The clear and present danger of TrumpCare

In President Trump's America, you can't always keep a terrible idea down.

When the American Health Care Act was first withdrawn in March, House Speaker Paul Ryan said that "we're going to be living with ObamaCare for the foreseeable future." But liberal relief may have been premature. Without even the benefit of a score from the Congressional Budget Office, House Republicans are poised to hold a vote on Ryan's plan to take health insurance away from millions of people to pay for a massive upper-class tax cut. While passage is far from guaranteed, the House leadership would not be scheduling a vote if they weren't confident that they could get the votes necessary to pass it.

Should opponents of TrumpCare be concerned? Very.

Subscribe to The Week

Escape your echo chamber. Get the facts behind the news, plus analysis from multiple perspectives.

SUBSCRIBE & SAVE

Sign up for The Week's Free Newsletters

From our morning news briefing to a weekly Good News Newsletter, get the best of The Week delivered directly to your inbox.

From our morning news briefing to a weekly Good News Newsletter, get the best of The Week delivered directly to your inbox.

Sign up

Heather Caygle of Politico reports that some House Democrats are actually welcoming the vote. And it's certainly possible that it could work out in favor of the Democratic Party. If the House passes a bill that dies in the Senate, numerous potentially vulnerable House Republicans will be on the record as having voted for legislation that is massively unpopular. This would be another headwind for Republican efforts to retain the House with a widely disliked president from their party in the White House. The vote could mean that Democrats regain the House in 2018. So should Democrats be welcoming Republicans passing a bill and going on the record?

Not on your life (in some cases literally.) Like many arguments that losing in politics is secretly winning, this is too clever by half. The reasons Democrats should want TrumpCare to die are simple: It's an unimaginably horrible bill, and anything the House passes might ultimately become law.

It's tempting to think that any bill that can get enough votes from Freedom Caucus members in the House will be D.O.A. in the Senate. But it's more complicated than that. "For the many millions of Americans who will be adversely affected by any GOP health-care bill," observes Ed Kilgore of New York, "betting on failure could be a costly gamble." In the most likely worst-case scenario, the Senate would pass a more moderate version of TrumpCare, the conference committee would strip out enough moderate provisions to satisfy House conservatives, and then 50 senators would buckle under enormous pressure (including Senate Majority Leader Mitch McConnell, who like him or not is a formidably skilled legislative mechanic) and pass the bill.

The key, as Kilgore says, is that the House passing a bill changes the political dynamics. The House passing a bill that dies in the Senate means that Republicans put their House majority in grave peril — and probably inflicted further damage on Trump's already underwater approval ratings too — and received nothing substantive in return.

This is not to say that the Senate passing TrumpCare is likely. As many presidents have found to their displeasure, major health-care bills are a hugely difficult political lift. It won't be easy for McConnell to find a bill that the few Republican Senate moderates, Republican senators whose states have accepted the Medicaid expansion, and orthodox conservatives can agree on. McConnell has almost no margin for error: With the maximum number of Democratic votes at zero, Republicans have only two votes to spare. And even if the Senate can pass something, negotiating a bill both houses support won't be easy.

Difficult, but not impossible. And we must remember that the passage of TrumpCare would be a human rights catastrophe. TrumpCare is a huge cut to federal health-care spending that would result in millions and millions of people losing effective access to health care, with an unconscionable amount of unnecessary death, suffering, and bankruptcy as a result.

Whether you estimate the risk that a bill that passes the House would eventually become law at 5 percent, 10 percent, or 20 percent, the risk is too high. It would be better if the vote fails, even if it means that some marginal Republican House members vote "no." The sooner the effort to repeal the Affordable Care Act can be stopped, the better.