Another ACA repeal bill is dead, but it was never about crafting policy

And Democrats are beginning to fall into the same trap.

David Barrows of Washington dresses as the grim reaper and wears a sign that reads "Give me your poor, your sick, and your uninsured" as he joins others outside a hearing room where the Senate Finance Committee will hold a hearing to consider the Graham-Cassidy healthcare proposal, on Capitol Hill, Monday, Sept. 25, 2017, in Washington. CREDIT: AP Photo/Andrew Harnik
David Barrows of Washington dresses as the grim reaper and wears a sign that reads "Give me your poor, your sick, and your uninsured" as he joins others outside a hearing room where the Senate Finance Committee will hold a hearing to consider the Graham-Cassidy healthcare proposal, on Capitol Hill, Monday, Sept. 25, 2017, in Washington. CREDIT: AP Photo/Andrew Harnik

On Monday night, Sens. Bernie Sanders (I-VT), Amy Klobuchar (D-MN), Lindsay Graham (R-SC), and Bill Cassidy (R-LA) gathered for a CNN town hall debate over a health care bill spearheaded by Graham and Cassidy.

“This is a debate about who has the power, you or the federal government?” Cassidy said at one point. “I will tell you, if it’s a decision about you versus the federal government, we side with you…. Those who oppose us and those who want single-payer, they choose otherwise.”

The primetime debate was an opportunity for the Republican duo to sell their plan to repeal and replace the Affordable Care Act and for Sanders and Klobuchar to tear it down. Everyone played their part as planned.

But they were debating a dead bill.

Hours before, Sen. Susan Collins (R-ME) announced she would vote against the bill, leaving Republicans without the votes to repeal Obamacare — again.

Collins said she would vote no minutes after the release of the Congressional Budget Office report that scored a revised version of the bill, which had been released on Monday morning. The report lacked any hard numbers and only noted that Graham-Cassidy would save the government the same amount of money as a previous version of Obamacare repeal that passed the House earlier this year.

A last-minute hearing over the bill was still underway when Collins announced her opposition. But the fact that Republicans were short of votes didn’t matter for the hearing and didn’t affect the prime time CNN debate.

That’s because the Trump-era health care debate has never actually been about health care policy.

Health care in the Trump era, in fact, has almost exclusively been about performed politics. That was exceedingly clear Monday afternoon.

When protesters arrived at the Graham-Cassidy hearing chanting “No cuts to Medicaid,” Sen. Orrin Hatch (R-UT) adjourned until the protesters were arrested. “If the hearing is going to devolve into a sideshow or a forum for simply putting partisan points on the board, there’s absolutely no reason for us to be here,” Hatch said.

In reality, the hearing was always about putting partisan points on the board.

Republicans in Congress have tried and failed to repeal and replace Obamacare half a dozen times since Trump took office. The Graham-Cassidy bill picked up steam just days before the end of reconciliation, a process that would allow the Senate to pass a health care bill with a simple majority, rather than the 60 votes needed for cloture.

Senate Republicans have been busy trying to get those 50 votes for Graham-Cassidy and get the bill to the floor for a vote before Saturday for a while; this week’s hearing wasn’t actually scheduled until Sen. John McCain (R-AZ) said he would vote against any bill that didn’t go through regular Senate procedure.

The bill, if signed into law, would have block granted health care funding to the states and capped Medicaid. Analyses of the bill found that every state would suffer under the $4 trillion cuts to federal health care funding over the next two decades and that 32 million people could lose their health insurance by 2027.

Last week, Sen. Chuck Grassley (R-IA), a top Republican, made it clear that he knew it was a bad bill — and that it didn’t matter.

“You know, I could maybe give you 10 reasons why this bill shouldn’t be considered,” Grassley told reporters. “But Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign. That’s pretty much as much of a reason as the substance of the bill.”

Grassley’s argument is nearly identical to the one that President Trump has been making since he took office.

In August, Trump tweeted, “Can you believe that Mitch McConnell, who has screamed Repeal & Replace for 7 years, couldn’t get it done. Must Repeal & Replace ObamaCare!”

The president has consistently called for Senate Republicans to repeal the ACA at all costs, despite the fact that McConnell said it was time to “move on” from health care after the failure of skinny repeal.

With just days left to pass a bill with a simple majority, Trump this time seemed to finally wear leadership down and Graham-Cassidy picked up steam. Because the plan was actually an amendment to the Better Care Reconciliation Act, it would be allotted just 90 seconds of debate on the Senate floor.

But again, that didn’t matter, because the current health debate has never been about ideas or how best to get people the care they need. For Republicans, it has always been about keeping a years-long campaign promise — and the same thing has begun to happen with Democrats.

As their bill picked up steam, Graham and Cassidy were on every cable network, often pitching their bill as a choice between “federalism” and “socialism.”

Their pitch is misleading, but it’s one they’ve been able to make because Sanders recently introduced a Medicare for All bill with 16 Democratic co-sponsors.

The bill is the kind of lofty, aspirational stance many believe could win Democrats seats back in Congress, and nearly every Democrat who has been talked about as a potential candidate for president in 2020 is represented among Sanders’ band of co-sponsors.

Medicare for All is a good idea. Pushing Democrats to embrace progressive ideas is a strong step for the party. But everyone knows the bill won’t pass with Republicans in control, and Democratic leadership isn’t on board (at least for now), so the bill’s success, at least in the near future, is highly unlikely.

The idea of health insurance for every resident of the U.S. is certainly a more sympathetic way to govern than the Republican pitch (stripping people of their insurance and strapping anyone who gets to keep their insurance with skyrocketing premiums). But Medicare for All also doesn’t yet engage in the kind of important, in-the-moment policy-making necessary for addressing the problems many people face right now.

While Democrats should certainly run on big, progressive ideas, doing so without also throwing their weight behind shorter-term fixes is a mistake.

It’s worth noting that a bi-partisan ACA stabilization bill did gain some traction before Graham-Cassidy took center stage, but work on the bill stopped indefinitely last week. And Sanders did ultimately prove a better defender of the ACA on Monday than many of his Democratic critics believe him to be.

“The truth of the matter is the Affordable Care Act has done some very important things,” Sanders said. “What the American people want is for us to build on and improve the Affordable Care Act, not repeal it.”

He’s right: many Americans are unhappy with the ACA. Although the law has polled better since Trump took office and Republicans began their attempts to dismantle it, the individual market has fewer options than ever before and premiums continue to rise. (Notably, the increases in premiums can, in part, be directly traced back to the way Trump has stoked uncertainty about the law.)

But unless legislators really get into the mud of actual policy-making, with actual hearings and actual debate and actual Congressional procedure, no one, on either side of the aisle, will ever actually be able to make good health care policy a reality.