There are three problems you could have imagined the manager's amendment to the American Health Care Act trying to fix:
- The Congressional Budget Office estimates the AHCA will lead 24 million more Americans to go uninsured, push millions more into the kind of super-high-deductible care Republicans criticized in the Affordable Care Act, and all that will happen while the richest Americans get hundreds of billions of dollars in tax cuts. Voters — including the downscale rural whites who propelled Donald Trump into the presidency — aren't going to like any of that.
- Virtually every health policy analyst from every side of the aisle thinks the AHCA is poorly constructed and will lead to consequences even its drafters didn't intend. Avik Roy argues there are huge implicit tax increases for the poor who get jobs that lift them out of Medicaid's ranks. Bob Laszewski thinks the plan will drive healthy people out of the insurance markets, creating even worse premium increases than we're seeing under Obamacare. Implementing this bill, as drafted, would be a disaster.
- As written, the AHCA is unlikely to pass the House, and so GOP leadership needs to give House conservatives more reasons to vote for the bill, even if those reasons leave the legislation less likely to succeed in the Senate. For this bill to fail in the House would embarrass Speaker Paul Ryan and President Trump.
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.