Well, for starters, let's stop calling it a healthcare plan, because what it really is a bastardized version of the Affordable Care Act. It keeps all the goodies that poll real well, like prohibiting insurance companies from denying you coverage for a pre-existing condition and allowing your kid to stay on your insurance plan until he or she turns 26. That's where the good news ends, however.
The GOP plan removes the individual mandate that basically paid for the ACA and replaces it with a 30 percent surcharge payable to insurance companies if you let your coverage lapse, which basically means if you get laid off and you elect not to pay for Cobra, you're fucked.
Next up on the Von Ryan Express is Medicaid. It's phased out by 2020. Instead states will be given block grants that they can distribute as they see fit. And if the amount is insufficient to cover all those who may need it, oh well. That's the price you pay for freedom and liberty.
Next to go are the subsidies, well, as it turns out, not all of them. Under the GOP plan, the top 2 percent receive $275 billion in tax breaks that they can use to buy all kinds of wonderful things like yachts, investment property, politicians, etc... The working poor? They're shit out of luck. Under the GOP plan, they would get tax credits which won't be nearly enough to cover the cost of even a modest healthcare plan. In other words, most of them will be forced to forgo getting insurance. It's probably just as well. I mean, with all those poor people covered, what would the emergency rooms do?
At the risk of sounding repetitive: elections have consequences and this is one of them. But on to the question I posed: how should Democrats approach this bill from hell? For the time being they should do nothing. Just sit back and watch the GOP duke it out. It'll be fun seeing Republicans tear their hair out over this bill, just like Democrats did back in '09. If you recall there were several "moderate" Democrats who ostensibly hijacked the bill and wouldn't let it out of committee until the public option was taken out.
We are already seeing the beginnings of what will be a blood letting of sorts brewing in the Senate. Assuming the bill passes the House, and that's still up in the air thanks to the Freedom Caucus, you have two intransigent camps in the upper chamber who are sure to muck things up: On the Right are Rand Paul and Ted Cruz who are demanding an outright repeal of the ACA and consider the Ryan plan Obamacare Light. They have vowed to vote "No." Then there are the "moderates" like Rob Portman and Lisa Murkowski who are objecting to the Medicaid provision. Both realize that their states could be devastated if the GOP plan became law.
In case you weren't counting, that's four senators out of 52. That leaves dear old Mitch McConnell with only 48 potential "Yes" votes, assuming there are no further defections. And it is highly likely there will be others. The GOP may be 40 years behind the times but they're not stupid. They know full well that once Obamacare is repealed and this new law takes over, they will have their names attached to it. They also know what happened to Democrats in the 2010 midterms after the ACA passed and was signed into law by President Obama. They want no part of that nightmarish scenario. They've already gotten an earful from their constituents in town halls. Can you imagine the fury that will be awaiting them this summer if they vote to repeal?
With the prospect of 14 million people losing healthcare coverage in 2018 and up to 24 million losing it by 2026, if I'm the Democrats, I'd grab a comfortable chair, get some popcorn and enjoy the carnage. Why on Earth would they want to get entangled in this shitstorm, especially when Republicans have been praying for this moment for seven years? Now that it's here, let them have their civil war. Let them find out just how "complicated" healthcare is. Let them deal with the real-world consequences of trying to come up with a law that pays for itself that doesn't screw over millions of people. Good luck with that, Paul.
But after the civil war is finally over and the GOP comes to its senses and realizes that it will need Democratic support in order to get 50 votes in the Senate, what then? Well, that depends on what Republican some up with. Assuming Ryan throws the Freedom Caucus under the bus and McConnell is willing to do the same with his conservative faction, I would then dip my toe into the water.
I'd insist on the following: 1. Leave Medicaid alone, 2. Drop the ridiculous tax break for the wealthy and 3. Keep the subsidies for the working poor intact. Those would be my starting points. Make sure that McConnell knows that no Democratic senator will vote "Yes" unless they see those concessions in the bill. He may not need 60 votes to repeal the ACA, but he'll sure need 60 votes for a replacement. If he balks, tell him to have a nice day and you'll see him at next year's midterms.
It may not come to that. What is more likely is that Portman, Murkowski and a few other brave souls will reach out to Chuck Schumer and form a partnership of sorts. Perhaps a new gang of eight that will box McConnell in and force Ryan's hand. I may be pipe dreaming a bit, but I actually think a few of the more lucid GOP senators could be persuaded to save the ACA; maybe even fix the flaws in it, of which there are many.
Democrats may have more leverage here than they realize. While the Far Right has been chompin' at the bit to get rid of Obamacare, the fact is that, like any other entitlement, once imbedded into the society, it is almost impossible to extricate. Frankly, the political will for a repeal just isn't there. Ryan and McConnell know that. That's why they're fast-tracking this bill. They know the longer this process goes on, the less likely their prospects at repealing Obamacare will be. In fact, I predict that if we go into the summer and the ACA is still on the books, it is probably here to stay, warts and all.
Note: An earlier version of this post said that 26 million people could lose health insurance by 2026. The actual number is 24 million. I have corrected the error.
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