If Obamacare is repealed in the Senate and no one is around to hear it, does it make a sound? That’s certainly what Senate Republicans are hoping for, as they’ve spent the last month or so writing their version of the GOP health care bill entirely in secret, and as they make plans to fast track the legislation straight to a vote, skipping the normal committee process and avoiding even a single hearing on the bill.
And it looks like they may get their wish, as they’re getting a huge assist from both the media and Democrats, all of whom are letting this process proceed with barely a whimper, let alone the primal scream it deserves.
The details of the Republican bill, and where exactly they stand in terms of gathering the needed votes are not entirely known, because as mentioned, they are proceeding entirely in secret. But a handful of enterprising reporters have been able to smoke out some of the details. It does not appear that there’s a final bill in place yet, however, the Senate seems to be nearing agreement on what will be in the bill. They are aiming to have a vote on the bill before they recess for the Fourth of July, and Mitch McConnell has already filed to fast track the bill so that as soon as the bill is finalized, it can be put up for a vote without having to go through any of the usual committees.
This means that once Republicans do finally release their bill to the public, we’ll have around two days, maybe even less, to read it and attempt to contact our representatives about it. There will be no hearings and no public discussion of this bill that will impact one-sixth of the economy and many millions of lives. Even though almost every significant stakeholder group (doctors, hospital, nurses, patient advocates) has spoken out against the House bill, the Senate is ignoring all calls to slow down and is pushing ahead without consulting anyone outside their working group.
What We Think Is In the Bill
As for what’s in the bill (or, at least, what we think is in the bill based on limited reports), it’s very similar to the House bill, with a few minor adjustments. The Senate bill, like the House bill, will allow states to request waivers to opt out of certain Obamacare provisions. As of right now, it looks like the Senate bill will allow states to opt out of the Essential Health Benefits (EHBs) requirement only. It will not allow states to opt out of the provision that bans discrimination against customers with preexisting conditions, as the House bill does.
However, by allowing states to waive out the EHBs, the bill does in effect take away protections from individuals with preexisting conditions, because insurance companies will be able to sell plans that don’t offer many needed services, purposefully excluding sicker customers who need more comprehensive plans. In waiver states, it will likely become impossible to find a comprehensive health insurance plan and junk plans will proliferate. (See here for further explanation).
This move is a very cynical and misleading ploy that will enable Republicans to say that their bill keeps the ban on discriminating against preexisting conditions – which it technically would – but still allows them, in reality, to gut protections for preexisting conditions. And unfortunately it’s a ploy that’s very likely to work, because their sales line will be simple, while the explanation required to counteract it is not.
Next, the Senate bill will retain all – or nearly all – of the Medicaid cuts that are in the House bill, it will just phase them in more slowly. This is despite the fact that so-called “moderate” Republicans in the Senate have insisted since the House bill passed that they would not go along with ending the Medicaid expansion. Yet, now they appear ready to sign onto a bill that not only ends the expansion but also makes significant cuts to the old Medicaid program that existed before Obamacare, just as the House bill does.
The House bill gets rid of Obamacare’s Medicaid expansion in 2020 – the Senate bill will phase it in over some number of years (the number is not settled on yet: the “moderates” want 7 years, McConnell and others want 3). As for the cuts to the older Medicaid program, discussion is still ongoing about exactly how to fashion those cuts (some in the Senate want the cuts to be slightly less severe than in the House bill), but it is clear that there will still be massive cuts.
Overall, the House bill cut more than $800 billion out of Medicaid over ten years, and the CBO projected 14 million people would lose their coverage. Even if the Senate bill makes that slightly less severe, the cuts will still be huge and have an extremely detrimental effect on people who’ve been relying on the program. (Ironically, these Medicaid cuts will disproportionately hurt Trump’s rural base. However, it seems likely that the vast majority of GOP Congress members will be insulated from any electoral consequences, due to the deep redness of their districts and the party loyalty of their constituents).
Additionally, the Senate bill may make some slight adjustments to the formula for determining the premium tax credits, possibly making them more generous for older Americans. That seems to still be up in the air.
But . . . This Wasn’t Supposed to Happen, Right?
