House Speaker Paul Ryan and President Donald Trump appear to be testing just how cruel their healthcare plan must be to win enough Republican support to pass Thursday's House vote.
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Despite widespread outrage over what is already said to be a "massive transfer of wealth" from the lower to upper class while also stripping millions of people of their healthcare coverage, Trump and Ryan have been negotiating with the ultraconservative Freedom Caucus over last-minute changes hours before Thursday's floor debate and vote on the American Health Care Act (AHCA).
Watch the C-SPAN feed here.
The leaders have reportedly agreed to consider a proposal to repeal the "essential health benefits" (EHBs) that were central to the Affordable Care Act (ACA), or Obamacare. This mandate, The Hill explains, "was intended to require insurance companies to provide coverage in 10 areas, including mental health coverage, pediatric dental and vision care, maternity care, and prescription drugs," in order to "prevent insurers from offering skimpy plans that would leave people on the hook for thousands of dollars in costs if their plan doesn't cover certain services."
House Minority Leader Nancy Pelosi (D-Calif.) gave a press conference Thursday during which she decried the changes, namely eliminating the maternity care provision, as "a pregnancy tax," saying it would re-institute the idea of womanhood itself being a "pre-condition."
However, that concession may torpedo the plan's viability among moderate Republicans. Politico reported late Wednesday:
Moderate Republicans huddled with Speaker Paul Ryan and House leaders for nearly two hours Wednesday night but emerged without consensus. Immediately after exiting the meeting, Rep. Charlie Dent (R-Pa.), leader of the House's moderate Tuesday Group, panned the bill, known as the American Health Care Act.
"After careful deliberation, I cannot support the bill and will oppose it," Dent said in a statement upon leaving the meeting. "I believe this bill, in its current form, will lead to the loss of coverage and make insurance unaffordable for too many Americans, particularly for low-to-moderate income and older individuals."
Similarly, Republican Rep. Justin Amash of Michigan wrote online:
Repealing EHB, w/out making other substantial changes, would make the bill worse, not better. It would hurt the sickest people on exchanges.
— Justin Amash (@justinamash) March 23, 2017
But that's not all. Freedom Caucus members on Thursday are reportedly pushing for even more drastic changes, namely repealing protections for people with pre-existing conditions—which Politico notes is a "non-starter with most Republican lawmakers," in addition to betraying a key promise during Trump's presidential campaign.
McClatchy is tracking where House lawmakers' votes are falling. With no Democrats backing the bill, the GOP can only afford to lose 22 members in their 237-member caucus.
Whether or not those final amendments make it into the House draft, and whether or not a bill even makes it past the Senate floor, Democratic lawmakers and healthcare advocates say that anyone who backs the AHCA—including President Trump, who has thrown his full weight behind it—will have to answer to those who will suffer as a result.
Vox columnist Ezra Klein went so far as to declare the AHCA Trump's "Iraq War," writing Thursday: "Just as there were no WMDs in Iraq, there is no health insurance Eden where everyone has better coverage at lower costs waiting on the other side of the AHCA—and there will be no hiding that fact if the law passes."
Similarly, pointing to the healthcare debate, Sen. Bernie Sanders (I-Vt.) observed in an interview posted on his Twitter feed early Thursday that "in the midst of this Trump disaster, millions of people, a lot of working people, some of whom voted for Donald Trump, are catching on that Trump lied."
"Remember, he said, 'I am going to bring you a wonderful program, healthcare for all people.' Well guess what," Sanders continued, "he lied. He's gonna throw 24 million people off health insurance. The American people are catching on."
"Our job," he continued, referring to congressional Democrats and left-leaning Independents, "is to not forget for a second we remain the only major country on Earth not to guarantee healthcare to all people as a right and the fight continues for a Medicare-for-All, single payer system."
If there is a silver lining to the effort to repeal and replace Obamacare, it is the swell of support for a single payer option.
"[E]ven if the Republicans succeed in repealing the health care law, they won't be able to erase what may be one of the Affordable Care Act's most important accomplishments: significant progress on the idea that all people should get health care," LeeAnn Hall, co-executive director of People's Action, wrote Thursday.
"What's new," she continued, "is the opening that the callousness of the Trump administration and the GOP provides for holding up an alternate vision—one in which what we want for health care reflects what we want for our country overall."
To wit, an analysis published this week by Dr. David Himmelstein and Dr. Steffie Woolhandler with Physicians for a National Health Program,found that, in contrast to the 24 million people expected to lose health coverage under the AHCA, by replacing the ACA "with a universal, single-payer health system, along the lines of the Expanded and Improved Medicare for All Act, H.R. 676, would provide immediate coverage to the 26 million Americans who are currently uninsured, saving at least 20,984 lives in year one."