House Passes AHCA; A Few Thoughts On The Future

So they've done it. Republicans in the House just passed the AHCA which will cause at least 24 million to lose insurance, premiums for older people and probably those with pre-existing conditions, even those who have employer-provided health care, to skyrocket, gut Medicaid, and threaten thousands of Americans with medical bankruptcy once again. And all in the name of hundreds of millions in tax cuts for the very rich.

This bill will move on to the Senate where it is theoretically dead on arrival. But, as we just found out in the House, what may look dead and buried can easily come back to life and get passed. Take nothing for granted except the fact the Republican moderates will almost always cave (see Susan Collins entire career).

The cruelty and horribleness of this bill are evident for all to see. They will be put into stark relief when the CBO score of the bill comes out next week or the week after. That score will, in all likelihood, be even worse than before, if that seems even possible.

Amidst my anger and depression, I can give you a couple of slivers of silver linings. First, the Senate will have to wait until the CBO score comes out and then a couple of weeks after that before it can even be able to take up the bill. This will take us into June and give Democrats plenty of time to continue the resistance. In addition, this will waste even more time from the legislative calendar, especially if Schumer can slow Senate business to a crawl, and keep Republicans from doing even more damage in other areas.

More importantly, this vote, even if nothing gets done in the Senate, gives Democrats a much better chance of retaking the House in 2018. In the wake of the passage of Obamacare, Democratic representatives saw a loss of support of between 10% and 15% which helped lead to the wipeout in 2010. If we see a similar move in 2018, there are nearly 100 Republican House seats that could be at risk. Obviously, a lot can happen between now and 2018 but there is no indication that the resistance is losing steam at this point.

On the other hand, I'm pretty sure this vote means the end of Obamacare, even if nothing happens in the Senate. What insurance company is going to decide to participate in 2018 amidst all this uncertainty. As I've been warning last fall, Republicans don't have to repeal Obamacare to kill it, just create enough uncertainty to drive the insurers out of the market. And the insurers are apparently only too happy with that result.

One of the more remarkable features of the debate in the last few months is the overwhelming opposition from almost every sector of the medical profession to what the Republicans were proposing to do and now have done. But there was one notable exception and that was the health insurers themselves. They were shockingly silent throughout the entire debate. The lesson, of course, is that the next run at health care must have some sort of public option and not rely on the private insurance market entirely, if at all.

And, on a personal note, I just want to thank all those Trump voters for raising my premiums and, perhaps based on my age and health, essentially denying me health care by making it unaffordable. It's not politics for me, it's personal.