Last week’s abrupt firing of FBI Director James Comey has pushed health care out of the headlines, at least to some extent. However, the progress of the health care bill through Congress raises its own questions about the health of our democracy. Only about 20 percent of the public supports the American Health Care Act (AHCA), according to the most recent polling. And nearly the entire health care industry plus groups like AARP, American Cancer Society and National Alliance on Mental Illness (NAMI) deplore the bill. Furthermore, there is a large intensity gap, with supporters lukewarm and opponents intense in their dislike of the bill. Moreover, health care now tops the public's issues of concern, tied perhaps not coincidentally with poor government leadership.
In a functioning democracy, such massive public opposition coupled with equally unified opposition from the most affected segments of the economy would spell legislative doom. However, in the current political environment, passage of legislation that serves the narrow ideological and financial interests of only a very few is a better than even bet.
Washington DC – Home of the Whopper
But democracy still matters. And the best proof of that is that the proponents of the AHCA, both in the House and in the administration, feel compelled to continuously misstate (aka lie about) the content and the consequences of their legislation. They have claimed, for example, that no one would lose coverage as a result of the cut to Medicaid (HHS Secretary Price), that the bill was bipartisan (Rep. Denham), or even that no one dies because they don't have access to health care (Rep. Labrador). But lying has been a foundational part of the strategy to oppose the ACA since before it even became law. Remember "death panels" and, more recently, candidate Trump's promises not to cut Medicaid or Medicare (both broken, of course, in AHCA)?
In addition to the outright falsehoods, in the past week we have heard Republicans offer up statements ranging from the ludicrous to the bizarre to the reprehensible. On the ludicrous front, just a few weeks ago President Trump observed that no one could have known how complicated health care was; now he claims to know everything about it.
For an example of the bizarre, we have Rep. Mo Brooks suggesting that preexisting health conditions only afflict those who have done something wrong to deserve their illness.
As for the reprehensible, I give you Senator Hatch, perhaps channeling his inner Mitt Romney, dismissing all of the people who benefit from the ACA as people "on the dole who are trying to get every dime they can."
While lying is a critical part of the ACA takedown strategy, it is not enough by itself. Too many people have benefited to make the lies credible to most of the public. Therefore, another essential component of the ACA takedown strategy is to undermine its effectiveness through a combination of action and inaction. In particular, by creating a climate of financial and regulatory uncertainty, the Trump administration is leading even those insurers who choose to remain in the marketplaces to seek large premium increases. If we had an administration and a Congress that tried to make the ACA work rather than undermine it at every turn, there is little doubt that more people would be covered and premiums would be lower.
Senate Off to a Shaky Start
Things did not get off to a great start in the Senate for Majority Leader Mitch McConnell when, following the House's male-dominated victory party, he appointed an all-male task force to work on the Senate version of reform. In addition, the complicated dynamics in the Senate were on full display, with Senators Cruz, Lee and Toomey all pressing to make the Senate bill even worse than the House bill by making the cut to Medicaid bigger and by rolling back even more insurance protections. At the same time, Senators Collins and Cassidy were publicly criticizing the House bill because it both cuts benefits for seniors, kids and people with disabilities to pay for tax cuts for the rich, and would undermine protections for people with pre-existing conditions.
Most pundits expect McConnell to figure out some way to thread the needle in his chamber, although it remains to be seen whether something that can pass the Senate can make it back through the House.
Meanwhile, the dodges and deceptions don't appear to be working. Public fear and anger are intense and seem to be growing. With a majority of Republicans now saying that government should guarantee access to affordable quality health care, continued embrace of the AHCA puts Republican legislators at odds not just with the general public but also with their own voters. Passage of the AHCA immediately increased Republicans' chances of losing the House in 2018, according to some election watchers. People have focused special vitriol on Rep. Tom MacArthur, who originally opposed the first version of the AHCA, for his role in getting the bill through the lower chamber. And members such as Mark Amodei from Nevada, who flipped from opposition to support of AHCA, have seen their favorability ratings drop--a warning for Senator Dean Heller, one of the most endangered members among Senate Republicans.
With at least a couple Senators nervous (and McConnell can only lose two in total), getting a bill through the Senate is already a high hurdle to clear. Getting a bill that could become an anchor around the necks of Republican candidates in 2018 through to final passage seems likely to prove a much greater challenge.