Opinion

The GOP's health-care plan is a monstrosity. Republican moderates may embrace it anyway.

Only a handful of senators stand between America and health-care disaster

The American Health Care Act is a monstrosity that would roll back ObamaCare's subsidies and regulations, gut Medicaid, and rob 23 million more Americans of their health coverage by 2026. When the House GOP passed this bill by a razor-thin vote, I wrote that Senate Republicans would never muster the votes to pass something so aggressively cruel.

Well, silly me.

Reports suggest that Senate Majority Leader Mitch McConnell (R-Ky.) has gone to Defcon 1. A group of 13 GOP senators is crafting a health-care bill behind closed doors, and it bears a remarkable resemblance to the House version of TrumpCare. McConnell intends to bring the Senate bill to the floor for a vote before the July 4 recess, with no committee hearings beforehand and minimal time for public debate or scrutiny of the bill.

The secrecy is bad enough. But the thing we should really focus on is that this is just a terrible bill. It will have horrible consequences for millions of Americans, including millions of voters that Republican senators represent. The AHCA represents a massive collapse in the basic moral awareness of GOP politicians. But it's not just that. It's also a complete break in the connection between voters' interests and politicians' desire to get elected. We're watching a national party come completely unhinged from the basic architecture of our democracy.

The Senate's version of TrumpCare looks like it will allow states to ditch ObamaCare rules that limit premiums that insurers can charge the elderly, and that require insurers to offer a suite of essential health benefits (EHBs). The Senate won't follow the House in allowing insurers to charge people with pre-existing conditions more. But millions of people with pre-existing conditions — cancer, diabetes, drug addiction, etc. — still rely on the EHB rules to make sure they can actually afford their treatments. And while the Senate might make the House's subsidies more responsive to Americans' income needs, an overall cut in the generosity of those subsidies is still probably in the works.

Then there's Medicaid. The House bill would both eliminate ObamaCare's expansion of the program and massively cut Medicaid's pre-ObamaCare spending. This was supposed to be the biggest stumbling block for the GOP moderates in the Senate: No less than 20 Senate Republicans represent states that chose to expand Medicaid. The program helps plenty of the working-class whites who swung to Trump. Two-thirds of its spending goes to the disabled and elderly to help with their nursing home stays and long-term care costs. A handful of GOP senators have already made a fuss over plans to cut the program. And McConnell can only afford to lose two votes.

But the moderates may fold. The elimination of the Medicaid expansion will take several years to phase in. And the cuts to pre-ObamaCare Medicaid may be made a little less draconian. That alone may be enough to buy the moderates off.

Partisanship has risen sharply as the internal ideological makeup of both parties has realigned. So the parties are a lot less willing to compromise or adopt any of the other side's values. The upper class votes at much higher rates than the poor and working classes, and wields far more influence over both parties. As inequality rises, the upper class is also increasingly segregated from the rest of society. The average politician is far wealthier than the average American, so they're as effected by these blinders as anyone. And, in a post-Citizens United world, big-money donors have far more influence — especially at the local and state levels — over what ideas the parties consider in the first place.

The result: National debates are driven by the solipsistic tribal obsessions of the American upper class.

The entire Republican Party is seriously contemplating throwing millions of its own voters under the bus. They either think doing so will have no serious consequences for their own political futures, or are so committed to their ideology they're willing to sacrifice some of their own political futures. (Weirdly admirable, in an incredibly perverse way.)

Obviously, Democrats are detached and blind in their own way. Liberal senators can't stop the bill, but they can gum up the procedural works to slow it down by a week or two. Yet Vox's Jeff Stein is reporting that the Democratic leadership has decided even that isn't worth the effort.

Ezra Levin, a co-director of the Indivisible movement, which has organized protests and town hall gatherings around the country to combat President Trump's agenda, explained why this strategy is crazy — not to mention weirdly tone-deaf to the Democrats' own voter base. McConnell needs the Senate bill to resemble the House bill as much as possible, so the two versions can be quickly reconciled and brought to President Trump's desk. Getting the Senate bill to that point requires ramming it through as fast as possible, to minimize political blowback for the Senate moderates. Thanks to procedural rules, the Senate bill must be scored by the Congressional Budget Office before a vote is taken. The Senate should finish the bill any day now, and scoring will take roughly two weeks. That leaves just a few days between the arrival of the score and a vote before the July 4 recess.

That McConnell is focusing so much on speed suggests he fears the political weight of voters' anger can still be brought to bear on the moderates. The more the Democrats can drag this process out, the more time they give activists to mobilize, deluge the Senate with phone calls, show up at town halls, stage protests, and generally give the Republican moderates an intolerable case of political heartburn.

Why aren't they leaping at that opportunity? It may be the only way to ensure that Senate moderates do the right thing.

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