"Hell is empty and all the devils are here."—Shakespeare, the Tempest
House Republicans showed a stunning disregard for human dignity and human life yesterday when they passed their "repeal" of the Affordable Care Act (ACA). If it ever becomes law, it will lead to thousands of deaths annually and incalculable suffering. It appears the GOP House Caucus has a "pre-existing condition": It lacks a soul.
The American Health Care Act (AHCA), or Trumpcare, passed by the House yesterday, could hurt Americans in many ways. But the biggest victims of this recklessness are the people who can least afford it: those who are sick and those who are poor. The hastily passed law, which wasn't scored by the Congressional Budget Office and was barely read by members of Congress, calls for $880 billion in cuts to Medicaid, allows for discrimination against those with pre-existing conditions and is projected to result in 24 million Americans losing their insurance.
After the House passed the bill, they threw a party to celebrate. President Trump canceled a trip to New York City to host. Americans were at home worrying about the future. Many took to Twitter with heart-breaking stories about various illnesses using the trending hashtag #IAmaPreExistingCondition. Meanwhile, the people who created this sense of dread were bused to the Rose Garden to exchange hugs and high-fives, pose for selfies and drink beer. The appalling display will not soon be forgotten by the public, which militantly opposes the AHCA. The bill may or may not become law, but this vote will have lasting political consequences either way.
How the Bill Rose From the Dead: Rep. Fred Upton's Con Job
The passing of the bill was a stunning turnaround. On Tuesday, it seemed all but dead. Rep. Fred Upton came out against the bill, citing his concern for its treatment of people with pre-existing conditions. On social media Upton was thanked for being a rational, compassionate moderate. Many thought this was would kill the House reform effort.
But, in fact, Representative Upton's actions did not kill the bill, and quite possibly saved it. The next day Representative Upton showed his momentary compassion was either fleeting, or a brazen con. Bolstered by his new aura of faux compassion, he offered an amendment adding $8 billion to "high-risk pools" -- a drop in the bucket relative to the size of the bill, and for a flawed policy. This gave moderates cover, and soon the GOP could whip together enough votes to pass the bill by a slim margin.
The idea that $8 billion for high-risk pools was a game-changer is laughable. These pools were implemented in 35 states with little success in the ACA. They take people with the highest costs for health care, those who are sick and/or have pre-existing conditions, and place them in their own risk pool. The function essentially defeats the purpose of insurance: to share risk. Sick people can only get affordable care if healthy people are in the same risk pool.
There are many other problems with these plans, and without specifics it is hard to know how bad they may be. But it is not uncommon for high-risk pools to reject patients and/or impose "waiting periods" for patients so their care won't be covered until they pay into the system for a year.
"In Texas, for example, a patient with hemophilia would have to pay premiums for an entire year before the high-risk pool would begin to cover his treatment," explains Sarah Kliff at Vox. "That's a big deal: Hemophilia is an expensive condition to treat, with medical bills upward of $150,000 annually."
Upton's proposal was used by Paul Ryan, Trump and the rest of the GOP to falsely claim they do cover "pre-existing conditions." Upton's little dance provided them this excuse, despite the fact that this money is expected to have almost "no effect," on the impacts of the bill.
If something resembling the AHCA ever becomes law, Representative Upton's complicity will follow him for the rest of his life. The first paragraph of his obituary should acknowledge his role in the tragedy. In fact, all 217 of the Republicans who voted for this bill should be reminded of this vote in perpetuity.
"What Ryan and his minions have voted for is not just wrong. It is immoral," wrote John Nichols in The Nation.
The Coming Battle in the Senate
It is important to note again, that despite the victory laps taken by Trump and his merry men in the House, the ACA has not been repealed yet and may never be. The fight will continue in the Senate, where its fate is uncertain. There is debate as to whether the House bill would qualify for "budget reconciliation," and thus only require 51 votes, or if it must meet a 60-vote threshold, according to The New York Times. If it is the former, the Republicans could pass a repeal bill without a single Democrat. But even among Senate Republicans there is concern about the House bill.
"It's just -- that's not the way it's going to work, to be honest," Sen. Bob Corker said on MSNBC's "Morning Joe." "People are going to want to improve it. I don't see any way that it goes back in the form that it comes."
Sen. Lindsay Graham also expressed concern. "A bill -- finalized yesterday, has not been scored, amendments not allowed and three hours [of] final debate -- should be viewed with caution," he said on Twitter. But Senator Graham later added, "the collapse and replace of Obamacare may prove to be the most effective path forward."
Clearly there is at least some hesitance among Senate Republicans who are well aware that the AHCA is not popular (only 17 percent of people support the bill, according to a Quinnipiac poll) and is opposed by virtually every medical organization of significance in the country: the American Medical Association, AARP, American Heart Association, American Cancer Society, National Disability Rights Center, American Federation for Suicide Prevention, Association of Addiction Professionals and countless others.
There is also a real chance that the Senate will pass something to "repeal" Obamacare but nevertheless water down some of the more egregious provisions from the House bill. If this occurs, the amended version of the bill will go back to the House and may be opposed by the House Freedom Caucus, which successfully pulled the House bill to the right by arguing, absurdly, that the past iterations of the AHCA were too generous. Talking Points Memo reported yesterday that 12 Republican senators are planning on writing their own repeal bill "from scratch" -- a process that would also need to get past the Freedom Caucus radicals down the line.
All of this reinforces the important point that, while the Republicans won the battle on Thursday, the war is not over. There is still time to pressure Republicans to, if not kill the bill, write one that is far less damaging. And activists are ready for that fight. Some groups are raising money to try and oust GOP politicians who supported yesterday's bill, while others are focusing on the coming Senate battle, which is expected to begin in June.
The Other Battle for Health Care Justice: Medicare for All
The fight for health care justice is not relegated to influencing the Senate on the repeal bill. There is also the broader fight for single payer or Medicare for All. A poll from the Economist/YouGov showed 60 percent of the public supports single payer, including a plurality of Republicans. This makes single-payer health care far more popular than the ACA (which has 54 percent approval) or Trumpcare (17 percent).
"This vote shows that House leaders are not only out of ideas on health care, but out of touch with their own constituents," said Dr. Carol Paris, president of Physicians for a National Health Program, in a statement. "In polls and at town hall meetings, Americans consistently demand Medicare for All, the only plan that is universal, sustainable and proven to work in every other industrialized nation."
There is also a fight for a statewide, single-payer plan in California, a state that has come close to passing such a system in the past and is hoping to finally make it happen. National Nurses United is pushing hard for this legislation.
Indeed, as Democrats talk about the moral imperative of providing health care for all, it should not be lost that there are 30 million uninsured Americans who lack insurance as we speak, despite the ACA. As Truthout recently documented, single-payer health care has never been more popular in Congress, and the debate over Trumpcare seems to be bolstering this support.
Yesterday's events are a harsh reminder: It is cruel and unnecessary to force people to go through life unsure if their medical needs can be met. Earlier this week, Rep. Mo Brooks of Alabama made the contemptible argument that bad health is a sign of personal or moral failings. The real moral failings are occurring within the halls of Congress.