The original Republican health care plan, unveiled by House Speaker Paul Ryan (R-Wis.) a few weeks ago, landed with a thud. Independent estimates found the GOP proposal would strip 23 million Americans of their health coverage, and when Ryan told his members they could either take it or leave it, many House Republicans went with the latter.
So, Ryan tried again, this week unveiling an overhauled version of his plan, which failed to address any of the problems with the first version, and which the Congressional Budget Office found would take coverage from 24 million Americans. The Speaker again told members they had to accept this his bill, and GOP lawmakers again said they wouldn’t.
And now, with their backs against the wall, Republican leaders are making even more changes, managing to make a bad bill even worse in the hopes of avoiding a humiliating failure.
Eleventh hour changes to the bill were made Thursday night – one more attempt to appease Republicans on both sides of the spectrum who weren’t yet on board.
Those changes include a temporary extension of a 0.9 percent Medicare tax on people making more than $200,000…. The other change would move the Essential Health Benefits from being a federal requirement and allow states to determine which ones they want to include in health insurance plans such as maternity care, hospitalization, emergency care and mental health services.
I can appreciate the fact that “Essential Health Benefits” may sound like some wonky phrase that makes readers’ eyes glaze over, but this is a critical element of the debate. Under the Affordable Care Act, private insurers are required to cover a series of health care treatments in every plan. The benefits include things like prescription drugs, maternity care, and various pediatric services, such as vision care for children.
To woo right-wing House members, Republicans have agreed to scrap the Essential Health Benefits from federal law. As Business Insider’s Josh Barro explained yesterday, “If the EHB rules were repealed, insurers could literally sell plans that do not pay for you to go to the doctor, or that don’t pay for prescription drugs, or that don’t cover pregnancy-related care. EHB repeal would also allow insurers to sell plans that do not cover substance-abuse treatment, a key issue for members of Congress from states hit by the opioid epidemic.”
That’s the new GOP plan, as of this morning. It includes all of the provisions most Americans already hate – drastic Medicaid cuts, tax breaks for the wealthy, et al – and then adds additional right-wing cruelty, on purpose.
This may actually work. Much of yesterday was spent marveling at the scope of the Republican fiasco, but it’s entirely possible that the combination of 11th-hour changes, electoral threats, arm-twisting, and heavy-handed appeals based on partisan loyalty may persuade just enough GOP lawmakers to drag this monstrosity across the finish line.
As of now, Republican leaders do not yet appear to have the votes, but a lot can happen in six hours (the vote is tentatively expected this afternoon, between 2 and 4 eastern). On the other hand, Ryan & Co. don’t exactly have a compelling pitch: members will vote on a bill they know Americans hate, without a CBO score, which faces ridiculously long odds in the Senate.
For the White House, Donald Trump has said he’s done negotiating, and if Congress defeats the wildly unpopular American Health Care Act – which I’m reasonably sure he hasn’t read and doesn’t understand – then the president will give up and leave the Affordable Care Act in place.
For the latest vote counts, NBC News and the Washington Post put together good overviews. Note, their numbers don’t match exactly, which reinforces the fluidity of the broader dynamic.