Paul Ryan's American carnage

The American Health Care Act is an absolute moral abomination.

House Republicans voted Thursday to pass this monstrosity by the narrowest of margins, 217-213. Not a single Democrat voted for it, and 20 Republicans broke with Speaker Paul Ryan and voted against the bill. It now goes to the Senate, which will also have to pass it (no small feat!) before it can be sent to President Trump to be signed into law.

In the meantime, Republicans are celebrating with a bunch of Bud Light.

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But let's not get lost in the hypocrisy or the politics. The substance of this bill is awful, and demands examination.

As Sarah Kliff explains, this bill is quite similar to the previous one that failed to pass the House — only the new version is much, much worse. It would get rid of the individual mandate and replace it with a more punishing rule that wouldn't work as well, phase out the Medicaid expansion in ObamaCare, and slash the rest of Medicaid by putting it through a welfare-reform style meat grinder (total cuts: $880 billion over 10 years). ObamaCare subsidies would be calculated based on age rather than income, leading some elderly people to have tremendously increased premiums.

States would be able to get waivers from regulations that insurance companies cover "essential health benefits" and that they not charge people with pre-existing conditions more. Those waivers would certainly be taken up by conservative states, and would unquestionably cause many bankruptcies and deaths.

Earlier this year, defections from moderate Republicans helped sink the original American Health Care Act. How did Paul Ryan and Co. bring them around this time? By adding a piddling $8 billion of extra funding for high-risk pools, which is only about $192 billion short of what would be necessary to make them maybe work. Just as I predicted, "moderate" Republicans are actually just slightly more cowardly versions of the ultra-conservative Freedom Caucus.

Why would Republican lawmakers do all this? So that they can massively cut taxes on the rich, of course. TrumpCare is in no meaningful sense a health-care reform bill. It is a bill to cut the taxes of the top 2 percent, paid for by taking health insurance away from poor and working-class people. (Naturally, when Republicans are done with this they're moving on to regular old tax "reform," where they will cut taxes on the rich even more.)

The Congressional Budget Office found that the previous version of the bill would leave 24 million more people uninsured by 2026, as compared to current law. We don't know what the precise number would be this time, because Republicans voted before the CBO could even conduct an updated analysis, which would only take a couple days. Not only that, but they have held no hearings, no committee markups, and didn't even circulate a final text of the bill before the vote. They quite obviously don't want the American people — or even their own membership — to know precisely what carnage this bill will inflict.

Here's what Paul Ryan thought in July 2009 about the ObamaCare bill, which had already been debated in excruciating detail for six months and would not pass until March of the next year:

Now, the CBO is coming out with its analysis next week, perfectly in time to bottle this god-awful legislation up in the Senate. The results are certain to be brutal, and ought to make it very possible to keep the American Health Care Act from passing in the upper chamber. But it is vitally important to not take that for granted. Quite literally, the lives of the poor, working-class, and those with pre-existing conditions depend on it.

And alright, as for the politics: Whether the American Health Care Act becomes law or not, in the 2018 campaign, Democrats need to hang this piece of poison around the neck of every one of the 217 Republicans who voted for it. Make them own the cruelty and carnage that is the American Health Care Act.