Now, having described the bill we’re likely to get, I want to take a look back to just a few days after the House passed its version of the bill. On May 8, I wrote a post called Dueling Band-aids in which I said that if the final GOP bill looks similar to the bill that just passed the House, that would be the worst case scenario for Democrats. (If you missed that post, I hope you’ll read it now to see why I said that – I think this is a truly critical issue that Dems/Obamacare supporters are missing). The underlying premise of that post was that I believed the final GOP bill almost certainly would look very much like the House bill.
I wrote that the Senate bill would likely have the same general framework as the House bill, i.e. allowing states to waive out of certain Obamacare provisions. And I also said that, while numerous GOP Senators were claiming to have huge problems with different aspects of the House bill, we would likely only end up seeing cosmetic changes that would allow the members to claim they held out for fixes, while in reality nothing of substance had changed (e.g. retaining all the Medicaid cuts, but just phasing them in more slowly – so all the pain is still there, it just comes a little later).
This went entirely against the conventional wisdom at the time. In fact, at the time, the conventional wisdom was that the Senate would most likely not even be able to pass a health care bill at all. And the idea that the House bill would get anywhere at all in the Senate was literally laughed right out of the conversation. This seemed to be the general consensus among neutral pundits, Democratic strategists, and elected Democrats – at least the ones who were appearing on tv to talk about it in the weeks after the House passed its bill. And this had me extremely worried. Based on my Dueling Band-aids post, I obviously did not believe the conventional wisdom was correct.
To be clear, I really wasn’t sure if the Senate would be able to coalesce around the bill. Even today, as close as they appear to getting it done, it’s still possible it will fall apart because they just won’t be able to get that last vote or two. Their margins are extremely slim – they can only lose 2 votes – and they have a pretty disparate caucus they have to bring together. But listening to all that talk last month, I thought it was dangerous & arrogant to assume that the bill would not pass.
Passing this Obamacare “repeal” bill is THE priority for Republicans. They’ve been promising their base Obamacare repeal for seven years. And not just promising – through years of lies & propaganda, they’ve convinced their base that Obamacare is the work of the Devil, the end of civilization, the worst thing to ever happen to America, and every other hyperbolic description you can think of. As a result, there is truly nothing they could say to their supporters now that would be a justification for failing to repeal it. They need to do this no matter what it takes to make it happen.
So Paul Ryan and Mitch McConnell are determined to make it happen. And just as with the House bill, once the ball starts rolling, no individual Congress member will want to be branded as “the one” who prevented Obamacare repeal. So the incentive to go along with the plan – any plan – is just too great. So having watched the House go from total debacle to passing a plan practically overnight, why couldn’t the pundits and – more importantly – the Democrats see this??
What’s the Point of Looking Back?
And the reason I want to look back and point this out now is not to brag about my foresight, because the thing is, I don’t think that it took any special foresight to see what might be coming. All it took was paying attention – honest, open attention. I support the Democrats, I’m with them almost 100% on policy positions, but when it comes to the “politics” part of politics, the strategy, and yeah, the ability to play the game and move the chess pieces, they leave so, so much to be desired. They should not have been on tv making smug jokes after the AHCA passed the House. That bill’s passage – when everyone thought it would never happen – should have been a huge kick in the butt, a wake-up call that said to the Democrats, “wow, they might be actually be able to pull this off and we need to mobilize against this NOW.”
If they’d taken it seriously back then, the Democrats could have spent the last month working against a Senate bill, motivating their own base, getting their message out into the public to counteract the GOP messaging (which pretty much the entire GOP is out there spreading every day on tv, radio, social media), making sure the GOP would be too terrified to think they could get away with this.
Instead, they arrogantly laughed off the whole idea, and let their guard down on the issue.* Now Republicans are on the verge of having a bill ready to pass, and even at this point, with reporting beginning to roll out about the Senate bill’s imminent passage, there has been almost no response from the Democrats. And yeah, I’ve been frustrated by the fact that there has been so little media focus on what the Senate is doing (print outlets have been starting to focus over the last few days, but tv coverage has been almost non-existent), but really, the responsibility for this is on Democrats.
We can’t count on the media to do that job. Yes, they should be covering what’s going on with legislation & policy instead of being entirely focused on the Russia/Comey drama. But whether the media is doing its job or not, Democrats need to do theirs. So where the heck have they been?? Why aren’t they out there selling a message the same way the GOP has been out there every single day selling theirs?
