of injected the federalist element into this,” Garrett explained, referring to provisions that leave it up to states to determine how to cover high-cost individuals. “It would be a little bit hypocritical of me not to say ‘OK, this is something we can swallow.’”

Rep. Garrett is in Washington, D.C. this morning and afternoon holding high-level intellectual conversations with himself. Perhaps you have a different idea about the sufficiency of what he and his Freedom Caucus peers are proposing to do with health care. If so, you may want to dial his Washington office: the number is 202-225-4711.

Light up the switchboard, and maybe someone will get the message. Remember, if opposition doesn’t pan out now, there’s always 2018, when every seat in Congress will be up for a vote. That’s probably a useful point to be making with Rep. Garrett right about now. Just sayin’.

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