AHCA Is the Legislative Broccoli That No One Wants to Eat

Michael Brochstein via ZUMA


Hardline conservatives in the House aren’t happy with AHCA, the Republican health care bill. It’s just Obamacare with a fresh coat of paint. And they have a point:

  • When they say that AHCA tax credits are the same thing as ACA tax subsidies, they’re right.
  • When they say that AHCA’s community rating with a 5:1 age band is the same thing as ACA’s community rating with a 3:1 age band, they’re right.
  • When they say that AHCA’s continuous coverage provision is the same thing as ACA’s individual mandate, they’re right.
  • When they say that AHCA’s ban on turning down people with pre-existing conditions is the same as ACA’s ban on turning down people with pre-existing conditions, they’re right.
  • When they say AHCA’s reliance on Medicaid for the very poorest is the same as ACA’s reliance on Medicaid for the very poorest, they’re right.

But moderates aren’t too happy either. And they also have a point:

  • When they say that AHCA tax credits are far stingier than ACA tax subsidies, they’re right.
  • When they say that AHCA’s community rating with a 5:1 age band punishes old people compared to ACA’s community rating with a 3:1 age band, they’re right.
  • When they say that AHCA’s continuous coverage provision is a pretty clunky way of implementing ACA’s individual mandate, they’re right.
  • When they say that AHCA’s ban on turning down people with pre-existing conditions is less rigorous than ACA’s ban on turning down people with pre-existing conditions, they’re right.
  • When they say that AHCA slashes Medicaid support for the very poorest compared to ACA’s Medicaid expansion, they’re right.

You can see the problem. Hardline conservatives object to Obamacare in principle, but AHCA mostly adopts the same principles. Moderates don’t care so much about how it gets done, but they object to voting for a bill that’s likely to produce big electoral blowback when people figure out just how crappy it really is compared to Obamacare. There’s really nothing here for anyone to like.1

Paul Ryan has tried to tap dance around this, but Andrew Prokop is the latest person to mention that Donald Trump isn’t even bothering:

When Trump talks health care in public statements and in accounts of his private meetings, he keeps making the following four pretty simple points:

  1. Obamacare is a disaster that’s falling apart.
  2. If Republicans don’t pass the bill, they’ll do badly in the next election.
  3. Republicans have to pass the bill so they can move on to tax cuts.
  4. He — President Trump — and the Republican Party need this “win.”

There is no case for the American Health Care Act itself there. It’s all either political or a rote condemnation of Obamacare.

I give Trump points for having the right approach here. There’s almost nothing about AHCA that would earn it passage based on the merits. There’s just too much disagreement. Except about one thing: sticking it to liberals and Obamacare. Appealing to that kind of tribalism is literally the only thing that has a chance of producing enough emotional energy to overcome conservative fear of selling out and moderate fear of voter blowback.

It’s likely to work, though it’s encouraging that AHCA is (probably) going to pass only barely in the House. That was supposed to be the easy part. But if it’s a nailbiter in the House, what chance does it have in the Senate? Probably not much, though appeals to tribalism, vindication, and party loyalty are, once again, the only plausible path to victory.

Mitch McConnell, savvy old warhorse that he is, knows this perfectly well, and that’s why he wants to speed AHCA through the Senate in record time. It’s either going to pass or it’s not, and either way, time is not on his side. The longer AHCA festers, the more outrage and opposition it will generate. The justification for doing health care before tax reform is already gone, so if it’s not going to pass, best to find out quickly and move on to the real business at hand.2

1Except for AHCA’s big tax cuts for the rich, of course. Both moderates and conservatives agree about that.

2Tax cuts for the rich reform, of course.