Who's to blame for the defeat of the GOP health care plan?
Why, Obama, of course!

Today the question I heard over and over, as the Republican health care bill crumbled into dust, was, "Who is to blame?"

Obviously, the old cliche holds true. Who created a plan that insured tens of millions of Americans and gave them much more economic security? Who shepherded that plan through Congress? Who brought in stakeholders and got their buy-in? Who worked tirelessly to get Republican input, even though they ended up refusing to support a bill based on a Republican success story in Massachusetts? Who showed political savvy by making it a comprehensive, many-faceted effort that would difficult to undo? Who endured the pushback, both from a misinformed public and a Republican party that thought they could deny him a legacy? Who worked tirelessly to address problems that sprang up, from balky websites to Supreme Court challenges, with almost no support from a dysfunctional Congress? Who was, I hope, today sitting somewhere on a warm beach with a cold drink and a big grin on his face?

I think all Americans should take a moment this evening to silently say:

"Thanks, Obama."

Barack Obama wanted to do something no U.S. President had done: provide a universal health care system for a country that badly needed it. His ultimate success or failure is yet to be determined. But he got us much, much closer. We have a record low number of uninsured Americans in this country, according to Gallup. We have seen significant efforts to make health care more rational and efficient, even as costs continue to be too high. The ACA needs fixing, there is no doubt. The Republican plan was clearly not the correct fix. It would have made things much, much worse.

Whatever you think of Obama, it's clear that he accomplished all the things Trump has failed to do. He got a complex, difficult bill through Congress. He sold it to the public, at least enough to get 8 years of implementation... now it will be more than 8 years, apparently. He got his party unified in support of it, even at great political cost. He showed strength, toughness, and smarts. Have we seen that from the White House lately?

Trump is now saying he will let the current law fail and blame the Democrats. Well, besides the great compassion that shows for the American people, there are a couple questions that plan raises.

One--what if it doesn't fail? What if the states and the health care industry, realizing how royally screwed we all might be if incompetents and ideologues get their way, find a path to making the ACA work better, without the federal government's intervention? That actually would be a big win for conservative principles, although the conservatives might not realize it.

Secondly, what if it fails? We're in a situation now where Trumpcare is dead, and Obamacare could very possibly die from neglect and malpractice, with a Trump-led campaign of malign neglect from HHS. If this happens, many Americans will suffer, and their suffering will prolonged by a President who clearly doesn't understand the issues and doesn't really care to. Will the American people really blame Democrats, who passed health care reform and got it up and running? Or will they blame the party that can't shoot straight?

When Trump was bumbling through his presidential campaign, a lot of progressives said we were seeing the end of the Republican party. They said that Trump's defeat would split the GOP into two parts, the more traditional wing and the crazy Trump wing. It seems that even in victory, that split is happening, and the first casualty is governing. Trump's "art of the fail" has only clarified the divide among the Republicans. It's a little scary to contemplate where they'll go from here. It's even more scary to realize we all have to go with them.

In any case, what Republican senators once called "Obama's Waterloo" is still standing. It's too early to say that the attempt to repeal and replace the ACA was Trump's Waterloo, but one thing is for sure: Trump tried to take on Obama's legacy, and he got his ass thoroughly kicked.

Sunset is at 7:26 pm. 

At the end of this day, we know that:
1. Our president and his spokesmen are shameless liars.
2. The heads of the FBI, National Security, and the Justice Department all tell a story that directly contradicts what Trump says.
3. Trump's campaign members, possibly including the President himself, are being investigated for colluding with a foreign power in activities that have been called "an act of war."
4. Our President cannot stop himself from doing self-damaging things. This also applies to acts that damage the country.
This is not a sustainable state of affairs. I can only wonder when the GOP ship abandons this sinking rat.

Yes, this is Obamacare Lite.
It’s also Obamacare Cheap.

