GOP is playing a dangerous game with health care

May 07--In the hours after Michigan's nine Republican congressmen cast their votes for the American Health Care Act, critics made much of the fact that they had done so before the nonpartisan Congressional Budget Office -- whose function is to warn lawmakers when they are about to do something spectacularly irresponsible -- had been able to vet the bill in question.

After all, the critics wondered aloud, what sort of nincompoop hands over his credit card -- or, to be more precise, the U.S. Treasury's credit card -- without demanding to know 1) what he's buying or 2) how much it costs?

The short answer, of course, is: the sort of nincompoop who knows, with reasonable certainty, that the charge in question will never show up on his account.

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House Republicans have been engaging in this charade for seven years. They voted to repeal the Affordable Care Act, aka Obamacare, more than 40 times between 2011 and 2016, knowing full well that the incumbent president would veto their initiative, even in the extremely remote event the U.S. Senate rubber-stamped it.

Like the 6-year old who grandiosely announces that the restaurant bill for his parents' party of 12 is "on me," House Republicans knew they were in no danger of being taken seriously.

The gambit has become a little riskier since Donald Trump became president. Trump campaigned on the repeal-and-replace soundbite himself, and he has boasted that he almost never reads the documents he signs.

So in order to secure the support of House Republicans who had bothered to learn some of the things the House health care bill would do if it ever became law, Speaker Paul Ryan of Wisconsin had to assure them that would never, ever happen.

Destined to fail

It wasn't a hard promise to make.

The more the details of the AHCA become known, the more obvious it becomes that its primary purpose is to scuttle the coverage Obamacare guaranteed to millions of Americans who had previously lacked health insurance and refund the tax revenues the federal government had captured to subsidize that coverage to the somewhat smaller, more affluent group of Americans who bankroll Republican congressional campaigns.

And as much as U.S. senators like the idea of keeping their donors happy, they understand that there is a limit to what their constituents will stand for.

So the chances 51 senators will embrace a bill that cuts rich people's taxes at the expense of middle-class cancer patients, special-needs students and workers covered by employer-subsidized health plans -- all of whom face a loss of coverage, dramatic premium hikes or both under the House plan -- are roughly equivalent to the odds that Fox News will tap Barack Obama to replace Bill O'Reilly.

Every Michigan Republican who signed on to this travesty knows it won't survive even the most superficial Senate scrutiny. Their decision to stand shoulder-to-shoulder with their speaker was not so much callous and cruel as it was cynical and calculated.

But the prize for the most nauseatingly disingenuous performance goes to U.S. Rep. Fred Upton, a Republican from St. Joseph, who protested loudly that he couldn't support a bill that failed to protect constituents with pre-existing illnesses, then sold his vote (and credibility) for an amendment that did more to camouflage the defect than to remedy it.

Malign neglect

The likeliest prospect is a protracted period of legislative dithering, which would be politically catastrophic for Republicans if states, insurers and health care providers exploited that intermission to reinforce and strengthen the coverage provided under the Affordable Care Act.

But that isn't likely to happen, either. Obamacare is not intrinsically doomed to failure, but it is being systematically sabotaged by the Trump administration's refusal to provide critical maintenance, or to guarantee payment of the federal subsidies that have made coverage affordable for millions. Like a car whose owner refuses to fill the gas tank or change the oil, it is bound to break down eventually.

Uncertainty is the bane of actuaries, and health insurers are already abandoning the exchanges in which they had formerly enjoyed the prospect of recovering a fair return. The challenge for the White House and Republican lawmakers is to conceal their own responsibility for the uncertainty undermining the status quo.

If you've figured out that providing affordable health care to the maximum number of Americans is no longer a priority for any of the Republicans celebrating their legislative triumph, you've grasped the cynical essence of the their health care game plan, which is to 1) promote the failure of the status quo and 2) make sure they don't get blamed for it in 2018 or 2020.

It's still a high-stakes game, but it'll be fun to watch -- unless, of course, you're unlucky enough to get sick.

Contact Brian Dickerson: [email protected]

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