Last Monday, Republicans revealed their long-talked about plan to replace Obamacare. By this Wednesday, the end-all-be-all plan has gone back to the drawing board to try and stave off the complete collapse of its support in the Republican party. It's almost like they just cobbled the thing together in the last few weeks instead of spending any of the almost seven years they've been railing about it to come up with an alternative. That's the kind of attitude and strategy you can trust in a government.
Much like the first Muslim ban, the scale and intensity of push back against the plan seems to have caught everyone completely off-guard; which, in context, is even worse this time around because the White House Office of Management and Budget wrote a report estimating that 26 million people would lose their coverage under the plan, which is two million more than the coffin-nail estimate the CBO did. So, armed with that knowledge, the best they could do was have Sean Spicer point at two piles of paper and say the smaller one is what Freedom looked like? Or have Paul Ryan stand in front of a pie-chart for the wonky conservative crowd and say how unfair it is for healthy people to pay for the treatment of sick people? Really? That's it?
Paul Ryan is saying that he and the other leaders of the party will "make the necessary improvements and refinements" to get the thing back on track. But I really don't see how that's going to improve the situation, at all. The main "improvements" I see them Ryan making is stripping away the already minimal tax credits that replaced the subsidies in the ACA and ending the Medicaid expansion in 2018 instead of 2020. Removing those is a play to get the support of the Freedom Caucus assholes whose main problem with the current bill is that it does too much to help people get insurance and want to kill Medicaid as fast as they possibly can. Problem with that, though, is that if the bill removes the tax credits but keeps the provision allowing insurers to charge the elderly five times what they charge the young will only keep more people from buying insurance and more than likely cause people who already have coverage to drop it because it would get too expensive. Obviously, ending the Medicaid expansion would also drop the amount of new people signing on, and if the cuts went into effect, would also cause the amount of uninsured people to spike immediately instead of nine years from now.
If Ryan goes that route, he's sure to gain the extremist votes he needs which may, theoretically, carry him through in the House. Except, those measures would send the moderate Republicans in both the House and Senate running for the hills, and Republicans simply cannot afford that. Under the Reconciliation rules they're trying to pass thing under, they just need a simple majority to make the bill law; but since they only have a 52-48 majority in the Senate, losing just two people makes the bill dead in the water and there at least four Senators who have already said they'd bail on the bill over the Medicaid cut. Maybe, maybe, with enough cajoling and threats, they could drag two back into line to force the 50-50 tie and have Mike Pence cast the tie-breaker vote. Relying on desperation saving throws is never a good policy plan, though, so that makes me think they'll try a second, more winding way around the problem.
When everyone had a chance to read the bill (oh the benefits of short legislation), instead of being the one-stop shop for all things healthcare, it suddenly became phase one of a suddenly three part plan to repeal-and-replace Obamacare. After the bill was passed, Tom Price was to write up some regulations at some point that could possibly make way for the selling of insurance across state lines leading to the big finale of some super-awesome legislation to cap it all off and make all the conservative wet dreams come true. That this is all cobbled-together bullshit to distract people was pointed out by none other than Iran-letter shithead Tom Cotton, who was quick to mention that 1. Any regulations created by the Health Secretary would be subject to legal challenges so there's no way Republicans could control that outcome and 2. If Republicans really had legislation they thought could get 60 votes in the Senate, that's what they'd be trying to pass right now. There wouldn't be any need for all this hoop-jumping if they already had the capability to execute that part of the plan.
Nevertheless, what I'm expecting to happen is Ryan will role out a more craven version of the current bill with some vague bullshit schedule for Phase 2 and Phase 3 to kick in. I'm sure they'll be suitably delayed until after the midterm elections, so that Republicans can have a better shot at building their majorities in Congress and better stack the bench with sympathetic judges, of course. In no way at all will it be a blatant stall tactic to dupe people into thinking he's actually trying to accomplish something, nope, not from him, stand-up guy that he is. I haven't mentioned the possibility that Ryan and the Trump White House will role all those things together in one grand bill and present it to Congress because, well, that simply isn't going to happen. If they did that, they'd be setting themselves up for at least a year-long debate much like the ACA went through with everything in the bill getting dragged across the coals every single day. There's no way in hell they'd set themselves up for that kind of punishment, not when they've already got their backs against the wall trying to cobble together a simple majority on a budget reconciliation measure. They're stupid, sure, but even I don't think they're that stupid.
The most enjoyable aspect of this whole thing, for me, is watching Republicans realize how completely and utterly they have fucked themselves over with all the fanatical rabble-rousing they did against Obamacare. Because now, if they pass this bill, it will wreck so much havoc against the old and poor white-working class that elected them that success puts them at legitimate risk of being eaten-alive by their own base. On the other hand, if they don't pass anything, that same base will have some very pointed questions about why, after over half-a-decade of promises to repeal the worst thing since slavery the second they got into power, a Republican President with a Republican Congress failed to even put a dent into Obamacare's existence. If Congress fails to pass a healthcare bill quickly, that political failure will hang over the rest of Trump's administration and it will be impossible for him to recover from. Every other signature policy initiative he rolls out will be overshadowed by his inability to follow-through on one of his main campaign promises. It'll drive the little baby President nuts, and he'll lash out more and more against the Congressional leaders who couldn't deliver for him. It's a nifty little noose they've all tied for themselves, here's hoping that when it closes, it's as snug as it looks.