I have to say, I’m a little surprised at the new Republican bill to reform health care: the American Health Care Act. It would appear that the strong pushback from constituents and stakeholders such as state governors is having an effect: Republican congress members have crafted a bill that does retain some of the signature elements of Obamacare.

Financial assistance to help Americans afford insurance? Check. Not allowing insurers to deny coverage due to pre-existing conditions? Check. A list of “essential benefits” that all plans must cover? Check. Keeping young adults on their parents’ plans? Check. Cadillac Tax? Check. (Yeah, that one surprised me.)

In short, when hard-right Republicans call this “Obamacare Lite,” they’re not wrong. The problem for Republicans is that while Americans agree with them that premium increases and taxes and less choice are all bad outcomes, they still believe that the government does have a role to play in helping everyone obtain health care. They agree with the spirit of the ACA, if not the letter of the law.

As CNN reports,  “The bill on the table right now is closer to a restructuring, than eliminating Obamacare.”

So Republicans are trying to thread the needle—get rid of the parts of Obamacare that people don’t like, while not throwing millions off of their insurance plans and letting them fend for themselves.

But there’s a bigger point—and a bigger problem—here, one that harkens back to one of the cornerstones of Republican principles. The AHCA is an effort to keep some of Obamacare’s reforms, but pay much less for it. They are pushing to cut the taxes, fees, and other elements of the ACA that conservatives are philosophically opposed to. They also believe the ACA imposes regulatory burdens on businesses that are cumbersome and unnecessary.

So, it’s Obamacare on the cheap. Unfortunately, in America, health care isn’t cheap. We have the most expensive health care system by far, with outcomes that are simply not as good as they should be, considering how much we pay for them.

The ACA had a number of initiatives that attempted to cut down on rising health care costs. So far, they’ve had limited success. And this new GOP bill simply assumes that more “choice” and less regulation will reduce costs. That’s more of a wish than a plan. In real life, cutting corners on health care often raises, rather than lowers, costs in the long run.

The truth is, the ACA probably should’ve put more money into providing health care, not less. The problem, for both insurers and consumers, is that the system continues to cost more than their budgets can cover. Yes, we should cut back on health care cost increases. But that’s a nut we still haven’t cracked—and the old mantra of getting government out of the way is simply not going to work. Reducing the number of insured Americans is not the way to cut costs. 

Today, any effort to cut back the scope of the ACA is going to be problematic for providers, state governments, and the consumers of health insurance. Providers will lose insured patients, and hospitals will be forced to do more charity care—which will force insurers to raise premiums. Insured patients will have higher copays and deductibles, and many will lose some or all of the subsidies. It’s hard to see this law not resulting in millions losing coverage.

At first glance the Medicaid piece stays pretty much the same until 2020, when states will start to have to pay more for that population. But… that’s just kicking the can down the road, isn’t it? And there’s troubling language in the bill suggesting that mental health treatment could be degraded over time with the Medicaid changes.

That brings us to my last point. Whether you call it Obamacare Lite or Obamacare Cheap, this proposed law is simply inferior to the current law. It will cover fewer people. It will almost certainly make health insurance more expensive for many.

So far, trying to create Obamacare Cheap has not met with a lot of support. Put aside the opposition from both ends of the political spectrum, the stakeholders affected by this bill are not fans. Groups like the American Medical Association, the American Hospital Association, and AARP have come out against the bill. The current medical director of Medicaid has spoken out against it. The health insurance industry’s biggest lobbying group, Americas Health Insurance Plans, has asked for major changes.

Also troubling is the fact that House Republicans are trying to push the bill through committees before the CBO can score it—a sure tell that Republicans know an impartial analysis will find the numbers in their bill will not add up.

As Ezra Klein plaintively asks in the video below, what’s the point of all this? If we end up with a fix for Obamacare that still does some of the same things, only not as well, what have we accomplished? Yes, Republicans can say they kept their promise. But if the country is worse off for it, is that really what we want?