Republicans are Messing Up on Healthcare Even More Than You Thought

Earlier this week, there was a lot of chatter about how the House GOP’s Obamacare repeal and replace package, supposedly strongly supported by Donald Trump but totally justifiably opposed by the House Freedom Caucus and people like Sen. Rand Paul, could turn out to be really bad for all those white working-class, rural voters who put Trump in the White House and Republicans in charge of both chambers of Congress.

The core problem, as RedState alumnus Erick Erickson deftly noted in a New York Times op-ed, is that most Republicans have shown zero interest in taking steps to bring down the cost of actual health care. While I’m sure Erick has his own ideas how to do this, it seems pretty obvious that keeping guaranteed issue of insurance plus price controls in place as well as banning benefit caps—all of which seems to be part of the Republican plan—is the opposite of it. Basically, by saying they’ll keep these provisions of Obamacare around, Republicans are keeping policy in place that straight-up tells health care providers that they can charge literally whatever they want and know that it will all be paid for. That means health care costs aren’t going anywhere but up, and that makes the whole package a bad deal for taxpayers and poorer, older, less healthy, exurb and rural area inhabiting Trump voters who are probably not going to find themselves better off with the AHCA than they were with un-“reformed” Obamacare, or so indicates the Wall Street Journal.

But if you were worried that these voters were about to get screwed by the Trump-supported House GOP Obamacare “repeal and replace” plan, pay attention: They might be about to get further screwed because a super-simple, small move that the Department of Health and Human Services was planning to take to keep drug prices down for these voters has been postponed until May 22, or maybe indefinitely.

The rule in question relates to the 340B drug discount program, which basically says that if pharmaceutical companies are going to pad their bottom line with taxpayers’ money dished out via entitlements that Big Pharma has consistently fought hard to expand, they have to sell drugs to people with the exact demographic profile of your stereotypical Midwestern or Southern Trump voter at a discount. No taxpayer money is involved. Pharmaceutical companies just don’t like it because it would mean that they have to sell drugs like muscular dystrophy-treating Emflaza for less than $89,000 a dose. Delaying the rule is a big giveaway to Big Pharma, which has spent millions lobbying to kill off 340B, because the rule specifies how to calculate the top price for discounted drugs, and contains anti-overcharging provisions—much milder stuff than having Medicare negotiate drug prices directly or authorizing prescription drug re-importation, both things Trump has proposed.

Given all the outcry over drug pricing in the last 12 months, even though 340B is a teeny-tiny thing, it’s pretty unlikely that its demise or curtailment won’t be noticed—if that’s what ends up happening, which would be weird, not just because of all of Trump’s rhetoric on drug prices, but also because of Tom Price’s reported prior strong support for 340B, and the bad politics of it. But then again, this is the Beltway establishment GOP, and they’ve already proven they’re cool with simply tweaking Obamacare rather than repealing it. Policy being nonsensical and politically suicidal is not an obstacle to their pursuing it, as they prove at least half the time they’re given the chance.

But hey, go for it. If the plan is to make healthcare worse as well as destroy conservative (much less Republican) credibility for a generation, they’re doing a bangup job. But I guess that ship already sailed in November.