While much of Washington fixates on Donald Trump and his scandals, a small band of Senate Republicans is working—in secret—on a bill that would slash health insurance for tens of millions of Americans and jeopardize access for millions more. And they’re doing this on a so-called fast track meant to preclude debate. The reason for this rushed process? To obscure the obvious: that at heart, the American Health Care Act is little more than a massive tax cut for the wealthiest Americans.
Once the working group emerges from its cloister, the bill will be scored by the Congressional Budget Office, and then—in a sharp break with procedure—bypass the committee process and go straight to the floor without a public hearing. There are even suggestions that Senate Majority Leader Mitch McConnell will use legislative gamesmanship to avoid debate entirely, so Republicans can pass the bill without any discussion of its contents and provisions. As Paul Ryan did in the House of Representatives, McConnell intends to restructure one-sixth of the American economy with as little input as possible, freezing out experts, industry representatives, and Democratic lawmakers. This, despite overwhelming opposition from the public; in one recent poll, just 23 percent of respondents said they approved of the Republican health care bill.
And what will the public get if and when the final version of the bill is passed into law? Millions of Americans will either lose their health insurance, see massive new costs, or face added obstacles, from “lifetime” caps on care to limits based on pre-existing conditions.
There’s no indication Republicans are thinking deeply about free market reforms to the American health care system. But let’s just say they are. Perhaps a drastically less-regulated insurance market is worth the cost to ordinary individuals and families. If that’s the case, then Republicans owe the country both honesty and transparency. It will get neither. Instead, every indication is that the GOP will push through with a process that holds deliberation in contempt. That’s not to say Republicans aren’t responding to someone—there are groups, like the Republican base, that want this bill—but the broad public opposes the effort.
As it stands, there’s a chance the Senate health care bill could pass before the July 4 holiday. Compare this to the process behind the Affordable Care Act. It took most of 2009 for Democrats to produce a bill: months of negotiation—including a summer of talks between Democratic and Republican senators—that involved debate and input, as lawmakers produced drafts, defended proposals, and sold their plan to the public. Congress saw testimony from patients and other ordinary people, and citizens were able to lobby lawmakers with their input.
It was as open a process as possible, and while Democrats weren’t immune to misleading rhetoric (“if you like your plan, you can keep it”), the final law wasn’t a surprise. It did what Democrats and the president said it would. And the party was proud of their work. “This is a big fucking deal,” Vice President Joe Biden famously whispered.
None of this is true of Republicans and the AHCA. Theirs is a closed, secretive process. There are no drafts, no inkling of the plan. No speeches defending its major planks or hearings where lawmakers and experts hash out concerns. When pressed with questions, Republicans from the Senate working group refuse to answer. Indeed, asked if it was important to bring a bill to the public, Republicans say, in effect, no. “Well, I think we’re not worried so much about that as we are getting it together so we can get a majority to vote for it,” said Sen. Orrin Hatch.
This might be tolerable if Republicans were open about the effects of their plan. But they aren’t. They’re lying. Tom Price, secretary of health and human services, insists that the bill preserves Medicaid, telling CNN, “We believe the Medicaid population will be cared for in a better way under our program because it will be more responsive to them.” In reality, the bill phases out the Medicaid expansion and makes additional cuts, slashing 14 million people from the program. President Trump has made assurances that the bill “guarantees” coverage for people with pre-existing conditions, which just isn’t true. Vice President Mike Pence promises “a dynamic national health insurance marketplace that lowers costs, increases quality and gives more choices to working families.” Given the massive coverage losses projected under the GOP’s health care plan, there’s no evidence that anything approaching that promise is on the horizon.
Republicans are pushing forward on an unpopular bill that, by every independent account, will harm millions of Americans. To justify this sprint, the White House is actively sabotaging insurance markets while telling the public that the Affordable Care Act is failing. And in taking this course, they’ve shown a breathtaking contempt for democracy, insulating themselves from any political pressure, lying about the policies in question, and hiding this bankrupt process from the country.
This cowardly and factional governing—meant to satisfy a small minority of Republican Party backers, not the public at large—will likely backfire. Given Democratic anger, the president’s unpopularity, and broad discontent with the bill in question, there are decent odds this story ends with a Democratic victory in the 2018 elections and a chance to repair the damage. But between now and then, real people will suffer. Real people will have to decide if they can afford continued treatment. Real people will die. And as far as anyone can tell, the point of all of this—the secrecy and dishonesty and likely pain—is tax cuts. That’s it.