While the rest of the country has been transfixed by Trumpian chaos, members of the Senate have spent the last two weeks talking about taking health insurance from millions of Americans.
There is an alarmingly large chance that they'll decide to do so. But if they do, they will almost certainly rely on a political sleight of hand to disguise their bill's damage. Understanding that sleight of hand — and calling attention to it — offers the best hope for defeating the bill.
The effort to take health insurance from the middle class and poor and funnel the savings into tax cuts for the rich is a little like mold. It grows best in the dark.
That's why Republican leaders in the House handled their bill as they did. They did not hold a single hearing, because they knew that attention would have been devastating.
Just imagine a hearing featuring the leaders of these groups, every one of which opposes the House bill: the American Medical Association, American Nurses Association, American Hospital Association, American Academy of Pediatrics, American Cancer Society, American Heart Association, American Diabetes Association, American Lung Association, March of Dimes and AARP.
The House also passed its final bill without waiting for the Congressional Budget Office to estimate how many Americans would lose insurance. The C.B.O. will release that analysis tomorrow afternoon. There is no precedent, outside of wartime, for passing a bill this important in such haste.
After the House did, many observers assumed the bill was too flawed to have much chance in the Senate. Republican senators, aware of the bill's unpopularity, were careful to say publicly that they would start fresh. But the early signs suggest that Mitch McConnell and his Republican caucus are actually mimicking the House approach.
Think of it as the Upton strategy, and I'll explain the name in a minute.
It starts with avoiding public discussion. As Politico reported: "McConnell's strategy is to keep the debate within his conference for as long as possible. There will be no public hearings as a bill is drafted, according to several Republican senators and aides, and he's imploring senators not to leak."
The Democrats' process for passing the Affordable Care Act in 2008-10 was certainly not perfect. But it was radically more open than this process, including 44 hearings and other public events in the Senate alone. Republicans, by contrast, have invited select people to send feedback to an email address — HealthReform@finance.senate.gov — no later than today. (I encourage you to send your own email!)
If secrecy is the first part of the strategy, distraction is the second. Eventually, before a vote is taken, the details of the Senate bill will become public, as they did in the House. And those details will include a long list of problems.
Here's where we get to the Upton maneuver. The House managed to pass its bill only after Fred Upton, a Michigan Republican, offered a proposal purporting to fix one of the bill's highest-profile problems, related to pre-existing conditions.
Never mind that the proposal was only a superficial improvement. Never mind that the full bill was still opposed by conservative, moderate and liberal health care experts. Upton's proposal allowed House members to claim they had "fixed" their bill. It gave them an excuse to vote yes.
Watch for similar moving of the goal posts in the Senate. There, Republican leaders are likely to brag about the ways they have improved the House bill or early versions of their own bill. They will also point to problems in insurance markets, some of which President Trump is deliberately creating, as reason to do something.
But these are the wrong standards. The right standard is whether the bill improves the health care system. A bill that takes away health insurance from 15 million, 10 million or one million Americans — rather than the 20 million or so of the House bill — still deserves defeat.
The final part of the strategy will be arm-twisting. If victory is in sight, McConnell will invoke party loyalty to cajole his colleagues, whatever specific concerns some may have. Being the Republican who brought down Trumpcare wouldn't be fun.
So the current period is important. It's a time for all those groups that oppose the bill, and for the engaged progressive base, to put senators on notice. They shouldn't be tinkering around the edges of a bill that would hurt the middle class and the poor, the sick and elderly, children and the disabled. They won't get credit for making it marginally less cruel.
A small group of Senate Republicans has shown signs of being persuadable, and only three are likely needed to stop a bill. The group includes Lamar Alexander, Shelley Moore Capito, Bill Cassidy, Susan Collins, Dean Heller, Lisa Murkowski and Rob Portman.
They should hear a loud message that Americans aren't in favor of taking health insurance from their fellow citizens. The senators work for those citizens, not for Mitch McConnell, Paul Ryan and Donald Trump.
You can join the writer of this article, David Leonhardt on Twitter (@DLeonhardt) and Facebook. He also writes a daily email newsletter and invites you to subscribe. This article appeared in the New York Times today.
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May 23, 2017
