The railroading of our healthcare system continued at breakneck speed Thursday as both the Energy and Commerce and Ways and Means committees finished work on their respective Trumpcare bills, and by "finish work" I mean reject each and every one of the dozens of Democratic amendments to try to save people's health care.
And at the end of the marathon markups, the bills were unchanged.
By they way, no, we still don't have a score from the Congressional Budget Office estimating how many people will lose their health insurance and how much it's going to cost the federal government to piss it all away. The major development to come out the hearings was this:
There were some signs on Thursday that Energy and Commerce Committee Republicans were trying to tweak the bill to win over a large faction of House conservatives who’ve dubbed the House plan “Obamacare lite.” The Republican Study Committee said it would support an amendment from Reps. Joe Barton (R-Texas) and Marsha Blackburn (R-Tenn.) that would freeze Medicaid expansion enrollment at the end of this year, two years sooner than the GOP repeal bill allows. But Barton withdrew the amendment, which could have antagonized moderates who don’t want the GOP replacement to deeply erode coverage in their states.
That amendment was pulled from the committee, but we've got every indication that conservatives are going to push hard to get it into the bill in a floor amendment. Whether the big 170-member Republican Study Committee and the Freedom Caucus get behind Trumpcare could depend on this provision being added. Never mind that it would make it much harder to pass in the Senate.
The other big thing that happened today while the Energy and Commerce work was wrapping up was a PowerPoint presentation from House Speaker Paul Ryan in which he demonstrated that he doesn't know how insurance is supposed to work. It was kind of terrifying—Seven. Years. Later. and he still doesn't get this—but a lot of people had a lot of fun with it, so there's that.
Oh, and this is pretty significant, too: the biggest health insurance industry association will not support Trumpcare unless all the things that repeal Obamacare are repealed from it. Well, that's not entirely true, but the two basic pillars of the thing—the tax credits in place of current subsidies and the Medicaid cuts—have to go to get AHIP's support. You might remember AHIP being at the center of the months-long negotiation process that gave us the Affordable Care Act. They were in the room constantly. In the Trumpcare process, all this happened in a secret room where none of the stakeholders were allowed.
Here are some of the other highlights of the day.
- Trump has a plan in place just in case this whole venture falls apart (which has a least of 50-50 chance of happening): destroy Obamacare from the inside and blame the Democrats. Clearly, he's missing the fact that Republicans now own every bit of this.
- There's still plenty of infighting with in the Republican party, in the House conference, between the House and the Senate, and between all the interest groups who are pushing hard for full repeal and nothing else. This is not a unified GOP, and having both chambers of Congress and the White House in their control is only making the fissures more dramatic.
- The various ways in which this bill would really screw Trump's base became more and more clear today—from the millions it will take insurance away from to the fact that some extremists want it taken away faster, resulting in more people needlessly dying. Many of them would die from heroin overdoses.
- All this is making at least one vulnerable Republican senator—Nevada's Dean Heller—run for the hills. No one can get him to say anything about the bill, which is making nobody happy with him. Expect a lot more reticent Republicans in the coming days as the Senate tries to figure out what in the hell to do with this turkey.
- And figure it out they'll have to do, because there's a big procedural roadblock smack-dab in the middle of it that can only be overcome if Mitch McConnell decides to blow up the Senate.