Paul Ryan, Donald Trump Promise If You Like Your Cancer, You Can Keep It

You'll be so sick of winning

Now that Republicans have had a whole three weeks to reshape a fifth of the American economy, today's the big day for the House to vote on the GOP's crappy Obamacare replacement, the "American Health Care Act." In a frantic bid to get at least 215 Republicans to vote for the vile sack of crap that Donald Trump used to promise would provide "insurance for everybody" with lower costs and better coverage, the administration has added all sorts of terrific stuff to the bill, like doing away with the requirement for health insurance to actually cover any particular medical services, like ER visits, hospitalization, maternity care, mental health care, coverage for major illnesses, and so on. That way, people can once more buy really inexpensive "insurance" that won't cover them if they go to the hospital or get "sick."

The final bill that gets voted on later today still hasn't been pummeled into shape, but it's increasingly looking like it will toss out that minor part of the law, which had been a sticking point for the House Freedom Caucus, because, as Pennsylvania Rep. Scott Perry explained, allowing insurance companies to sell junk insurance that doesn't necessarily cover real healthcare needs is the very definition of "free market competition," don't you see? “We want the free market competition [...] How can you have free market competition when the government is mandating what is going to be included.” Presumably, the Freedom Caucus would like to eliminate building codes, too, because if people aren't free to buy houses with exposed electrical wiring and foundations made of Play-Doh, how can you speak of a free market?

Even if the final House bill strips out the minimal requirements for insurance, known as "essential health benefits," to win over more members of the Freedom Caucus, there's no guarantee the final mess will manage to get enough votes to pass, since such moves could lose votes from Republican "moderates" -- folks who are OK with a certain level of suffering for low-income voters as long as it won't lead to a Democrat winning. Also complicating the dream of bringing back junk insurance: Back in December, the Congressional Budget Office said if plans don't include those essential health benefits, people who bought such plans wouldn't actually be counted as having insurance in any CBO score of the bill. So if the essential benefits are axed, get ready for the CBO to estimate that far more people will be left without health insurance coverage, beyond the 24 million expected to be uninsured under the first version of the bill. Not that the sociopaths who think junk insurance is a beautiful example of Free Market Success would particularly care, but numbers like 30 or 40 million people uninsured would make for really helpful Democratic campaign ads.

From a more practical perspective -- again, not necessarily a big issue for rightwing ideologues -- there's another big problem with chopping the essential benefits out of the House bill: The main reason they were left in the AHCA in the first place is that stripping them out might make the bill impossible to pass in the Senate -- not just because many Republican moderates would vote against it, but because such a modification could mean the bill would no longer meet the strict parliamentary rules for passing the bill with a simple majority, denying Democrats a chance to filibuster:

In the Senate, the parliamentarian will have to go through every line of the bill to ensure that it meets the strict rules around reconciliation, the fast-track procedure the Senate is using to enact its bill without the threat of a Democratic filibuster. Every provision has to have a direct impact on the budget or it would get struck.

It’s unclear how the parliamentarian would rule on the issue. Republican sources tell POLITICO that when Republicans wrote the blueprint for the repeal bill in 2015, the parliamentarian made clear that insurance regulations would not comply and the issue wasn’t put under significant scrutiny.

Paul Ryan, the midwife to this hellbeast of a bill, is at least aware of the possibility the Freedom Caucus's demands could improve the bill to the point it can never pass the Senate, as he explained in a radio interview with Hugh Hewitt:

“Our whole thing is we don’t want to load up our bill in such a way that it doesn’t even get considered in the Senate,” the speaker said. “Then we’ve lost our one chance with this one tool we have.”

In the endlessly fascinating world of procedural fuckery, it's also possible the move to get the Freedom Cockers on board might just be a bait-and-switch for the sake of winning the vote in the House: Aides from the White House and the House GOP leadership glibly told the Washington Post that once the bill gets to the Senate, Republicans could strip out the provision eliminating essential benefits so the bill could still pass through the reconciliation process. Fun, huh? It's a kind of bipartisanship: To pass this clusterfuck, Trump is happy to screw the people who put him in office, and also to screw the rightwing House members whose support he wants to buy with the promise of a harsher bill.

Not surprisingly, Senate Dems are happy to remind Republicans this sucker is even less likely to make it through the Senate if essential benefits are eliminated:

“What the proponents aren’t telling conservative House Republicans is that the plan to repeal essential health benefits will almost certainly not be permissible under Senate reconciliation rules,” said Matt House, a spokesman for Senate Minority Leader Charles E. Schumer (D-N.Y.).

So hooray for the latest iteration, maybe -- this could get another shuffle before a vote -- of TrumpDoesn'tGiveTwoShitsAboutYouCare, which may be so finely calculated to pass the House that it'll be DOA in the Senate. Everyone's going to be so thrilled with this terrific Obamacare replacement that will make Americans sicker and poorer than before, but thank God, they'll at least have their freedom.

Too bad hospitals don't accept Freedom as a form of payment.

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[ Politico / WaPo / NYT ]