Opinion: The single most important thing about the health care bill is …

… this isn’t the bill.

The U.S. House today is expected to vote on the latest version of the American Health Care Act, a.k.a. the repeal-and-replace measure for Obamacare. It is slightly changed from the version that, almost six weeks ago, Speaker Paul Ryan put on ice for lack of support. If this version passes and moves on to the Senate, don’t get too hung up on the substantive differences between the two versions, because the key words here are “moves on to the Senate.”

CMS Administrator Seema Verma, Vice President Mike Pence and Secretary of Health and Human Services Tom Price leave a meeting on Capitol Hill, Wednesday. Vice President Pence met with House Republicans to lobby for health care legislation, as the House passed a spending bill to keep the government running. (Photo by Zach Gibson / Getty Images)

The biggest mistake in this entire process was House leaders presenting their text as if it would be more or less the final legislation, and House members voicing their decisions to support or oppose it on the same premise. Because this bill will be subject to the Senate’s reconciliation process — which severely limits legislators’ options, but is a practical necessity due to Democrats’ insistence on filibustering a bill moving through regular order — the most important thing the House could do is get the bill over to the Senate. There, leadership can tweak the bill to fit the reconciliation rules, knowing that ultimately its compliance with the rules will be judged by the president of the Senate. Who, of course, is Vice President Mike Pence.

That’s been the refrain I’ve heard for some time from Republicans involved in the process. Why that isn’t how it played out in the House from the start, either publicly or privately, is hard to understand.

Nor has the House been particularly good about the one thing it should have been doing all along: Making the case for the big policy elements that are likely to stay in the final bill. For example, the different way this legislation treats those with pre-existing conditions.

The key point here — one that some of us made eight years ago during the original Obamacare debate — is that this is a relatively small population. It’s enough people, with a significant enough problem, that some accommodations need to be made. But it’s not enough people that the entire insurance system needed to be overhauled with a government mandate created for purchasing a private-market product, a drastic change to the economics of health insurance in the way of Obamacare’s “community rating,” and other market-rattling changes.

Obamacare tried to tackle this problem by requiring insurers to take anyone who applies regardless of health condition, preventing insurers from charging these consumers more than healthier ones, and imposing a significant yet insufficient financial penalty (or “tax,” but only when arguing before the Supreme Court) on the uninsured as a way of making them maintain insurance all along. It hasn’t worked. What has happened is younger, healthier consumers have stayed out of the insurance market, leading to higher premiums to cover the higher costs of the older and sicker consumers who did buy plans, leading to an even more skewed population in the risk pool, leading to even higher prices, and so on. Eventually this will hurt those with pre-existing conditions, too, because insurers will simply stop offering plans in areas where they’re bound to lose money. Indeed, that’s already happening.

A far better way to approach the problem of pre-existing conditions is to let insurers price coverage for those consumers appropriately and then use tax dollars to subsidize that coverage for those consumers. That keeps prices down for younger, healthier consumers, giving them more reason to buy plans. Done correctly, it should lead to falling prices — not just for the healthy, but for the sick as well. That means there should be less need for subsidizing those without pre-existing conditions, as Obamacare does to the tune of billions of dollars.

House Republicans have not made that argument well. But I’ll give Democrats credit, if that’s the right word: They know the above explanation is a lot harder to make than “We’ll make sure everyone with pre-existing conditions is covered!” — the economic realities be damned. Had another year or two passed, with Obamacare’s fundamental flaws becoming still more obvious, perhaps their B.S.* sales pitch wouldn’t have worked on as many people. But even if the politics of repeal and replace might have been easier a few years from now, time is also an enemy of reform. The longer people have even a flawed system, the harder it is to persuade them to accept a substantial change from it.

Time is also the GOP’s enemy in this respect: The longer it takes them to pass a bill, the more it appears — or Democrats can scream — they don’t know what they’re doing. They might have gotten away with it had they not promised such immediate action, but they did. Then they didn’t act in the knowledge that getting a bill — any bill — out of the House was more a procedural necessity than a substantive one.

Now I guess we’ll find out if late really is better than never.

*Relax … I meant “bumper sticker.”

NOTE: I am aware that the commenting function is broken on the blog; other MyAJC blogs are having the same problem. Our tech folks are on the case. My apologies for the inconvenience.

