One of the prime arguments for U.S. House passage of the Trump-Ryan health care bill sounds depressingly familiar. And that should provide a warning for all but the most rigidly partisan.
It may not be perfect legislation, that argument goes, but we promised change, and change is better than more of the same. That’s similar to last November’s argument to vote for Donald Trump — despite misgivings about his character and qualifications — because he will change Washington and couldn’t be worse than Hillary Clinton.
By now, the likely damage from that 2016 illogic is becoming increasingly evident. So is the potential impact of this thoroughly bad legislation, which is why last week’s House action may threaten many Republican members of Congress, even if the Senate improves it.
Six months after Trump’s election, rather than cleaning the Washington “swamp,” he has staffed the government with millionaires, Washington lobbyists and conservative ideologues. They have set in motion steps that portend incalculable damage to the environment, voting rights and minorities without fulfillment of his extravagant promises of reopened steel mills and coal mines, and better and cheaper health benefits.
In areas like the environment and immigration, the administration is quite open with what it’s doing. In others, it’s been disingenuous, like touting White House meetings to discuss the opioid crisis while proposing to eliminate most funds for the agency that is fighting it.
Trump’s Rose Garden “victory speech” was “kind of like” President George W. Bush prematurely hailing the fall of Baghdad as “Mission Accomplished,” Rep. Mark Sanford, R-S.C, said on MSNBC. Though only the House has acted, Trump’s assurance of reduced health care costs and insurance deductibles might convince a casual viewer those problems were solved.
To be fair, the Affordable Care Act has issues that have to be addressed, including the need for expanded Medicaid coverage in states like Texas that rejected it. But much of the current situation, in which insurance companies are withdrawing their coverage, stems from the uncertainty spurred by seven years of GOP efforts to undercut the law and Trump’s failure to develop an acceptable replacement.
Instead, House Republicans passed a measure that would cost millions of lower-income Trump voters their health care coverage and transfer $800 billion from Medicaid recipients to wealthy taxpayers.
Some members justified their votes on their confidence the Senate will improve it.
But regardless of any Senate changes, any ultimate compromise with the House may well lack some of the protections the Affordable Care Act gave many Americans who are older and poorer or have pre-existing conditions. That’s a likely result if Republicans meet their goal of repealing and replacing Obamacare.
Note these key House provisions:
—The bill curbs the Medicaid expansion, which enabled 12 million more Americans to receive health insurance, dumping future costs on states that in many cases won’t be willing or able to afford them.
—It replaces the federal subsidies that helped 9 million lower-income Americans pay for health coverage with tax credits that will provide less financial support, especially for older, sicker people.
—It provides a $765 billion tax cut for wealthier Americans by eliminating tax increases on investment income and higher Medicare taxes that paid for the ACA.
—It punches a hole in the required coverage of certain specific medical conditions like maternity and mental health benefits and the protection against higher costs for those with pre-existing conditions. States could seek waivers of those requirements from the Department of Health and Human Services, headed by bitter ACA foe Tom Price.
Most political analysts agreed that a backlash from the vote could threaten Republican control of the House next year. In an initial test next month, the June 20 runoff election for Price’s old seat in Georgia’s 6th District in the Atlanta suburbs will almost certainly be read as a harbinger of the 2018 midterms.
Another upcoming special election, the May 25 test in Montana, illustrated the tightrope some GOP candidates may try to walk. The New York Times said Republican nominee Greg Gianforte told potential Washington fundraisers he was “thankful” for the House action, but an aide said that only meant he appreciated the process was under way, not that he would necessarily have voted for that bill.
The argument for change over the status quo is always a powerful one in American politics. It was in November. But on health reform, the changes taking place in Washington provide a powerful counter-argument in favor of caution.
Carl P. Leubsdorf is a columnist for The Dallas Morning News. Readers may email him at firstname.lastname@example.org.