The next two weeks are “red alert” critical for you to focus your attention on the GOP attempts to repeal “Obamacare” and to destroy the health insurance market and Medicaid with it. GOP Senate leaders aim to bring health-care legislation to the floor by end of June: “The push has been laden with secrecy — and rank-and-file Republican senators are increasingly frustrated that Mitch McConnell and a small group of GOP aides are crafting a bill behind closed doors.”
Paul Waldman of the Washington Post explains, Why Mitch McConnell’s secrecy gambit on his health-care bill could backfire:
Right now, the Republican leadership in the Senate is undertaking an unprecedented effort to write and pass a bill to remake the entire American health-care system in secret, with not a single hearing or committee markup and with its details kept hidden even from many Republican senators. This plan was devised by Senate Majority Leader Mitch McConnell (Ky.), who is widely respected for his strategic acumen even by Democrats who believe he has a bottomless void where his soul ought to be.
But is it possible that McConnell’s plan will backfire?
I’ll explain why that might happen in a moment, but it’s important to understand that the secrecy with which this bill is being crafted is a tacit admission on Republicans’ part that its likely effects on Americans’ health care and financial security are so gruesome that it must be kept hidden until the last possible moment, lest the public have time to understand what’s in it.
We don’t know exactly what the Senate’s bill will consist of, but there are a few things we do know. At its heart, it will do what the bill the House passed to repeal the Affordable Care Act does: take health coverage away from millions of people in order to give a tax break to the wealthy. While some hoped that a few moderates and senators from states that had accepted the ACA’s Medicaid expansion might try to save the expansion, that hope is dead. According to various reports, those supposed moderates now support phasing out the expansion, but doing it over seven years instead of the three years that the House bill provided for.
The Senate bill would also likely transform Medicaid — which today covers nearly 70 million Americans — into a block grant, for the first time allowing states to toss people off and cut back benefits. It will cut back on the subsidies that currently allow those not poor enough for Medicaid to afford coverage. It will likely undo the ACA’s mandates for essential health benefits, allowing the sale of “insurance” that in practice covers almost none of the needs people actually have. It will probably allow insurers to once again impose yearly and lifetime caps on coverage, which can turn a life-threatening illness or accident into a financial catastrophe as well. And it could undermine the protections the tens of millions of Americans with preexisting conditions now enjoy.
You can see why Republicans might not be too eager to invite Americans to get a good long look at this rancid smorgasbord of poison and misery. And as we get closer to seeing it, we’re learning even more about what the effects of the ACA repeal could be. In the past day or two we’ve seen the release of three new reports on those effects:
- The Kaiser Family Foundation looked at what non-group plans (analogous to what people now purchase on the ACA exchanges) covered before ACA’s essential benefits mandate was in place. They found that 75 percent of the plans didn’t cover maternity care, 45 percent didn’t include coverage for substance abuse, and 38 percent didn’t cover mental and behavioral health. Once that mandate is removed, non-group plans could revert to what they covered before.
- A Commonwealth Fund study concluded that if the House health-care bill became law, “By 2026, 924,000 jobs would be lost, gross state products would be $93 billion lower, and business output would be $148 billion less. About three-quarters of jobs lost (725,000) would be in the health care sector. States which expanded Medicaid would experience faster and deeper economic losses.”
- An analysis by the Center for American Progress concludes that if yearly and lifetime caps are once again allowed, 27 million people with employer-based coverage could be subject to yearly caps and 20 million could be subject to lifetime caps.
It just gets better and better, doesn’t it? So McConnell’s theory is that if the Senate’s bill were seen, debated and discussed, opposition would grow and grow, and eventually at least three of his members would bail out (the Republicans’ 52-48 majority means they can only lose two votes). Which might well be true.
But the opposite might also happen. The bill’s secrecy is garnering more and more attention, and more and more outrage. It has become one of the leading complaints Democrats make about it. And as any marketer knows, suspense is a terrific tool to increase public interest in your product. Tell people that your new movie or album is coming out soon, but give them only a taste of what it contains, and you’ll heighten the anticipation.