Reader Comments 0

231 comments
AndyManUSA#45
AndyManUSA#45

 In the twilight of his life, Madison wrote that "belief in a God All Powerful wise and good, is so essential to the moral order of the World and to the happiness of man, that arguments which enforce it cannot be drawn from too many sources." Only in a culture that "bristles with hostility to all things religious" (as Supreme Court Chief Justice William Rehnquist recently put it) could such a common-sense view fall into controversy--or neglect.


http://www.heritage.org/political-process/report/james-madison-and-religious-liberty

AndyManUSA#45
AndyManUSA#45

You weren't expecting eyeball to discuss the issues, were you?

breckenridge
breckenridge

"What influence, in fact, have religious establishments had on society? In some instances they have been seen to erect a spiritual tyranny on the ruins of the civil authority; on many instances they have been seen upholding the thrones of political tyranny; in no instance have they been the guardians of the liberties of the people. A just government, instituted to secure and perpetuate it, needs them not."  James Madison, Father of the Constitution, 1785

What a nice Sunday sentiment!

Starik
Starik

@breckenridge @JohnnyReb I don't care if you're religious, but why do I have to pay taxes to replace the ones churches and the like don't pay?

breckenridge
breckenridge

May 7 - The House Republican bill repealing and replacing ObamaCare faces high procedural hurdles in the Senate that will likely force GOP negotiators to throw out key portions of the legislation.


GOP senators have already flagged two problems: language allowing states to opt out of regulations defining what healthcare services insurers must cover, and a provision banning them from discriminating against people based on their health.

Another part of the House bill that allows health plans to charge older policyholders five times what they charge young adults — a shift from the 3-to-1 ratio mandated by ObamaCare — could also be a problem.

JohnnyReb
JohnnyReb

@Eye wonder

Kyle should ban you for posting such crap.

You LibProgs who supposedly find no issues with gays and their lifestyle stoop low to use such tripe to nag Cons who they know have a problem with it.

Doom a classical liberal
Doom a classical liberal

@JohnnyReb @Eye wonder


I disagree. Posts like that one by eyesore simply show that they don't have anything intelligent to say. That kind of silliness is perfectly reflective of their intellect imo. So I say let him continue to display his own silliness and lack of intelligent debate. 

SGTGrit
SGTGrit

@JohnnyReb @Eye wonder  Geez, is that eye sour and his lover photo shopped for Trump and Putin on their heads? Yes, Kyle should take serious note. I thought sexually suggestive material is in defiance of AJC blog rules.

breckenridge
breckenridge

Each and every year Planned Parenthood spends over $200 million providing birth control to poor women.  If you want to take that away? Then you're in favor of many more abortions being done every year, and you want to see a massive expansion of the welfare system.  And you really need to be ashamed of yourself.

SGTGrit
SGTGrit

@breckenridge  We must applaud you for being a poor woman advocating for other poor women. Your experience as a victim of unwanted pregnancy lends credence to your arguments but should abortion really be the solution?

breckenridge
breckenridge

@SGTGrit @breckenridge 

You can't have an intelligent discussion about this topic because you just aren't smart enough.  Now run along and play with your confederate flag.

JohnnyReb
JohnnyReb

@breckenridge

Aspirin would be a lot cheaper.

Of course the challenge would be getting that group to keep it pinned between their knees.

They would actually swallow it and then wonder why it didn't keep them from becoming pregnant.

SGTGrit
SGTGrit

@breckenridge @SGTGrit  "Intelligent"? That is a word you can't comprehend let alone be a blessing you don't possess. I was mocking you dip shyte for your uber feminine posts and ridiculous atheist rants.

AndyManUSA#45
AndyManUSA#45

If you want to get an abortion, that's great, I'm happy for you.


You're not using my money to pay for it anymore.


Too bad, huh?

breckenridge
breckenridge

@AndyManUSA#45 

Federal funds have never been used for abortion by Planned Parenthood. You are well aware of that but you repeatedly choose to lie about it.  Why?  I have no idea, maybe you're simply a serial liar.

breckenridge
breckenridge

If the Planned Parenthood defunding in Trumpcare is not scuttled then, for starters, Senators Collins and Murkowski will not support it. Defunding PP would be a fiscal fiasco with extremely costly ramifications.

breckenridge
breckenridge

@SGTGrit @breckenridge 

It's time to break the back of the radical activist Freedom Caucus and drum them right out of Congress.  This sort of radical activism hasn't been seen since the late 60s and the lefties - Students For A Democratic Society, etc etc etc.

SGTGrit
SGTGrit

@breckenridge @SGTGrit  Look we get it...your body belongs to you and if you choose to abort it's between you and your God. We can only hope at the very least you won't use abortion as a means for your birth control.

breckenridge
breckenridge

@SGTGrit @breckenridge 

We've moved on, try and keep up Coast Guard boy.

Now we're discussing the vermin that are the Tea Party/Freedom Caucus and their goal in life - shutting down the government.

SGTGrit
SGTGrit

@breckenridge @SGTGrit  I'm just saying that you're right to abortion is protected under law. Why are you so afraid? I don't agree with your decision/decisions but you're free under the law. Just a personal question, though, don't you feel any remorse for the life/lives you took?

