There are three problems you could have imagined the manager's amendment to the American Health Care Act trying to fix:
Of the three problems in the AHCA, the third is by far the least serious — but it's the only one the manager's amendment even attempts to solve. These aren't changes that address the core problems the GOP health care bill will create for voters, insurers, or states; instead, it's legislation that tries to solve some of the problems the bill creates for conservative legislators. It might yet fall short on even that count.
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This is a trap for Republicans. Both the process and the substance of the American Health Care Act have revealed a political party that has lost sight of the fact that the true test of legislation isn't whether it passes, but whether it works.
Republican leaders have moved this bill as fast as possible, with as little information as possible, and with no evident plan for what will happen if the bill actually becomes law and wreaks havoc in people's lives. This is not the health reform package Donald Trump promised his voters, it's not the health reform package conservative policy experts recommended to House Republicans, and it's not the health reform package that polling shows people want.
About the only thing that can be said for the revised bill is this might be the health reform package that can pass the House. And that appears to be the only problem Republicans care to solve right now.
The major changes to the bill, which were first reported Politico and which Vox has now confirmed, are:
None of these provisions meaningfully change the underlying legislation, nor any of its flaws. These are mostly tweaks meant to win over hardcore conservatives and Congress members from New York.
The locus of effective opposition to the American Health Care Act has been the House Freedom Caucus. Monday night, its leader, Rep. Mark Meadows, sounded a pessimistic note.
"There are some small tweaks that are good tweaks, but there's not substantial changes in the manager's amendment that would make anybody be more compelled to vote for this," he said. "I don't think that the bill will pass without substantial changes."
Meadows may, of course, be wrong. Trump is lobbying individual House Republicans hard, and it's possible a critical number of conservatives will be swayed by Ryan's argument that this is their last, best, and only chance to repeal Obamacare.
But it's also possible that the bill fails in the House. Some conservatives think they can get a better deal by holding strong, even though the better deal they seek would ensure the legislation is dead on arrival in the Senate, if it even makes it to the Senate.
One dynamic that may work against Ryan and the legislation is the secrecy, speed, and unilateralism of the process. The bill hasn't been heavily debated or seriously amended in the committees. The changes to the bill were made by leadership, and they were made fast. Long legislative efforts are annoying for everyone involved, but the reason they're undertaken is that the process leaves members feeling heard, and feeling bought into the end result.
The House GOP leadership has decided that their bill is unlikely to survive a longer and more open drafting process, and so they need to jam it through the House as fast as humanly possible. It took the House more than five months to pass the first iteration of the Affordable Care Act. Republicans are trying to clear their bill in mere weeks. (See this excellent Sarah Kliff piece for more on the stunning hypocrisy at play here.)
I keep thinking about something that New York Times columnist Ross Douthat wrote today. "Republican politicians may offer pandering promises of lower deductibles and co-pays, but the coherent conservative position is that cheaper plans with higher deductibles are a very good thing," he said. It's a gently written sentence, but it's damning beyond measure.
Republicans have been promising the literal opposite of the bill they are trying to pass. Trump swore he'd oppose Medicaid cuts — but this law has more than $800 billion of them. He said everyone would be covered — but the CBO estimates this bill will push up the ranks of the uninsured by 24 million people. Republicans everywhere said they would replace Obamacare with a plan that ensured more competition, lower premiums and deductibles, and an end to skyrocketing annual increases — but this bill will have the opposite effect for most of those affected.
So what happens when voters realize their new tax credit doesn't cover anything close to the insurance they had? What happens when they find themselves with fewer choices, paying much higher premiums after their smaller subsidies, and being told by insurers that costs are doubling because Republicans changed how much more the old could be charged than the young?
Voters will notice all this. And what are Republicans going to say then? That it's all Barack Obama's fault? That high deductibles are actually good, they just forgot to mention it? That they needed something they could pass quickly so they could move on to tax reform?
This bill has always seemed like an answer to the question, "What can we pass that would count as repealing and replacing Obamacare?" But that's not the right question. The right question is, "What can we pass that will actually make people's lives better?" Given the truncated, fearful process Republicans have retreated behind, I'm not persuaded even they believe this bill is the answer.
Commentary by Ezra Klein, editor-in-chief at Vox. Follow him on Twitter @ezraklein.
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