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The dense thicket of lies around Obamacare repeal makes it hard to tell what’s happening

Go ask Alice.

Unknowns always exist in politics, but in the case of the Trump administration, that’s severely compounded by his habit of constantly lying. That’s especially true because the lying disease seems to be catching.

High-ranking administration officials regularly stand before the public and say things that plainly aren’t true. Increasingly, so do many of their leading allies in Congress. Not just in the sense that they make exaggerated or contestable claims about the likely impact of their policies — though they do that too — but in the sense that they aren’t even correctly stating what their policies are.

On the campaign trail, for example, Trump promised time and again that his administration would build the Keystone XL pipeline and do it with American steel. His actual executive orders do not require this. But even after his administration clarified that he wasn’t requiring the pipeline to be built with American steel, Trump stood before the cameras at an Environmental Protection Agency event and said, “If you want to buy pipelines in this country, you’re going to buy your steel here and you’re going to have it fabricated here.”

There’s no sneaky verbiage here or technical explanation of some sense in which this is accurate. Trump is just claiming to have ordered something he never ordered — just as how in the alternative universe of Trumpland, he held the best-attended inauguration in history and had the most productive first 100 days since FDR.

There’s always been a certain amount of dishonesty in politics, but Trump has taken it to a new level — and seems to be making it work. His allies in Congress have adopted the same technique, and it’s the core of House Republicans’ health care sales job.

As the Senate takes up the topic, the conventional wisdom is that the bill as written is DOA in the upper house. That certainly seems to be the case based on Republican senators’ stated views. But it’s impossible to really know. After all, based on House Republicans’ stated views, they shouldn’t have voted for the American Health Care Act either. When legislators adopt the honesty level of Trump University, it’s essentially impossible for outside observers to tell what’s really going on. The situation is both baffling and dangerous, as nobody knows what any of the key players truly stand for.

The mystery of the Republican health bill’s passage

When the original version of the Republican health bill failed, it faced dissent from two directions. On the one hand, there were conservatives who felt it hadn’t gone far enough in rolling back the Affordable Care Act’s regulations to protect consumers against insurance company abuses. On the other hand, there were moderate Republicans who were leery that the bill went too far in rolling back popular ACA provisions.

It seemed to me that there was no basic way out of the circle. But it turned out they could just deploy some flimflam:

  • First, Republicans came up with the MacArthur Amendment to change the AHCA to allow states to waive the Obamacare regulations that the Freedom Caucus objected to.
  • Then when this prompted vulnerable Republicans to complain that patients with preexisting conditions were going to be subject to too much harm, they added the Upton Amendment, which created an $8 billion fund that can be used to defray those problems.
  • The both sides proclaimed themselves happy with the bill, even though this pair of amendments in no way addressed the moderates’ stated concerns.
  • Then they just started making things up. Rep. Steve Scalise said that under the AHCA, nobody can be charged more than anybody else regardless of their preexisting medical conditions. In fact, the law does the opposite.

Paul Ryan told the same lie, but amplified it by placing the words “VERIFIED” in all caps before his tweet.

Earlier in the process, House Republicans had promised that they would “never” let insurance companies charge more to patients with preexisting medical conditions. When they changed the law to break the promise, they dealt with that by deleting the promise from their webpage.

And then when the bill passed the House, Trump stood in front of the cameras to celebrate promising that under the AHCA, “premiums will be coming down; yes, deductibles will be coming down,” even though the law has no provisions to that effect.

This kind of lying is weird and new

It’s worth emphasizing that this kind of lying is different in character from what we are used to hearing in politics.

Politicians, for example, exaggerate routinely about the job-creating punch of whatever new initiative they’re touting, far beyond what most objective analysts would state. But typically, politicians select economic policies that they truly believe would boost economic growth and create jobs. There happens to be systematic ideological disagreement about whether tax cuts supercharge the economy or environmental regulations kill growth.

But what you don’t hear is politicians saying they are cutting taxes when they are actually raising them, or claiming to have put in place a rule to reduce greenhouse gas emissions when they actually did the opposite.

On the ACHA, in contrast, House Republicans just voted for a law that will let insurance companies charge patients with preexisting conditions arbitrarily high premiums to avoid covering them. And they are running around the country saying the opposite.

Under Obamacare, you are not allowed to discriminate against patients with preexisting conditions in any way. Under the AHCA, that anti-discrimination provision can and will be waived at the request of state governments. Insurance companies can’t formally refuse to cover someone based on past medical history, but they could charge a $1 billion annual premium to achieve the same goal.

