Diary

Are You a Conservative Who Supports AHCA? I Have a Bridge to Sell You.

I’ll admit, the full Ryan-Trump healthcare plan, on paper, doesn’t sound all bad.

They tell us dismissively that the AHCA is only the first phase, containing items that are strictly budgetary in nature, and that the second phase will include scaling back the requirements for what constitutes an eligible insurance policy, and the third phase is a conservative wish list for lowering premiums, including competition across state lines and tort reform.

If you’re a particularly gullible conservative legislator who trusts Paul Ryan and Donald Trump with your life, then perhaps it would be justified to vote for the AHCA—after all, they say we’re going to get what we want with the other two phases of the plan.

But trusting Ryan and Trump to fight for conservative priorities, after they’ve gotten what they wanted, would be a foolish decision, as some senators are pointing out.

We need to pay attention to how GOP leadership is framing the AHCA in their public statements. During the campaign, Trump promised to do away with Obamacare. Ryan’s Republicans have been saying the same thing for years. In their minds, what they need to do to continue getting elected is look like they’re repealing Obamacare.

The AHCA has been mostly framed by both Trump’s administration and Ryan’s leadership team as a replacement for Obamacare, not just one part of a major effort. If they cared about Phases 2 and 3, they’d be advancing those causes in the media as well instead of independently advocating for the AHCA. In fact, they’ve even convinced the National Right to Life to score the vote by inserting modest pro-life language, so that conservatives who vote against the AHCA will be punished.

It’s fairly clear that what they plan to do is check the “Obamacare replacement” box for uninformed voters by passing the AHCA, and leave conservatives (and the American people) out in the cold when it comes to real philosophical reform.

Remember-Phase 2 (regulatory reform) relies on HHS secretary Tom Price to roll back regulation at the agency level. He might be willing to do that, but regulatory reform can easily be washed away by the next liberal administration that comes along.

Phase 2 is essentially worthless when it comes to instituting real long-term change. Apparently here Ryan and Congress plan on punting important policy matters to an executive agency.

Ted Cruz had it right this weekend with regards to Phase 3-he called it the “sucker’s bucket” in an interview with CBS’s John Dickerson. Yes, it looks great. But why should we trust Ryan (who only cares about checking the box) and Trump (who has no philosophical moorings) to fight for our conservative priorities once we’ve given them what they want: the ability to say they’ve delivered on their campaign promises by “replacing” Obamacare?

Cruz also brought up another important point: instead of relying on Democratic support for only the third phase (a priority for conservatives) why will Ryan not make a good faith attempt at passing all three through the reconciliation process, which is likely allowable under Senate rules? The establishment seems desperate to avoid this discussion, and public discussion of Phase 3 in general, probably because they actually hope to see it fail.

The GOP’s healthcare reform package will largely be judged on how it affects premiums. Everyone understands that a small minority of people will lose coverage once the government stops paying for their healthcare, and we need to find a way to take care of this in the short term.

But if premiums continue to increase, as is likely under either continuation of the ACA or the new AHCA, this Republican congress will be held accountable at the polls as more and more people are unable to afford health insurance.

Because of the immediate effect this has on voters, and because the system is so broken, healthcare is an issue that needs to be addressed in a comprehensive fashion.

Yes, the AHCA would be a small step in the right direction, as it purports to replace subsidies with tax credits, cut taxes slightly, and slow Obama’s Medicaid expansion-but by agreeing to take that step, without putting the other steps into place, conservatives will be walking the plank. There will be no motivation for moderates and GOP leadership to risk political capital to fight for the as-yet nonexistent Phase 3 once AHCA has passed.

If Republican leadership does not put forth a comprehensive plan (combining Phases 1, 2, and 3 in legislative form) that will drive down premiums for everyday Americans (regulatory reform, tort reform, HSA expansion, and allowing competition across state lines), conservatives should not fall in line and bail them out by supporting their half-baked AHCA based on vague promises that we will get what we want down the road.

We’ve seen Lucy pick up the football too many times to fall into this trap again.

Yes, there will be blowback and recriminations for conservatives who oppose this legislation, probably on Trump’s twitter account and across the GOP establishment. But if healthcare policy, the signature issue on which most conservatives campaigned, isn’t something to fight over, then what is?

The solution is not to jump on board as Paul Ryan, Donald Trump, and the rest of the GOP establishment, in their quest for short-term political gain, drive the healthcare train off the rails, probably forcing massive bailouts of health insurance providers and allowing the Democrats to institute single-payer the next time they’re in power.