If it passes, the American Health Care Act will be Donald Trump and Paul Ryan's Iraq War. It's been sold with lies. It's been pushed forward with a shock-and-awe legislative strategy. And its architects are woefully unprepared for the chaos it would unleash upon passage.
There is an honest argument that could have been made for the AHCA. Conservatives believe it is not the government's responsibility to ensure the poor can afford decent health insurance. They argue that if taxpayers are pitching in for someone's coverage, that coverage should be lean; a high-deductible plan that protects against catastrophic medical expenses is plenty for charity care. Under this view, the basic structure of Obamacare — which taxes the rich to purchase reasonably generous coverage for the poor — is ill-conceived and should be reversed.
The core philosophical disagreement here is real and worth hashing out. Whereas liberals see access to health care as a right, conservatives see it as more akin to transportation — important, and perhaps worth subsidizing at low levels, but if someone can't afford a car, it's not the government's responsibility to buy them one, much less buy them a nice one. This is the viewpoint the AHCA reflects.
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It is not the viewpoint elected Republicans are selling. Instead, their rhetoric fits the sort of plan that Sen. Bernie Sanders might offer. Donald Trump won the 2016 election promising to protect Medicaid from cuts and ensure coverage for all. After the election, he reiterated the vow, telling the Washington Post "we're going to have insurance for everybody" with "much lower deductibles."
@realDonaldTrump: I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid. Huckabee copied me.
At about the same time, Senate Majority Leader Mitch McConnell went on Face the Nation to lament that under Obamacare, 25 million people remained uninsured, and many of those who did get coverage were in plans where the "deductibles are so high that it's really not worth much to them."
Much as Americans were told the Iraq War was about removing the threat of Saddam Hussein's weapons of mass destruction, they have been told that the GOP's health care effort is about replacing Obamacare with "something terrific" — a plan that covers everyone with good health insurance that they can actually afford to use. In both cases, they were lied to.
Just as there were no WMDs in Iraq, there is no health insurance Eden where everyone has better coverage at lower costs waiting on the other side of the AHCA — and there will be no hiding that fact if the law passes. The Congressional Budget Office estimates the bill would eventually push 24 million people into the ranks of the uninsured, and it would be particularly punishing to the old and the poor and the sick. The architecture of the bill pushes insurers to create plans with higher deductibles and less coverage and the shrunken tax credits push consumers towards crummier insurance. The experience most people affected by the AHCA will have is either giving up health insurance altogether or trading down into a cheaper plan with much higher out-of-pocket spending.
This is not what Republicans promised — and it explains why they have rushed their bill through Congress so fast. Their legislation does not do what they say it does, and it does not do what voters want it to do, and so a normal, deliberative process that exposed those facts would be lethal.