SGTGrit
SGTGrit

@breckenridge @SGTGrit  You should in the interest of decency try to keep yourself from becoming impregnated. Condoms at the very least you should demand from your male partners.

breckenridge
breckenridge

May 6 - A conservative Republican congressman from Idaho is drawing criticism for his response to a town-hall attendee’s concerns about how his party’s health-care bill would affect Medicaid recipients.

“You are mandating people on Medicaid to accept dying,” the woman said.

“That line is so indefensible,” said Rep. Raúl R. Labrador, a member of the influential House Freedom Caucus. “Nobody dies because they don’t have access to health care.”

The boos instantly drowned him out.

This is one thing republicans have to overcome. With specifics, not empty talking points.

SGTGrit
SGTGrit

The most important thing as it pertains to the healthcare issue is that Obamacare is failing. Insures are pulling out as are providers, premiums are continuing to climb along with unaffordable deductions. The objective of the ACA to insure more people has failed because the more who have it can't use it because they can't afford to use it. The fact that something must be done to relieve the situation isn't debatable. In the face of this failure Democrats have proposed nothing to fix it. All they can do is say that it should not be repealed only fixed but they haven't proposed a fix. The Senate needs to take what the House sent them and carefully make changes or additions as needed. There should be no rush. Let Obamacare continue to fail and make certain the public is advised continually. The Democrats think they can sit back and simply throw stones but the Republicans can make that backfire if they play their hand correctly. They hold the cards and the Democrats have no cards to play. Make them own the ACA failure as they deserve to own it.

Starik
Starik

@SGTGrit Obamacare is not what we need, nor is Trumpcare. I agree with you - have a rational discussion in the Senate about what we need and can do to improve health care.  Meanwhile, remember that Obamacare, even if it does fail in some areas, is better than what we had before.

SGTGrit
SGTGrit

@Starik @SGTGrit  Better in what way? Is/does it insure more people, well evidently it does but is that insurance only on paper, on the roles? It seems that is all it does. Real healthcare for the poor is not what Obamacare achieves. No the federal government can't take on healthcare because it has failed. Case in point is the VA. I've seen that failure myself. Fortunately, I don't depend on it now. The federal government can't accomplish what the states are able to do. Sorry, but that's a fact.

SGTGrit
SGTGrit

@Starik  The core disagreement with the left and conservative right as it pertains to domestic issues is a centralized federal government better to control such issues or are the states better to oversee and control those issues. History, I believe has proven that the states are far more effective. The federal government should concentrate on national security and leave it to the states to provide welfare and other social services to the public.

Starik
Starik

@SGTGrit @Starik Southern states have done a lousy job in many, many ways. See public education. Look at the Georgia General Assembly.

SGTGrit
SGTGrit

@Starik @SGTGrit  Sorry, but I live in the South...moved from Georgia to Florida and In comparison to Ohio and Michigan where I once lived during my corporate career, the schools here are far and away far superior. It's location, location, location, the inner cities are way below par, which is true up North. Raised 3 up to adults and have a nine year old late life blessing whose in the gifted program here in Florida. First class teachers.

Starik
Starik

@SGTGrit @Starik I went to the Florida public schools, and some of the teachers were awful, some good. It was, and is easy for the truly ignorant to become teachers. Look at national testing: either the schools in the south are generally inferior or the students are.

SGTGrit
SGTGrit

@Starik @SGTGrit  National testing, I don't put much faith in. It's all about students and more importantly, how involved are the parents with those students. The inner cities fall short because of parent involvement or lack thereof and it doesn't matter where the inner cities are geographically.

Starik
Starik

@SGTGrit @Starik Not when the teachers don't know the subjects they're teaching. Should people who can't read or write well teach? Should a teacher who can't speak standard English speak anything?

breckenridge
breckenridge

Whatever the final healthcare bill looks like, you can be assured that democrats will come up with a list of talking points to try to torpedo the legislation. A few of those talking points will be true; many will bear an ever-so-slight resemblance to the truth; and a few will be outright false.  That is what republicans will have to overcome.


Since this is such an important issue I'd like to see a televised prime time debate to suss out exactly what we would be getting.  Include both proponents and opponents of the legislation, as well as a non-partisan third party to do on-the-spot fact checking.  So if Nancy Pelosi says "this bill will blah blah blah" and Paul Ryan says "no it won't, it will actually blah blah blah" a timeout can be called and an instant fact check conducted.


I think We The People deserve as much.

AndyManUSA#45
AndyManUSA#45

The only Republican who lost an election since obozocare was made into law was the man who created obozocare, mitt romney.


Yes, you can ignore reality, if you so choose.