Why House and Senate Republicans hide Trumpcare bill

Clergy and counselors sometimes have to keep secrets. But in politics, what you don’t know can hurt you.

When it comes to crucial public policy, there is no excuse for hiding who a bill affects and what it costs, particularly when the stakes range from bankruptcy to untreated illnesses and deaths. This makes the prospect of a quick reveal of a revised Trumpcare bill and Senate vote so very awful. But there is still potential for concerned citizens to stop this horrible process and the Trumpcare bill.

Health care constitutes one-sixth of the United States economy but the Senate bill has been written entirely behind closed doors. In contrast, for Obamacare, the House held 79 open hearings and the Senate about 100 public events.

Although details about the secret Senate edition are sparse, leaks indicate that it’s a lot like the House version. Millions of Americans would lose coverage, including 14 million on the public insurance program, Medicaid. As health expert Andy Slavitt notes, such secrecy makes special deals more possible.

When the House of Representatives was working on its Trumpcare bill, the first version was negotiated without any hearings or committee consideration. It was so terrible that, after details came out and the Congressional Budget Office analyzed the budgetary and coverage implications, it didn’t go up for a vote.

House Speaker Paul Ryan at a news conference about the American Health Care Act on March 15. Aaron P. Bernstein | Reuters

The lesson for Republicans was to tell Americans even less. Secret negotiations led to a second version allowing states to remove federal protections. This was then rushed out and passed, with the support of Rep. Bruce Poliquin, before the CBO analyzed it.

So it wasn’t until weeks after the House of Representatives, including Poliquin, voted, that the CBO told Americans that 23 million would lose coverage. Low-income elderly people would have to pay absurdly high prices for coverage. While Obamacare cut the percentage of Americans without coverage by more than half, under Trumpcare a higher percentage would be uncovered than before Obamacare.

Among the 23 million losing coverage, 14 million receive Medicaid, a public health insurance program for which over two-thirds of the funds go to children, the elderly and disabled people. At the same time, the top 400 highest income taxpayers would get an average tax cut of $7 million each.

What’s known about the Senate bill is much the same. The shift from covering a percentage of costs to a per capita amount that is tightly capped means less money in all states. It would be a big problem in Maine, since we have a relatively old population. Older people have more preexisting conditions, more expensive illnesses and are more likely to require nursing home care. Medicaid nationally pays for 40 percent of all nursing home costs. Children in rural areas would be especially hurt by these cuts because Medicaid eligible children disproportionately live in such places.

Maine’s fight against the opioid addiction crisis would also be hamstrung because Medicaid has been a major source of funding for treatment, particularly in states that expanded Medicaid. Maine is slated to vote on expanding Medicaid this fall and now has, on average, one opioid-related death a day.

It also appears the Senate bill would allow insurance companies to block care to people with preexisting conditions while formally stating that preexisting conditions would be covered. Because Trumpcare would drop requirements for what’s covered, companies could refuse to cover procedures needed by people with certain preexisting conditions or raise the price for ones that cover them so that they’re unaffordable.

And so it’s rather obvious why Senate Majority Leader Mitch McConnell won’t let people see the Senate version of Trumpcare. It’s bad public policy that’s very unpopular.

A recent Quinnipiac poll found that only 20 percent of people supported the House’s edition of Trumpcare. Just 17 percent of independents said they would be more likely to support a legislator who backed it, with 41 percent less likely. According to the Kaiser Health poll, over 70 percent oppose changing Medicaid so that, as Trumpcare has it, states get a set amount of funds that don’t increase with patients’ needs.

McConnell plans to not release the bill until days before taking a vote in the Senate within the next few weeks. Citizens would have less time to organize and contact their senators.

Before that it’s being hidden because, as a senior Senate GOP aide brazenly told a reporter, “We aren’t stupid.”

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Amy Fried

About Amy Fried

Amy Fried loves Maine's sense of community and the wonderful mix of culture and outdoor recreation. She loves politics in three ways: as an analytical political scientist, a devoted political junkie and a citizen who believes politics matters for people's lives. Fried is Professor of Political Science at the University of Maine. Her views do not reflect those of her employer or any group to which she belongs.