The Weeds: The Republican stealth care plan

Senate Republicans are trying to pass a health care bill without letting anyone know what’s in it.

After the widely-disliked, much-protested American Health Care Act passed the House in March, many (including Vox’s Matt Yglesias) were skeptical it could pass the Senate. The actual policy’s coverage (or lack thereof), it was believed, would become a greater concern to several key senators, who seemed less likely than their House counterparts to be motivated primarily by the ideology of repealing Obamacare. But members of the Senate’s “Coverage Caucus” (as Vox’s Andrew Prokop nicknamed them) have proven to be less influential in the process than expected.

Relying on unprecedented stealth negotiations, Mitch McConnell seems to have a plan to pass a health care bill in the Senate with the help of moderate Republicans — despite only a slight softening of the House’s version.

In this week’s episode of The Weeds, Vox’s Ezra Klein, Matt Yglesias, and Sarah Kliff discuss the Republican’s health care strategy, which appears to prioritize the feat of getting a bill passed over the policy the bill contains.

Ezra says it’s not surprising that they aren’t inviting public debate over the bill. It is “politically indefensible,” he says. “The absolute core of the legislation—true in the House bill and, as far as we can tell, true in the Senate bill—is to move hundreds of billions of dollars from subsidizing health insurance for the poor to cutting taxes for the rich.”

Ezra, Matt, and Sarah also discuss Jeff Sessions’ recent congressional hearing, and they examine a new study on the effects of lead poisoning.

You can listen to the episode here, or subscribe to the show on iTunes here. And be sure to sign up for Voxcare, Vox’s nightly newsletter covering all things health care.

Here’s Ezra on the potential unintended consequences of repealing Obamacare.

EZRA: Republicans will create in Democrats the same kind of driving force that “repeal and replace” created in Republicans. Democrats naturally care more about healthcare than Republicans. So once Republicans take away these coverage gains, this will become like the raison d’être of the Democratic Party, with a lot more institutional and policy support behind it. So then, eventually, Democrats who, among other things, have won the popular vote in the last, what is it, six or seven presidential elections, are going to take back power. And they’re going to do something on healthcare.

And what will have happened here? There have long been these sort of Democratic incrementalists who believe, maybe they like single payer, maybe they don’t, maybe they like Medicare for all, maybe they don’t, but they don’t believe you can get it done. And they believe that for all kinds of reasons. They thought something would be more stable and more possible to pass with Republican support. They thought it was important to get the health industry onboard because they could exercise a lot of force in destroying anything that happened. That was one of the big lessons of 1994, where I think the “Harry and Louise” ads get more credit than they really deserve for killing that bill, but it’s part of the Democratic mythology around that failed effort.

So there are these sort of moderate Democrats, of which Obama was one. Obama said to us in our interview, if I could just do it from the beginning I would do single-payer but we’re not starting from the beginning. They decide to create these public-private hybrid programs, hoping to get Republican support, hoping to get insurance industry support. And so what Republicans have taught them now is, you will not get Republican support for one of these hybrid public-private programs. It doesn’t matter how much you want it. It doesn’t matter what you would bargain away to get it. It doesn’t matter whether you base it on Mitt Romney’s plan. Republicans are going to hate it as much as if it were true single-payer. So that argument is off the table. The health industry is proving to be a completely useless ally. So the idea that it’s really important to have them onboard, Republicans are disproving that.

Because of all this, you’re going to have from here on out the presumption that you do major health reform with 51 votes with a reconciliation, so you need something that can fit through that, which expanding government programs does whereas re-regulating private insurance markets doesn’t. And you’ll have these smoking ruins of Obamacare, which were already pretty hard to defend, because Democrats had to defend the decisions of private insurance actors—Aetna decides to raise premiums somewhere and now Democrats are on the hook for why there’s an Aetna-based premium increase. And so what’s going to happen when Democrats come back in?

I think what’s going to happen in a party that’s already moving left is they’re going to go, not all the way for single-payer where you wipe out everybody’s employer-based insurance, but to something like Medicare buy-in highly subsidized by taxing rich people. And the health industry is going to come to them and say, hey that’s a terrible idea, and I think Democrats and liberals are going to say, sorry you guys had your chance. Republicans might scream and yell, but they were going to scream and yell anyway. And there might be these Democratic incrementalists who say, well why don’t we go revisit Obamacare, and they’re going to be completely discredited, their political argument totally destroyed.

So one thing that I really think is true here is that if Republicans pass this bill, they are creating an unsustainable political equilibrium. Their idea of what to do in the healthcare system is not popular and that’s why it cannot be defended. It’s been proving reasonably straightforward to defend Obamacare’s coverage gains for Democrats, which is why the Republican bill is so unpopular. I do not think it is going to be easy to defend fewer people insured in the future. Democrats are going to have a lot of energy on this, and there’s going to be really no capital left in the wing of the party that has been trying to find compromises and trying to find middle-ground solutions.

And so, I do think that if they pass this, I believe this completely—Mitch McConnell went before Senate Republicans and said if Obamacare is left in place he thinks it will become single payer, and I think it’s just the opposite—if they destroy Obamacare, I think they’re going to get, again maybe not full single payer, but something like Medicare buy-in, within ten-ish years.