Republicans intend to pass the bill without calculating how many people will lose coverage or what the plan will cost. Paul Ryan is often described, including by himself, as a policy wonk. But after a previous draft of the House bill reportedly received a
disastrous preliminary rating from
the nonpartisan Congressional Budget Office, which reportedly suggested that the G.O.P. proposal would cause 10-20 million people to lose employer-sponsored coverage alone and a spike in the uninsured ranks of at least 15 million, Republicans are moving to “mark up” and vote on the bill before the C.B.O. completes its analysis of the new bill. That means that the House proposal could technically pass before there is any estimate of how many Americans will be covered by the new law. It’s price tag, too, is a mystery: while the A.H.C.A. would likely achieve some savings by gutting Medicaid spending over time, the bill also abandons the primary cost-control measure included in its predecessor, a cap on the tax break for employer-sponsored insurance.
While the formal analysis isn’t completed, it doesn’t mean that we don’t have any concept of what is likely to happen under the American Health Care Act. The G.O.P. plan offers tax credits ranging from $2,000, for individuals under the age of 30, up to $4,000 for people over 60. For individuals making more that $75,000 per year—and married couples who file jointly and make more than $150,000 per year—the tax credit would decrease by $100 for every $1,000 increase in salary.
2. There is no constituency for Ryan’s bill, besides the rich. While the A.H.C.A. would repeal a number of Obamacare-related taxes—
saving the average 0.1 percenter $195,000 annually—just about everyone else loses. About 70 million Medicaid beneficiaries would be impacted by cuts, as would millions more who currently receive subsidies to purchase coverage on state Obamacare exchanges. A provision of the House bill that drops the requirement for large employers to provide coverage to workers could force millions more to fend for themselves. While young, healthy people could choose to forgo insurance until they need it, if they are willing to incur the penalty, the elderly would see much higher premiums without Obamacare’s subsidies—especially if they end up shunted into higher risk pools.
In short, Trumpcare helps nobody who needs coverage, and hurts those who need help most. The biggest problem with the bill, as
Ezra Klein notes, is that “it’s not clear why it exists. What does it make better? What is it even trying to achieve? Democrats wanted to cover more people and reduce long-term costs, and they had an argument for how their bill did both. As far as I can tell, Republicans have neither. At best, you can say this bill makes every obvious health care metric a bit worse, but at least it cuts taxes on rich people? Is that really a winning argument in American politics?”
3. Trumpcare may be dead on arrival, anyway. With Democrats diametrically opposed to nearly every aspect of the G.O.P. plan, it will take three Republican defections in the Senate to kill the bill. That shouldn’t be hard: at least four Republicans say the current bill goes too far in its cuts to Medicaid, which has proven overwhelmingly popular in a number of red states. At the same time, a number of more hard-line senators (and many more congresspeople) say the G.O.P. plan isn’t conservative enough. Minutes after the House released the proposal, Rep.
Justin Amash lambasted it on Twitter as “Obamacare 2.0”—a sentiment echoed by many of his peers. Others have taken to characterizing the House bill as “Obamacare Lite” and have accused House leadership of creating a “new entitlement” with the tax credits under the plan.
“Keep the ‘Cadillac’ tax in place? Keep Medicaid in place until 2020?” Rep.
Jim Jordan, a co-founder of the House Freedom Caucus, said
in an interview with
The Washington Post. “We didn’t have Medicaid expansion in the bill we sent to President Obama, but we have it in the one we send to President Trump? That makes no sense to me,” Jordan added in reference to a 2015 Obamacare repeal bill that passed the House and Senate but was ultimately vetoed by President Obama.
A memo penned by the Republican Study Committee and
obtained by Politico derided the tax credits, as “a Republican welfare entitlement” and argued, “Writing checks to individuals to purchase insurance is, in principle, Obamacare. It does allow more choices for individuals, and is more patient-centered, but is fundamentally grounded on the idea that the federal government should fund insurance purchases.”
Dave Brat, who is also a member of the House Freedom Caucus, told Politico that “the bill maintains many of the federal features including a new entitlement program as well as most of the insurance regulations,” and added to the outlet that he would vote against the bill as it currently stands. Several conservative advocacy groups, including Heritage Action and Americans for Prosperity have come out in opposition to the plan on that basis.
While is too early to tell how many Republicans might break party ranks and veto the bill, Brat’s disclosure portends a contentious debate over the House bill. Not counting on any Democratic votes, Ryan can’t lose more than 21 Republican votes for the bill to survive.
Mark Meadows, the chairman of the Freedom Caucus, and
Mark Walker, the chairman of the R.S.C., have yet to indicate how they plan to vote on the bill, but between the two command more than enough conservative votes to sink the bill in the House.
