On Tuesday, the Senate voted 50-50 on a motion to proceed to a debate on Trumpcare, forcing Vice President Mike Pence to come in and make the tie-breaking vote in favor of moving the bill forward. This means the rest of the week will be filled with debates on the floor, procedural votes, and offerings of amendments culminating in a vote on a final bill. At this time, we do not know exactly when that vote will take place, what the bill will look like or if it will pass.
Senator Lisa Murkowski (AK) and Senator Susan Collins (ME) broke from party lines on the motion to proceed vote, arguing that they could not vote to move forward on a bill they didn’t know anything about.
The truth is none of the Senators, save for maybe Majority Leader Mitch McConnell (KY), know what Trumpcare will end up consisting of. The entire process has unfolded in secret, quietly crafted by the special interest groups of the far-right and major corporations, with no committee hearings and no opportunities for Democrats to participate.
What we do know are the main Republican goals for this healthcare plan. First, they want to end the individual mandate in the Affordable Care Act that required all Americans to purchase health insurance or pay a tax penalty. Ending the individual mandate would likely lead to many young, healthy people opting out of insurance coverage and fleeing the marketplace, causing premiums to skyrocket for those left enrolled.
Second, Republicans want to eliminate the Medicaid expansion, cut Medicaid funding by over $700 billion and re-structure the program so that each state would receive funding through either a block-grant or a per-capita cap. These cuts to Medicaid, which currently provides health insurance to 74 million people, would force states to either kick people off of coverage, limit the number of services available to recipients or most likely both. This would lead to the closure of hospitals and nursing homes, and flood emergency rooms with patients coming in with otherwise treatable conditions, forcing even higher co-pays onto the insured.
Third, GOP leadership intends to give an over $500 billion tax cut to the wealthiest Americans and corporations. One of the main reasons this bill is being forced through so quickly is so that there is enough money in the federal budget to fund those tax cuts when the 2018 fiscal year budget is crafted in September. As we know from past experience, if a budget doesn’t get passed by the end of September, the government shuts down, and Republican leadership is getting overwhelming pressure from their major donors to make sure those tax cuts are in the budget.
McConnell is trying to pass Trumpcare as a budget reconciliation bill—legislation that is meant to balance the budget not change policy—which allows him to force it through with only 51 votes as opposed to the 60 votes required for a typical policy bill. However, late last week the Senate Parliamentarian found that there are some much desired Republican provisions in Trumpcare that do not comply with budget reconciliation rules, including defunding Planned Parenthood, restricting abortion coverage in the private insurance market, and imposing a six-month insurance waiting period on people who have had a gap in coverage.
So far it is unclear what will happen. Multiple Republican Senators have amendments ready to introduce and McConnell has promised to offer monetary sweeteners to states who’s Republican Senators are on-the-edge. Still many are hoping to switch out Trumpcare with an actual bi-partisan bill that solves the short-coming of the Affordable Care Act by going back to the drawing board, crafting a plan in cooperation and bringing it through the committee process.
Democrats, insurance providers and healthcare advocacy groups all argue that there is currently nothing in the Trumpcare bill that would lower premiums or increase access to health insurance for most Americans. It is one of the most unpopular pieces of legislation in decades, and would force anywhere from 22-32 million people off of their health insurance. Yet the fire under Republicans to pass this bill continues to grow, both from the hard-right dead-set on destroying Obama’s greatest legislative accomplishment and the super-wealthy dead-set on stuffing their pockets by taking healthcare from the poor.