The Republicans are on the brink of passing a health care bill that will simultaneously destroy basic principles of legitimate governance and the social safety net. And it’s only Tuesday.
The details of the Republicans’ health care “bill” are still unknown, because the Republicans have yet to make public what version or versions of the bill they will be voting on. There have not been any hearings, of any kind, on the bill. The bill has been drafted by a small number of Senators, all of whom are men. The administration and various Senators have also brazenly lied about the contents of the bill and its expected effects (more on that in a second).
In case anyone has missed the details about the expected effects of the bill: The Congressional Budget Office has projected that all of the versions of the bill that it has scored would result in at least 20 million uninsured in the next 8 years, and millions more in the years thereafter. The insurance industry described one provision that may end up in the bill, the “Cruz amendment,” as dangerous and unworkable.
Basic notions of common sense support those conclusions. A law that ties health care spending to inflation will result in less coverage because health care costs grow more quickly than inflation. A law that allows insurers to deny minimal benefits to insured allows insurance companies to deny coverage for preexisting conditions to people with those preexisting conditions. A law that allows insurers to sell both crappy, minimal plans and more fulsome plans is unworkable, because people who are healthy when they purchase health insurance will select crappy plans, and sick people will select fulsome plans. That selection process does not create stable insurance markets, which require costs to be spread. It also will result in substantial medical costs and medical bankruptcies for the many people who will become ill unexpectedly. Yet that’s exactly what the Republicans’ health care bill(s) purport(s) to do.
Not content with that damage, Representative Griffith offered the following amendment to a spending bill yesterday:
The Budget Analysis Division of the Congressional Budget Office, comprising 89 employees with annual salaries aggregating $15,000,000, is hereby abolished. The duties imposed by law and regulation upon the employees of that Division are hereby transferred to the Office of the Director of the Congressional Budget Office.
In plain English: The division of the CBO that finds facts, such as the projected costs and benefits of legislation, will be abolished.
In some ways the move should be unsurprising. As Helen Murillo and I have written at length, the administration has engaged in a war on information on multiple fronts. It dismisses any negative reports as “fake news”; it offers lies as “alternative facts.” It tries to make inconvenient facts go away by denying them, disappearing them, or discrediting their sources in areas ranging from climate change, gun control, immigration, LGBTQ rights, and police violence, to name a few.
Gutting the CBO is the latest and most transparent step in that process. Throughout the health care debacle, the CBO has been a thorn in the administration’s side. The administration has insisted that no one will be worse off financially from the bill; President Trump has promised that no one will lose their coverage; and Vice President Pence has represented that the bill shores up Medicaid, instead of gutting it, and so on.
The CBO has discredited all of these claims. The CBO calculated that deductibles for people earning $26,500 would increase over one thousand percent, and that 22 million would lose the financial protections provided by health insurance in the next eight years. The CBO also projected that Medicaid would be cut by over $700 billion, or 25%.
In the last few weeks, the administration’s response has been to accuse the CBO of playing politics, calling it “bogus” and “not credible.” (The current CBO Director Keith Hall was a staff economist for President George W. Bush. Hall was chosen to lead the CBO by Republican leaders a mere two years ago.) The White House tweeted a video criticizing the CBO, and the OMB Director asked “Has the day of the CBO come and gone?"
Representative Griffith would have us answer yes to that question, in yet another stunning attack on the institutions and norms that enable legitimate governance. With the CBO gone (or morphed into some kind of “aggregator of think tank estimates,” which Representative Meadows apparently proposed), the government will no longer be in the uncomfortable position of having to discredit information that is offered by …. the government itself , or a government office that is led by an official of the same party as the President and the Senate and House majorities. The administration will instead be in a position to reject all unfavorable think tank estimates as coming from the “elite” or “liberals.” And it will selectively rely on estimates generated by organizations that are funded by interested parties, including the potential objects of regulation, rather than estimates generated by independent groups.
Bracketing its substance (the details of which we still don’t know), the process of the Republicans’ health care legislation has been bad. Things may only get worse from here. The best case scenario is that the Republicans repeat the health care process in other areas, meaning they will draft a law behind closed doors, lie about the contents of the law when it becomes public, refuse to have hearings or town halls on the law, and attack any entity or office that challenges the law. The worst case scenario is the CBO proposal, which institutionalizes the new front in the administration's war on information, and will enable the administration's efforts to deny the existence of problems by disappearing the (inconvenient) facts and promote unsubstantiated propaganda and falsehoods. That is not how sensible policies get made, or how a minimally democratic, republican, or principled government functions.