There was a little glimmer of life on Thursday. While most of the country’s attention was focused on the Comey hearing, Democratic Senator Claire McCaskill called out Republican Senator Orrin Hatch in a Senate Finance Committee hearing about the rushed, secretive process the Senate is using to write its bill. She was angry and righteous, and spot on. And the video of that confrontation has gone viral, because constituents are so hungry to see their representatives fighting for them. But other than that, there’s been almost nothing from the Democrats on this issue. Aside from a few – and I mean, very few – tweets from a handful of members on the topic, there’s been nothing on the fact that Republicans are writing the bill in secret, nothing on the fact that Republicans plan to hold no hearings and allow no Democratic amendments, and nothing on the terrible contents of the bill.
If Democrats would spend even a quarter of the time and energy on this that they’ve been spending talking publicly about the Russia investigation, most of the public would be incensed about what’s going on. (The most recent poll of the AHCA found it had only a 17% approval rating, so the public would likely be extremely unhappy to find out it’s on the verge of actually becoming law). So where are they??
So What Now?
I had forgotten until I just went back now and looked at the post, but I ended that Dueling Band-aids post with a section called “Let’s Be Better Prepared for What’s Coming This Time.” I’m going to say that again now: let’s be prepared for what’s coming. That’s the point of this post, that’s the point of looking back at where we were a month ago. It’s to say, let’s not make any more assumptions or get caught up in the conventional wisdom game. And – if we can – let’s call out our leaders when we see them doing it. Because we need to be prepared for whatever is coming next and make sure we’re ready to fight it.
Right now, what’s next is that the GOP is planning to spend the month of June talking about how Obamacare is “imploding” and what a “failure” Obamacare is. As we’ve seen already, this is the way they’ve been justifying their rush to pass their bill, claiming the American people urgently need to be saved from Obamacare, and explaining away any flaws in their plan by essentially saying anything is better than the failing Obamacare. They neglect to mention that in the locations where Obamacare is failing, it’s a result of their very successful sabotage.
And after they spend the month fraudulently convincing America why their bill is so urgently needed, they are going to finally make their bill public and vote on it just two days later. So will Democrats finally get their act together and come up with a strategy and a message to rebut this? Or are they going to continue to sit on the sidelines and allow the GOP to just move right in and destroy their landmark legislation – and take insurance away from 23 million Americans – without a fight??
I’m Freaking Out – What Can I Do??
And now that I’ve got you all worried, here are some resources that will help you with how to fight the GOP repeal bill:
Topher Spiro’s Twitter feed is a great resource, in general, on health care. Currently, his pinned tweet is this “Trumpcare Toolkit” with a bunch of different methods for making it simple to get in contact with your members of Congress to let them know how you feel about Trumpcare:
And here, former Obama speechwriter Jon Favreau lists the specific staffers to speak with at key GOP Senators’ offices:
And finally, Ben Wikler, Washington Director at MoveOn.org, gives some great tips on strategy for these phone calls in this Twitter thread (the phone tips start at tweet #12, though the whole thread is interesting):
It makes me especially nervous to see Democrats do this because it reminds me of the same sort of arrogant, knowing amusement elected Democrats (and strategists and pundits, etc) displayed toward Trump during the election. First they laughed off any possibility that he could get the GOP nomination, then they laughed off the idea that he could win the Presidency, then . . . well you know the rest.
And it’s reasonable that people who don’t spend their lives observing, working in, or writing about & talking about politics were shocked by Trump. But for people whose living is politics, they should have seen him coming. If they had been paying attention – and doing so with honest, open minds – to what was happening inside the GOP base over the Obama years, and to how GOP officials were responding to that, Trump’s rise (or at least the possibility of it) would have been entirely foreseeable to them.
I wrote about some of the reasons Trump’s win wasn’t really all that surprising in my very first post on this blog. It’s such a huge topic that I didn’t cover anywhere near all of the things I’d been observing over the years leading up to Trump’s emergence,
but what I wrote is enough to give you some sense of why it should have been predictable, or at least seemed within the realm of the possible. In any case, the fact that very few of the people in power seem to have learned from that experience – either a general lesson of “anything is possible, be careful getting swept up in the conventional wisdom” or a more specific lesson of “the GOP will do literally anything to achieve its agenda” – is very troubling.