There is something extremely Donald Trump about holding a celebration in the White House Rose Garden to mark the passage of a bill just through one house of Congress — especially when that bill faces considerable hurdles before it can become law, and especially when that bill is very unpopular.
Republicans in the House voted to pass the American Health Care Act despite not knowing what the bill would do. They say they didn’t wait for a Congressional Budget Office study because they don’t put much stock in CBO’s estimates of costs or coverage levels — but it’s not like they have their own competing study they relied on.
They just don’t care. They know the bill cuts taxes on rich people. Those are the important numbers.
The specific effects of this piece of legislation may not matter much anyway, since Republican senators say they will chuck out the House bill and write their own. And the Senate bill will almost surely be very different from the House bill.
Several Republican senators, including Shelley Capito of West Virginia, Tom Cotton of Arkansas, Cory Gardner of Colorado, Dean Heller of Nevada, Lisa Murkowski of Alaska, and Rob Portman of Ohio, have expressed concern about how the loss of the Medicaid expansion would affect their states. Four of these senators wrote a letter to majority leader Mitch McConnell saying a Senate bill would have to provide “stability for Medicaid expansion populations.”
Murkowski and Susan Collins of Maine have also expressed great concern about whether this bill sufficiently subsidizes insurance for low-income people in high cost areas. Insurance premiums are very high in Alaska; the House bill would provide flat subsidies, unadjusted for area costs, that would make insurance unaffordable for many in the state.
These two issues got relatively little attention in the House; addressing the senators’ concerns on them could add a lot of costs. Murkowski and Collins also support continued funding for Planned Parenthood, which is stripped in the House bill.
Whether a health care bill ever reaches Trump’s desk will depend on whether House Freedom Caucus conservatives, who yanked the House bill to the right, will be able to live with (and vote for) the Senate’s likely approach to health care.
I am sceptical. If they’re prepared to roll over and accept a bill whose approach will be blessed by Susan Collins, what was the point of their blocking the previous version of this bill in March?
If they won’t roll over, we’re likely to end up in a situation where both the House and the Senate succeed in passing a health care bill, but they can’t combine it into a single bill both houses can agree on.
The most important political effect of Thursday’s vote may then be that nearly the entire House Republican conference is now on the record for the proposition that health insurers should be able to charge patients more if they have preexisting health conditions.
In fairness to Republicans, that’s how most insurance products are priced: If your house is located on the oceanfront, you’re going to pay more for coverage against hurricanes. But the widespread unpopularity of medical underwriting (that is, the practice of charging people more if they have had cancer, etc.) reflects a public consensus that health risks are different from other kinds of risks; that the financial costs associated with them are appropriately pooled across the population instead of stuck disproportionately on the people most likely to need medical care.
Being at elevated risk for cancer is misfortune enough; it shouldn’t also come with the obligation to pay a whole bunch of extra insurance premiums.
Republicans have claimed to believe in this principle. Part of the reason I believed this bill would not pass the House is that so many Republicans insisted, very publicly, that they would insist any bill they vote for would align with this principle.
Preexisting condition coverage is a visceral issue on which House Republicans will have to defend themselves in next year’s elections to an electorate that really doesn’t like the stance they have taken. And they will have to justify their choice to party in the Rose Garden with a very unpopular president right after they voted to do so.
This column does not necessarily reflect the opinion of Business Insider.
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