There is a case to be made for this kind of broad deregulation on the merits, but that’s what the bill does — loosen regulatory constraints on insurance companies. Yet Republicans are claiming the reverse.

Do Senate Republicans mean what they say?

In ordinary political circumstances, I would say that the AHCA’s biggest challenge in the Senate relates to the steep cuts in Medicaid it contains. The AHCA not only rolls back the ACA’s expansion of Medicaid but also cuts the whole program down to something stingier than the pre-Obama level, with very serious implications for the elderly and disabled.

A bunch of Republican senators have voiced objections to these Medicaid cuts. In my younger and more innocent days, I would have categorized this as a big obstacle to getting a health care bill done, since the Medicaid cuts are really the fiscal centerpiece of the House bill.

That, however, is based on the possibly obsolete assumption that the reason Republican senators have voiced objections to Medicaid cuts is that they in fact object to Medicaid cuts. That’s traditionally how the legislative process has worked. People don’t just say they object to a provision of a bill and then a few weeks later turn around and vote for it anyway while pretending the problem has been fixed.

House moderates’ turnabout on preexisting conditions, however, calls that into question. It seems that rather than a solution for the problems of patients with preexisting medical conditions, all they wanted was a rhetorical fig leaf.

House members and the Trump administration already appear to be hard at work on a Medicaid fig leaf. This consists of simply insisting that current Medicaid recipients will see no change under the AHCA.

Health and Human Services Secretary Tom Price went on multiple Sunday shows this weekend to say, falsely, that somehow the AHCA’s $880 billion in Medicaid cuts are magic that can be implemented without anyone losing access to medical care. As my colleague Sarah Kliff recounted over the weekend:

“Are you actually saying that $880 billion in cuts, according to CBO ... that that is not going to result in millions of Americans not getting Medicaid?” [Jake] Tapper asked.

“Absolutely not,” Price responded. “We believe the Medicaid population will be cared for in a better way under our program because it will be more responsive to them.”

Price’s statement is at odds with everything we know about the AHCA. As Tapper noted, the Congressional Budget Office evaluated a previous version of the bill and estimated that it would cut $880 billion from the Medicaid program.

The CBO also estimates that the AHCA would cause 14 million people to lose their Medicaid coverage by 2026. This would mostly be a result of the AHCA ending the Medicaid expansion in 2020, a program estimated to cover 12 million low-income Americans.

Price himself has long favored Medicaid cuts. As a candidate, Trump promised not to cut Medicaid. But he also promised to fully repeal the Affordable Care Act, which would necessarily entail cutting Medicaid. A key question for America going forward is whether Sens. Rob Portman (R-OH), Lisa Murkowski (R-AK), Shelley Moore Capito (R-WV), and others who’ve voiced concerns about the impact of Medicaid cuts on their states actually mean what they say.

Changing the bill to spare Medicaid in a meaningful way would be really hard. But the House “Coverage Caucus” turned out to be willing to settle for cosmetic changes and shiny new talking points. Is the Senate different?

Trump is remaking the Republican Party in his image

Donald Trump’s campaign challenged traditional notions of how the journalistic function is supposed to be performed. He would say things that weren’t true, get dinged for them by various fact-checking columns and other media types, and then just plow ahead and keep saying them.

Trump, as Vox’s Ezra Klein observed more than a year ago, “has the reality television star's ability to operate entirely without shame, and that permits him to operate entirely without restraint.”

For most of the 2016 general election, it seemed like an approach that was basically failing — taking a very winnable election for the GOP and turning it into a potential landslide defeat. But then Trump won. And he hasn’t just continued to govern the way he campaigned — he is largely remaking his party in his image.

It’s become a party where you say you are strengthening protections for preexisting conditions when you are in fact weakening them, or say that nobody will lose coverage as a result of an $880 billion cut to Medicaid. You say you’re going to require a pipeline be built with American steel, then you don’t do it, and then a few weeks later you say you did it.

Capitol Hill reporting, meanwhile, has long more or less relied on the convention that what members of Congress say is an important guidepost to what they think, want, and believe. Not that no member of Congress would ever tell a fib, but that politics is largely an inherently public undertaking in which politicians take public stances on issues as a way to influence the course of policymaking. If that’s changed, then coverage of Congress will need to change too — taking on more of an investigative approach in which the key question is to find out what’s really going on, regardless of what members say they’re doing.

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