Opinion: Senate Republicans’ Brutal Honesty about Health Care Reform

Jun 20, 2017

Credit Courtesy / Abe Schwab

As I wrote in the Fort Wayne Journal Gazette earlier this week, there is something fundamentally undemocratic about the way that Senate Republicans are handling their effort to amend/approve the House version of the American Health Care Act (AHCA). Reports indicate that they plan to pass it by the end of June, and yet they refuse to publicly release any version of the bill. 

This has certain strategic advantages. For example, they can avoid being flooded with phone calls and protests from their constituents because their constituents will be unable to criticize anything about the bill. How could we possibly identify what we think is wrong with the bill if we do not know what the bill contains.

For example, one of the complaints about the House version of the AHCA is that it gives states the option to eliminate regulatory protections for individuals with pre-existing conditions. While this doesn’t formally guarantee that protections for pre-existing conditions will be eliminated, it effectively does. Insurance companies are in a better position to protect their bottom line by limiting their responsibility to pay for more services. Eliminating pre-existing conditions from covered services will accomplish this goal, putting pressure on insurance companies to lobby state legislatures to do away with the protections. 

Additionally, the AHCA produced a perverse incentive for those without insurance to not buy it. If effective, this incentive could actually put the insurance industry in a death spiral—because, despite what Republicans continue to claim, it’s not in one yet.

Will these dubious aspects of the House’s version of the AHCA be part of the Senate version? We don’t know and can’t know unless it is made public.

And it’s in this way that Senate Republicans should be admired for the brutally honest way in which they are handling health care reform. The House made their bill public, and it was shouted down by constituentsinsurers, hospitals, and physician groups. But the House ignored the voices of their constituents and the advice of experts and passed it anyway—a violation of basic democratic and professional norms and responsibilities. 

By refusing to make the bill public, Senate Republicans are owning up to their governing choices unlike House Republicans. Neither is interested in listening to their constituents or to experts in the area, but at least Senate Republican aren’t pretending. They’re not interested in democratic governance.