Thursday, July 27, 2017

Status report on health care legislation

Here's a rundown on the process of Republicans' attempt to repeal and/or replace the Affordable Care Act.

On Tuesday afternoon, the Senate voted 51 to 50 to proceed with debate.  That evening they voted 43 for, 57 against a proposal that would have repealed the ACA and replace it with something crafted by the Senate Republican leadership in secret.  Nine Republicans joined 48 Democrats in voting against it.

On Wednesday, they debated a proposal that would repeal the ACA within two years, giving time for a replacement bill to be put together.  It's the repeal and delay approach.   They passed something similar in 2015, and President Obama vetoed it.   On one hand, it seems like a reasonable approach.  But we're not dealing with a reasonable process here;   so even many Republicans, who are hesitant to commit to repeal without a replacement plan.  This also failed, by vote of 45 to 55.   So two days in, and two plans voted down.

Republicans then have one more trick, which is to pass something, really almost anything, that will then trigger a conference committee to try to reconcile the bill the House passed with whatever the Senate passes.

So they plan to introduce a "skinny" repeal plan -- designed to appeal to a few wavering Republicans because it seems like minimal change that will allow them not to revolt against their party, and to rationalize that they're just voting to keep the debate going.   So a skinny repeal would leave most of the ACA intact but eliminate the mandates' for individuals to buy, and for large employers to supply, insurance.  It may also weaken requirements on pre-existing conditions.

The CBO has scored this and says that, even with these "minimal" changes in the ACA, 16 million will lose coverage and premiums will go up by 20%.  In addition, insurance markets will suffer and further complicate the lack of competition in certain areas.

It's worse than that.  As Sen. Brian Schatz (D-HI) told Chris Hayes, McConnell is selling his own members a bill of goods, telling them to just vote on this bill so they can get to a conference committee with the House;  then all their wishes for this issue or that will be worked out.  In effect, "Just trust me and vote for this;  it's just a way station to get to conference where the real bill will be crafted."

But Schatz's fear is that Republicans are being naive to what McConnell is doing.  They will buy his promises, and then we'll wind up with this terrible thing becoming law.

Senate Minority Leader Chuck Schumer called it this way:  ""Make no mistake about it, "skinny" repeal is equal to full repeal.  It's a Trojan horse designed to get the House and Senate into conference where the hard-right flank of the Republican Caucus, the Freedom Caucus, will demand full repeal or something very close to it."

That's the risk we face.   Once they get to conference negotiation, there is greater pressure to come up with a compromise.  And the negotiators are hand-picked by the Republican leaders.    Then when a complete compromise bill goes back to each house for a final vote, it's very hard for members to vote against their party at that late stage.

Senate rules allowed 20 hours total for debate on all this.  Democrats' strategy is to create delay.   They invoked a requirement to have the entire bill read on the floor, which was done Tuesday night.   They also tried to get the bill sent back to the Finance Committee for consideration.

After the 20 hours have been used up, then they go into a process called a vote-a-rama, where amendments may be offered and voted on.  Democrats are planning to try to introduce hundreds of amendments.   That is expected to begin on Thursday.

There real danger is that, by this tricky strategy, Mitch McConnell may actually pull off something that destroys, rather than improves, what has been accomplished with Obamacare.

And that is despite the American people's desire.   As we've learned the hard way, Republicans have become masters at getting people to vote against their own best interests.    They're very clever at creating a false narrative, at getting people to believe lies and distortions -- and turning something good into a demon.   Without understanding what they've been told to hate, they repeat the lies as though they are facts.

It's very disillusioning to have to realize that the idea that truth will win in the end -- is simply wrong.  At least that's the way it seems to me right now.


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