Thursday, May 4, 2017

Listen and Do: we can still save healthcare.

Today, the House of Representatives passed the American Health Care Act.  It's a pretty terrible bill, and everyone knows it.  So what is going to happen, and what can you do to help save lives?

Let's take the last part first.  If you want to help save American lives by protecting Obamacare, then you do not want to start calling senators or congresspeople who don't represent you.  They don't care and that won't help.  You want to punish the people who did this, to scare senators who might consider voting for anything similar.

No Democrats voted for this thing.  If you're represented by a Republican, you should already be out there fighting.  If you're in a blue district, you have two options if you really want to make a difference:

  • Give your time and volunteer to help the closest swing district, as identified by SwingLeft.  For me, it's NY-19 and its Congressperson, John Faso.  Make them pay by making them lose their seat.
  • Give your money specifically to support the eventual opponent of those who voted for this thing.  Help make this a big number by chipping in $5 or target vulnerable representative Darrell Issa directly here, whichever feels more satisfying to you.

So now that you've committed your time or money, what's going to happen next?

Well, the AHCA is past the House.  But it's not a law.  Now it goes to the Senate.  They debate and vote their own version (since they won't pass this one, flat out), and then both bills go to a conference between the two groups.  They work out a compromise, and then that compromise is agreed-upon in the House and Senate a second time.  Then it goes to the president.

So we're closer to Obamacare repeal than we were yesterday, but still pretty far off.

What's likely to happen?

Well, first of all, it turns out that the Senate isn't even going to touch this bill.  In fact, they're saying they won't take it up at all.  Instead, they've been meeting for a while now to work on their own bill which may have some elements of the AHCA.  The Senate is much more loathe to make big and nasty changes, so they're taking their time.
A Senate proposal is now being developed by a 12-member working group. It will attempt to incorporate elements of the House bill, senators said, but will not take up the House bill as a starting point and change it through the amendment process.
"The safest thing to say is there will be a Senate bill, but it will look at what the House has done and see how much of that we can incorporate in a product that works for us in reconciliation," said Sen. Roy Blunt, R-Mo.
"We are going to draft a Senate bill," added Sen. Chuck Grassley, R-Iowa. "That is what I've been told."
There's no stated timeline, but it would be very ambitious for them to produce anything this month.  The Senate is much more deliberative, a fact that senators take distinct pride in, and so they won't rush.

As they work, other things will happen.  Congress is going on break again this week.  That's going to be a week of town halls and protests and reaction to fill the news.  Hopefully we'll also get some big fundraising numbers to target vulnerable House members.  A lot of vulnerable representatives were asked to vote for this, even though it's going to hurt them badly to pass such an unpopular bill.

Making this break even worse for them is that the CBO score will be released next week.  The CBO score, as you remember, works as an official estimate of the consequences of major legislation.  The last one found the original bill would have been disastrous.  The next one won't be much better (which is why they rushed this vote through, even though many representatives admitted they hadn't had time to read the amended bill).

One possible version of events: the Senate passes their own bill that's somewhat similar, then it goes to both houses of Congress.  They feel pressure to vote for it, since they already approved an earlier version, and so they do.  Trump wants to claim it as a win, so he signs it.

Along the way, here are things that could go wrong:

  • The Senate may find it very hard to come up with a version of a similar bill that can get 51 votes.  Talks might break down and they might find an excuse to let this quietly die.  The more scared they are of the consequences, the more likely they slow-walk this and let it waste away.  Perhaps a 30% chance of happening.
  • The conference might be unable to turn up with a bill that will pass muster in both houses.  This is less likely than you think, since what usually happens is that the Senate drives the bus and the House passes whatever they get.  That's what happened with Obamacare, after all!  Perhaps a 10% chance of happening, fleshed out to that number by virtue of how many other factors might get in the way.
  • Trump hears so much about how the bill cuts Medicaid (which he swore not to do) and doesn't protect pre-existing conditions (which he swore to do) that he decides he won't sign it.  This is very unlikely -- perhaps a 5% chance of happening, I think.
The end number is about a 45% chance this still gets derailed somewhere along the way, which seems about right to me.

Now, right about now you are saying, "What the hell?  You told me Obamacare would be fine!  That's 55% odds it dies!"

And that's true.  But I'm still right.

This was a big hurdle, make no mistake, and it's now more likely than not that Obamacare will be repealed.  There are a lot of things that might go wrong, but I have committed not to lie or sugar-coat things on this blog.  It's close to even odds that they get something to the president and he signs it.  (Even though it might, in all honesty, just be fiddling around the margins so they can claim a victory).

But repeal of Obamacare would not be the end, since as I wrote in February, there's no going back to the time before it passed.  The law has fundamentally and forever changed the entire way we regulate healthcare.  It is no longer acceptable to allow insurance companies to not cover people with pre-existing conditions, for example.  It is now widely believed that the government should be involved in making sure everyone has insurance.  That's not changing.  And to the extent that Trumpcare fails in those regards -- and it will fail -- then it will not be the end of the story.

So I'm going to throw another number at you:


I think that those are the odds that, in ten years, we have a healthcare system that allows insurers to discriminate against people with pre-existing conditions.  And that's being pessimistic -- I initially wrote 0%, before I came to my sense and tried to think skeptically.

This is the last war, folks.  This is the one that Republicans already lost.  They're fighting battles over this territory, but it's like the Battle of Palmito Ranch during the Civil War: it's terrible and the outcome is important, but the war is over.

Be outraged, but don't be afraid.  They're wasting our time and our money, and they might hurt a lot of people as they do it... but they'll lose.  As long as we march and sing and vote, they'll lose.

Here are those Do items again:

  • Give your time and volunteer to help the closest swing district, as identified by SwingLeft.  Make them pay.
  • Give your money specifically to support the eventual opponent of those who voted for this thing.  Help make this a big number by chipping in $5 or target vulnerable representative Darrell Issa directly here.  Make them afraid.

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