In our previous episode, Those Republican Sociopaths, Speaker Ryan had a terrible dilemma to deal with if he was going to pass his beloved Repeal and Replace Obamacare Bill. On one flank were moderate Republicans (apparently, they do still exist!) who were feeling guilty that the bill might be too cruel with the possibility of 24 million Americans losing health insurance in the next decade. On the other flank were the hard-right Freedom Caucus members who in their hate of all things government, in effect complained that the bill wasn’t cruel enough! Not seeing a way to satisfy both the moderates and Freedom Caucus members at the same time, Ryan pulled the bill rather than lose a floor vote.
Afterwards, Ryan himself conceded that Obamacare would be the law of the land for the foreseeable future. And President Trump said he wanted to move on to putting together a budget.
But that didn’t last for long. Trump, approaching his 100th day in office was desperate for something in the ‘Win’ column. In addition, the large tax cut that was part of this repeal bill would serve as a stepping stone to further tax cuts in an upcoming budget bill. Although Trump was not likely familiar with all of the bill’s details, needing a win, he pressured Ryan to renegotiate a new bill that would satisfy enough House Republicans to pass it.
The hard-right didn’t want the guarantee of insurance for those with pre-existing conditions from Obamacare to remain. But the moderates would never agree to this. So the compromise was to leave the pre-existing conditions requirement in – but in a concession to the hard-right, the bill would give individual states the ability to opt out if they choose – just like many of the Republican led states opted out of the Medicaid expansion for Obamacare.
The bill passed in the House by the narrowest of margins. The large tax cut that would be given to the wealthy who helped to finance Obamacare was preserved. The money to pay for this tax cut came in the form of a massive cut to Medicaid, a program that benefits the poor, disabled, and elderly to try and keep the bill revenue neutral. The onerous details of this bill are too numerous to mention. The interested reader can check out this link, The Trumpcare Disaster.
So what does a Republican who passes a cruel bill like this which may cause as many as 24 million people to lose their health insurance do? Celebrate, of course!
As a practical matter, this bill has almost no chance to become a law in its present form. With many of the parts of the House bill being so toxic, the Senate will likely start from scratch to put together a bill of their own – while trying to satisfy their own hard-right members, namely Ted Cruz, Rand Paul, and Mike Lee. And if the Senate somehow passes a bill, the Senate and House would then have to agree on a common bill that removes their differences before it can go to the president to sign. Good luck with that!!
Even if this Repeal and Replace bill never becomes a law, there will be some serious repercussions to the American political landscape.
Many Republican House members who were brave enough to hold town hall meetings back home have encountered bitter dissent from attendees who were scared to death of losing their health insurance. When the Democrats passed Obamacare, that dissent resulted in a 2010 wave election victory by the Republicans. The Democrats believe they can return the favor in the 2018 mid-term elections.
But even if Obamacare doesn’t get repealed, the chaos caused by all of the repeal activity has caused a great deal of uncertainty in the healthcare insurance marketplace which may cause more insurers to bail out of Obamacare, perhaps making the Republican predictions of its doom into a self-fulfilling prophecy.
But let’s try to end this all on a hopeful note. If Obamacare is flawed and the Republicans have no viable option to replace it, we must be reminded how President Trump famously complemented Australia as having "better health care than we do." Of course, the delicious irony (apparently lost on Trump) is that Australia like most of the rest of the industrialized world has universal government-funded health insurance, also known as single-payer insurance which by the way, includes Medicare here in America.
So although Trump is apparently a closet single-payer health insurance supporter, most Republicans are strongly against it on ideological grounds. For them, given a choice between the cruel bill passed by the House and universal coverage for all Americans, cruel apparently wins. But with the passage of this House bill, even if it never becomes a law, many Americans who voted for Trump based on his promise to repeal and replace Obamacare have gotten a strong jolt of reality.
I will conclude with this quote from Democratic Senator Joe Manchin of West Virginia where President Trump won in a landslide:
“I said, ‘Mr. President, 172,000 West Virginians got insurance for the first time,’” Manchin said. "They’ve got something they never had before. They don’t know how they got it, they don’t know who gave it to them, they don’t know the Democrats, nothing about, ‘It’s Obamacare.’ They don’t know any of that. All they know is they’ve got it.”
“And you know what? They voted for you, Mr. President,” he said. “They’re going to know who took it away from them.”