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Senate Republicans’ approach to health care is bizarre and appalling

You can’t blame Trump for this pile of lies and broken promises.

Nobody can tell exactly what Senate Republicans are doing with Americans’ health care, largely because they keep lying about it.

Five days ago, John McCain called on senators to pay more heed to governors’ words of caution about steep Medicaid cuts. Then he made a dramatic return to the Senate floor, denounced the entire process through which the Senate health care bill had been assembled, and then voted with leadership to continue the process. Nonetheless, he insisted that he opposed the underlying Better Care Reconciliation Act. But then when the BCRA came up for a vote, he voted for it, offering the excuse that the vote was procedural.

But if denouncing both the process by which a bill has been assembled and the substantive ideas it contains doesn’t lead you to vote against leadership on procedural matters, then what do your words even mean?

McCain is often an outlier among Republican senators. But in this instance, he’s being incredibly typical. Mitch McConnell is operating with a narrow Senate majority and basically zero margin for error ever since Susan Collins got off the BCRA bus. Objections to his approach are flying from virtually every direction of the caucus. Yet the health bill keeps shambling forward, since Republicans seem comfortable lying to the American people about essentially all aspects of the process, up to and including their own position on it.

That is the story of the health care process that has consumed the past several months in Congress: the almost unceasing parade of lies.

Republicans can’t keep their story straight

The saga of the “skinny” repeal concept that emerged suddenly Tuesday morning with no hearings, stakeholder discussions, or public debate makes the point.

This is legislation that could be intended to do one of two entirely different things.

  • In one interpretation, Republicans are now prepared to radically lower their horizons relative to what McConnell’s BCRA or Paul Ryan’s AHCA would have done. Rather than enact an enormous tax cut paid for with a gigantic Medicaid cut, skinny repeal would modestly cut taxes and blow up the exchanges while leaving Medicaid intact.
  • In another interpretation, skinny repeal is the opposite. The idea is basically just to have the Senate pass a skinny bill as a placeholder and then go to a conference committee process, at which hardline House conservatives will write a more robust Obamacare repeal bill. Then Senate Republicans will be faced with an up-or-down, no-joke binary choice between the hardline bill and no repeal at all, at which point they will presumably swallow the hardline bill.

There are two critical points about this. One is that even as the Senate GOP caucus appears to be coalescing around the skinny repeal strategy, its members cannot agree as to which version of the strategy they are pursuing.

The other is that neither interpretation accords at all with Senate Republicans’ stated public commitments. A critical mass of Republican moderates has stated clear and unequivocal objections to BCRA-style steep Medicaid cuts. That, if we take them seriously, would rule out the second version of the skinny strategy. At the same time, all Republicans complain that Obamacare’s exchanges are too unstable. That, if we take them seriously, would rule out the first version.

And yet ahead they go.

Republicans’ path to repeal is littered with broken promises

The ultimate irony is that at every step along the way, the argument that appears to propel Republicans forward is the notion that they have an obligation to fulfill their promise to repeal and replace Obamacare.

In reality, everything they have done in pursuit of repeal is breaking promises. As a candidate, Donald Trump promised to protect Medicaid, lower premiums and deductibles, and cover everyone. Every single version of repeal that Republicans have considered does the opposite on every front.

Meanwhile, along the way, key senators have made up new tests to violate. Louisiana’s Bill Cassidy spent several weeks touting the “Jimmy Kimmel test” for legislation and then voted “yes” on a bill (ORRA) that the CBO says would cost 32 million Americans their health insurance coverage. Dean Heller did a joint press conference with his state’s Republican governor in which they promised to protect Medicaid expansion, and then he voted yes on the key procedural vote that has kept Medicaid at risk. Shelley Moore Capito from West Virginia, likewise, flip-flopped on the BCRA after changes were made that were totally irrelevant to her stated concerns.

It’s not unusual for politicians (or, frankly, human beings of any kind) to shade the truth on something or other. But this kind of up-is-down behavior where stated preferences are unrelated to underlying behavior is bizarre. After all, if Capito ends up eliminating West Virginia’s Medicaid expansion after promising not to, she isn’t going to be able to trick people into thinking it hasn’t been ended. Why pretend she was opposed to ending it if she actually wasn’t?

The self-immolation of congressional Republicans

Trump and his administration have engaged in their fair share of nonsense throughout this process.

But it’s striking how much the heaping piles of bullshit that surround the health care debate have nothing in particular to do with Trump. McConnell and his staff spent all of 2016 looking reporters in the eye and touting his commitment to “regular order” as a legislative approach. He sent a senior staffer to the Vox office who very seriously attributed 2015’s relatively productive legislative session to a return of regular order and promised that regular order would continue no matter who won the presidential election.

McConnell and Paul Ryan then, entirely of their own volition, with no evident input from Trump, proceeded to enact the most fantastically irregular legislative process anyone has ever seen. And dozens of Republican senators proceeded to repeatedly bemoan the slipshod process even while continually voting to continue the process. Now they daily — hourly, even — express intense anxiety about the pressure they are under and profound eagerness to see their way clear of this mess. But at every turn, they resist the obvious alternative — a bipartisan process aimed at a bipartisan bill that would actually stabilize exchanges and fulfill both parties’ commitment to improve Americans’ health care.

And since nobody involved can be trusted to keep a promise for even a full afternoon, nobody knows what they’re really thinking or what they’re genuinely trying to do. Millions of lives are at stake, and the best Republicans can do to explain what’s happening is to congratulate themselves on distracting some people with a piece of petty bigotry. It’s bizarre and, frankly, appalling.

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