So this is what all the waiting was for? A warmed over hybrid of Obamacare and the House “repeal and replace” bill is all the United States Senate Republicans could come up with? They hid in a secluded room for weeks to produce this?
I’ll give them this: amending Obamacare is hard and complicated work. Who knew?
Certainly not Donald Trump, who pledged for his year-and-a-half campaign that everyone would have coverage and that there would be lower deductibles and lower premiums. He promised no cuts in Medicaid. He did nail it about the House bill being “mean,” but, then, he knows how to read the polls and that repeal bill is down to a 16 percent approval rating. He said he wanted the Senate bill to include more money and have “heart,” whatever he thinks that might mean. To explain Trump and “repeal and replace” issues you can choose between a lack of intelligence or outright lying. Okay, the third option is a combination of the first two choices.
House Speaker Paul Ryan had seven years of practice passing meaningless repeal bills, but when it came time to write and pass the real thing he came up short the first time, and then on the second try eked out a one vote margin for approval of a bill. Which led, of course, to that now-famous post-vote victory celebration at the White House. Imagine the victory parade if they ever actually get a bill to the White House.
Senate Majority Leader Mitch McConnell is a more contained operator but the product his house produced was nothing to crow about it. That’s why they kept their work hidden, without a single public hearing. Let’s set aside for the moment the obvious about the lack of transparency and the contradictions of his comments and behavior in his bill drafting compared with when the original Obamacare legislation was being drafted. The Senate bill was not even three hours old when four senators announced they were opposed, which if they hold on means the bill was basically dead-on-arrival – a pretty good metaphor for the situation. Among what passes these days for Republican moderates there is also opposition, but it is muted.
The punditry is suggesting that McConnell, being the sly fox that he is, is letting the drama play out while knowing that if he does a little of this or a little of that he will round up the necessary 50 Senate votes, plus Mike Pence, to pass the bill. Note how a minor tweak of the House bill was sufficient to get enough House Republicans in line.
The Senate bill tries to appease the less right-wing senators with some language that would make it harder to harm older people, the disabled, and those with preexisting conditions. The key words in that last sentence are “make it harder.” That means those folks will still in many cases be hurt by the legislation.
The Congressional Budget Office’s score of the bill says that 22 million Americans will lose their health coverage over the next several years. Premiums and deductibles will rise. The old, disabled, the poor, and those in nursing homes will be harmed. But the important thing for the Republicans is that taxes for the rich will be cut. There is no need in this post to review the details of the proposal, which are reported extensively elsewhere and will change up to the moment when there is a final vote. The 142 page Senate bill can be summed up in eight words – “take from the poor, give to the rich.” Everything else is window dressing.
There are two bases in the Republican Party and for the most part they only come together every four years at the national convention. Both bases have been committed for seven years to repealing Obamacare, which we now know they had no way of accomplishing. The establishment base is fidgeting as they try to mellow out what they see and understand as the damage that “take from the poor, give to the rich” will actually do to millions of people, particularly and disproportionately those who put Trump in the White House. In the end the establishment base will cave in, fearing retribution from the other base.
The other base is the radical Republicans best represented by the members of House Freedom Caucus and senators such as Ted Cruz and Rand Paul. Their basic political philosophy is that those who have need not help those who do not have. They are all good Christians, but just wondering, how would Jesus vote on their repeal and replace legislation?
This week might tell the tale. If the Senate majority can’t round up fifty votes will McConnell really move on to other things like straight-up unpaid-for tax cuts? Or will repeal and replace issues float through the summer, unresolved and impacting all the other things on the Republican agenda?
It is conceivable that following the Republican bill tweaking the Senate will pass the legislation, and it is possible that the House will rush to adopt the Senate bill and send it on for Trump’s signature. Trumpcare could be the law of the land in less than a week. Maybe there would be an Independence Day bill-signing.
But even if that were to happen, the issues don’t go away. Trumpcare will drive insurance companies away from the market. Many, many people will lose their coverage almost immediately. Hospitals, particularly in rural areas will get clobbered and will close. And yes, people will die.
Further down the political pecking order, Republican and Democratic state governors and legislators alike would then be thrown into the action because the states must implement what Trump and Congress send them. The state officials will need to decide which essential health services to allow, how to handle pre-existing conditions, and which Medicaid services to reduce or eliminate as the Trumpcare Medicaid cuts phase in. Gubernatorial and legislative candidates will need to tell voters how they will implement the realities of Trumpcare. The buck, passed on by Washington, will stop with them.
If Republicans fail this week, next month, or sometime this fall to “repeal and replace” Obamacare, there will be hell to pay among their bases who have been promised action for seven years.
If Republicans do enact their “repeal and replace” legislation, there will be hell to pay among a large portion of their far-right base as they lose their coverage and see their hospitals close. “Get rid of Obamacare but don’t touch my health coverage!” Either way, there is nothing to look forward to with pride and happiness.
Father Vincent Cooke, S.J. and Bill Mariani
Father Cooke, who passed away last week, served as President of Canisius College for 17 years. I had the honor of working for him as the College’s director of government relations for the last seven years of his time at the School. We raised more than ten million dollars in state and federal funds during that period, and Father Cooke was instrumental in informing, encouraging and sometimes cajoling legislators about the needs that funding would assist.
As I noted in a previous post about another Jesuit, Pope Francis, I have always thought of the Jesuits as the Marines of the Catholic Church, taking on challenges that others might not accept in the service of God. Father Cooke’s years at Canisius were marked by many academic improvements and new buildings, but he also took satisfaction in some less notable activities. I sat next to Father Cooke at a dinner shortly before he left Canisius. He pointed out that he had added hundreds of new trees to the campus – and he was quick to say that he wasn’t even counting the hundreds of arborvitaes that had also been planted. Rest in peace, Father Cooke. The achievements and memories you left us will live on forever.
Bill Mariani passed away unexpectedly on Sunday. Bill served as Erie Community College President for about ten years and most recently held senior administrative positions at D’Youville College, including Interim President and Executive Vice President.
Bill’s tenure as ECC President included the years that I served as county budget director. While we did not always agree on everything about the school, things were always civil and professional. Bill was a gentleman and served his institutions well. He will be missed.