So by the time we actually get a look at the Senate’s bill, all that waiting may have primed the media to give it a great deal of attention, primed Democratic officeholders to run to the cameras to denounce it and primed liberal activists to mount an all-out assault on the bill, pressuring potentially wavering senators to oppose it.
“In the end, the outcome may depend on whether the bill’s opponents are ready when the moment comes.”
E.J. Dionne of the Post adds, The GOP’s fantastically anti-democratic quest to kill health care in the dark:
McConnell is trying to eviscerate the Affordable Care Act using methods completely at odds with how the law was originally brought to life in the early Obama administration. The ACA was debated for more than a year and went through an elaborate hearing and amendment process that included some changes urged by Republicans.
By contrast, the bill Senate Republicans are writing is being held as close as the nuclear codes. In the meantime, President Trump and his administration (including, most recently, Attorney General Jeff “I don’t recall” Sessions) keep providing McConnell excellent cover as their assorted outrages dominate the news and deflect attention from Capitol Hill. The wrecking squad works in the shadows knowing that if the public were given time to absorb the damage in store for millions of Americans, the pushback would be enormous.
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One of the so-called improvements [to the House bill] that has leaked out: People will be thrown off Medicaid more slowly under McConnellcare than under Ryancare. But they’ll still be thrown off, and to pay for this reprieve, the Senate would reportedly include additional cuts to Medicaid elsewhere. To finance all their tax cuts for the rich, Republicans will have to gut insurance for a lot of people one way or another.
Why all the secrecy? McConnell is trying to keep the pressure off the many Republican senators who have offered pledges of varying degrees of specificity to protect Medicaid and other aspects of the ACA that benefit their constituents.
They include Dean Heller of Nevada and Jeff Flake of Arizona, both up for reelection next year, as well as Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Lisa Murkowski of Alaska, Cory Gardner of Colorado and Bill Cassidy of Louisiana. So far, Susan Collins of Maine has stood honorably as one of her party’s firmest skeptics of this fiasco-in-the-making, but even she seems to be wobbling. [She always does.]
Because Democrats have 48 votes against dismantling the existing law, any three Republican senators could put a stop to this fantastically anti-democratic process. They could walk into McConnell’s office and say they’ll oppose any bill that is not made public for at least a month of real scrutiny and discussion. Is this too much to ask of legislation that could threaten the health care of countless Americans (the exact number being unknowable because the bill’s architects won’t admit to what they’re doing)?
Are there three GOP senators with a conscience and a soul willing to stand up and be counted for their “profiles in courage” moment? I see no evidence of this yet.
There is work here for activists, politicians and the media. Activists must understand that they have less time to save the Affordable Care Act than they might think. Democratic senators must take every opportunity to force this issue to the fore. Disruption in the face of this violation of legislative norms is no vice.
When and if the bill comes to the Senate floor, Democrats will use every tool at their disposal to try to slow it down, from challenging the parliamentarian’s decisions on the arcane rules, to forcing a high-profile and lengthy series of amendment votes to shine light on the legislation. Senate Democrats plan offensive to try to save Obamacare.
As for the media, Jacob Leibenluft, a former Obama administration official, described the problem well in an interview: “If you don’t have hearings, and you don’t have big moments for television, you don’t have bandwidth for coverage.”
He added: “I hate to think that looking back on this period, we’ll realize that the most regressive piece of social legislation in modern American history was passed, and no one was paying attention.”
Right now it is all hands on deck to oppose this anti-democratic and draconian Senate bill that would take health care away from millions of Americans, fundamentallly alter Medicaid, and cause massive disruption in the health insurance market — all done in secrecy behind closed doors. This evil GOP bastard Mitch McConnel cannot be allowed to succeed with his evil plan, he must be defeated.
Call your senators daily to oppose this bill, write your letters to the editor, and take to the streets to protest if you must. And don’t let your local media bury this legislative process story for more salacious and entertainment reporting.