The Senate's health care sham

In 2009 and 2010, Republicans complained bitterly that a major health care overhaul was being rammed through Congress without their input.

Their objections were somewhat off base. The Affordable Care Act, which came to be known as Obamacare, borrowed heavily from a 1990s Republican bill, included multiple GOP amendments, and sprang initially in the Senate from a bipartisan group of six.

But those very same complaints are spot on when it comes to Republicans' own behavior today. Under heavy pressure from President Trump and Senate Majority Leader Mitch McConnell, the Senate voted 51-50 on Tuesday (with Vice President Pence casting the tie-breaking vote) to begin floor debate on a bill that has not been drafted. And when it is drafted, it will be in secretive Republican arm-twisting sessions.

As Sen. John McCain, R-Ariz., said, in a poignant floor speech following his return to Washington after being diagnosed with brain cancer, the American people expect Congress to behave better than "coming up with a proposal behind closed doors in consultation with the administration, then springing it on skeptical members, trying to convince them it’s better than nothing, asking us to swallow our doubts and force it past a unified opposition.”

McConnell bypassed the normal process of Congress, the committee system, in which legislation is drafted and then publicly aired in hearings where experts testify. He has come up with two partial repeals of the ACA and one total repeal. All have elicited significant opposition, largely because they would result in 23 million to 32 million fewer people having health insurance.

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Now McConnell has cajoled all but two Republican senators to begin debate on a mystery bill that not only has not gone through committee, it does not even exist.

The next strategy might be to pass a “skinny bill” that would do little more than repeal the requirement that individuals have health insurance. Never mind that the individual mandate was once a conservative idea to promote personal responsibility. The intent would be to pass something — anything — to form the basis of a common measure with the House.

But even a skinny bill, which the House could pass without it ever coming back to the Senate, is deeply problematic.

As experience in the states shows, guaranteeing a right to buy insurance, without a requirement to have insurance, causes markets to implode. People will wait until they are sick to buy coverage, which is untenable for insurers. Washington state, for instance, had a plan very much like the ACA in the 1990s. After the legislature voted to repeal the individual mandate, all 19 companies offering coverage pulled out of the individual market.

It is not surprising that Republicans would keep coming up with bad bills. The process they have employed to draft and consider this major legislation is an insult to their institution, their party and the American people.

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