House Republican leadership hopes to vote later this week on an unpopular health bill that will cause tens of millions of Americans to lose their health coverage. It’s the third time since Donald Trump moved into the White House that House Republicans have stepped up to the brink of such a vote — the last two times, the vote didn’t happen after it was clear that the bill would fail.
This time, however, Speaker Paul Ryan (R-WI) has two new weapons in his arsenal: an amendment, favored by the most conservative members of his caucus, that will make the bill even harsher for people with preexisting health conditions; and a completely shameless willingness to mislead people about what this amendment actually does:
VERIFIED: MacArthur Amendment strengthens AHCA, protects people with pre-existing conditions. https://t.co/6W7bDEO40r
— Paul Ryan (@SpeakerRyan) May 2, 2017
To explain, House Republicans hoped to vote on this bill last March, but they hit a serious roadblock after the nonpartisan Congressional Budget Office determined that their health care proposal would strip 24 million people of health coverage by 2026. A few days later, a Trump White House analysis of the bill leaked which showed that it may cause as many as 26 million people to become uninsured over the course of a decade.
The Trump White House supports the bill.
Trumpcare failed in March due to a combination of three factors — universal opposition from Democrats, scattered opposition from Republicans who viewed the bill as too harsh, and similar opposition from Republicans who viewed it as not harsh enough.
Since the bill’s failure, Republicans apparently tried to shore up support for it by appealing to the faction that wants a harsher bill. This effort produced the “MacArthur Amendment,” which contains several provisions impacting people with preexisting health conditions.
Under current law, insurers cannot discriminate against people with preexisting conditions, and they must cover certain “essential health benefits” — such as prescription drugs, pregnancy care, and hospitalization. The MacArthur Amendment, however, will allow states to “specify their own set of essential health benefits” at a lower level than the requirements set by existing law. And it would also permit states to obtain waivers that would allow insurers to charge more to many people with preexisting conditions.
The amendment Ryan refers to in his tweet, in other words, does not “protect” people with preexisting conditions. It raises costs for many people with preexisting conditions, and it permits many insurance plans to exclude benefits that people with preexisting conditions may need.
And that’s on top of the harsh cuts to federal health care spending that were already contained in the bill. CBO estimates that the March version of Trumpcare — the one that would strip about 24 million people of health coverage — would cut $880 billion from Medicaid alone over the course of the next decade.
To offset some of the bill’s impact on people with preexisting conditions, it does allocate as much as $13 billion a year to “high-risk pools” and similar programs that provide insurance to people who are unable to obtain it in an inadequately regulated private market. But that’s only enough to insure a small fraction of the people who will lose coverage under the GOP’s bill.
In 2008, the McCain-Palin campaign released a health plan that proposed spending between $7 and $10 billion on such pools. At the time, however, analysts estimated that a national program “funded at $7 billion per year would cover only 875,000 people.”
Republicans, in other words, would have to spend about 15 times as much on high-risk pools than they are planning to spend in order to cancel out the other impacts of their bill — and that’s a conservative estimate that does not account for inflation.
As Ryan nevertheless tried to rally support for Trumpcare, he apparently turned to the Almighty during a House Republican caucus meeting.
Ryan tells fellow Republicans behind closed doors to pray for the health vote they may be about to take this week.
— Billy House (@HouseInSession) May 2, 2017
Dear Lord, help us to immiserate the poor. Help us to enfeeble the meek, to quicken the deaths of the innocent, to cast suffering upon the infirm, and to give Donald Trump a fat daddy tax cut.
In the spirit of Your mercy we pray.