Right now, the Republican leadership in the Senate is undertaking an unprecedented effort to write and pass a bill to remake the entire American health-care system in secret, with not a single hearing or committee markup and with its details kept hidden even from many Republican senators. This plan was devised by Senate Majority Leader Mitch McConnell, Ky., who is widely respected for his strategic acumen even by Democrats who believe he has a bottomless void where his soul ought to be.
But is it possible that McConnell’s plan will backfire?
I’ll explain why that might happen in a moment, but it’s important to understand that the secrecy with which this bill is being crafted is a tacit admission on Republicans’ part that its likely effects on Americans’ health care and financial security are so gruesome that it must be kept hidden until the last possible moment, lest the public have time to understand what’s in it.
We don’t know exactly what the Senate’s bill will consist of, but there are a few things we do know. At its heart, it will do what the bill the House passed to repeal the Affordable Care Act does: take health coverage away from millions of people in order to give a tax break to the wealthy. While some hoped that a few moderates and senators from states that had accepted the ACA’s Medicaid expansion might try to save the expansion, that hope is dead. According to various reports, those supposed moderates now support phasing out the expansion, but doing it over seven years instead of the three years that the House bill provided for.
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The Senate bill would also likely transform Medicaid — which today covers nearly 70 million Americans — into a block grant, for the first time allowing states to toss people off and cut back benefits. It will cut back on the subsidies that currently allow those not poor enough for Medicaid to afford coverage. It will likely undo the ACA’s mandates for essential health benefits, allowing the sale of “insurance” that in practice covers almost none of the needs people actually have. It will probably allow insurers to once again impose yearly and lifetime caps on coverage, which can turn a life-threatening illness or accident into a financial catastrophe as well. And it could undermine the protections the tens of millions of Americans with pre-existing conditions now enjoy.
You can see why Republicans might not be too eager to invite Americans to get a good long look at this rancid smorgasbord of poison and misery. And as we get closer to seeing it, we’re learning even more about what the effects of the ACA repeal could be. In the past day or two we’ve seen the release of three new reports on those effects:
The Kaiser Family Foundation looked at what non-group plans (analogous to what people now purchase on the ACA exchanges) covered before ACA’s essential benefits mandate was in place. They found that 75 percent of the plans didn’t cover maternity care, 45 percent didn’t include coverage for substance abuse, and 38 percent didn’t cover mental and behavioral health. Once that mandate is removed, plans could revert to what they covered before.
A Commonwealth Fund study concluded that if the House health care bill became law: “By 2026, 924,000 jobs would be lost, gross state products would be $93 billion lower, and business output would be $148 billion less. About three-quarters of jobs lost (725,000) would be in the health care sector. States which expanded Medicaid would experience faster and deeper economic losses.”
An analysis by the Center for American Progress concludes that if yearly and lifetime caps are once again allowed, 27 million people with employer-based coverage could be subject to yearly caps and 20 million to lifetime caps.
It just gets better and better, doesn’t it? So McConnell’s theory is that if the Senate’s bill were seen, debated and discussed, opposition would grow and grow, and eventually at least three of his members would bail out (the Republicans’ 52-48 majority means they can lose only two votes). Which might well be true.
But the opposite might also happen. The bill’s secrecy is garnering more and more attention, and more and more outrage. It has become one of the leading complaints Democrats make about it. And as any marketer knows, suspense is a terrific tool to increase public interest in your product. Tell people that your new movie or album is coming out soon, but give them only a taste of what it contains, and you’ll heighten the anticipation.
So by the time we actually get a look at the Senate’s bill, all that waiting may have primed the media to give it a great deal of attention, primed Democratic officeholders to run to the cameras to denounce it and primed liberal activists to mount an all-out assault on the bill, pressuring potentially wavering senators to oppose it.
To be clear, nothing is guaranteed — McConnell’s gambit could work. But it’s also possible that his strategy will concentrate all the drama into one intense period of a couple of weeks, generating such loud opposition to it that a few of those Republican senators get spooked enough to abandon the bill. In the end, the outcome may depend on whether the bill’s opponents are ready when the moment comes.