AHCA Passed Ways and Means and Energy and Commerce. Here’s What’s Next, and What We Can Do.

For starters, let’s remember that literally almost no one likes AHCA (the Republicans’ American Health Care Act). Democrats don’t like it. Conservative Republicans don’t like it. Rand Paul really doesn’t like it. Comparatively moderate (as in those who realize that just maybe gutting Medicaid and, to a lesser extent, defunding Planned Parenthood might not be the best ideas) don’t like it. Hospitals, medical associations, and doctors don’t like it. The AARP doesn’t like it, and they even have a man talking to a squirrel to assert just how much it doesn’t like it. Lots of Americans don’t like it. Belying his professed support for the bill, one has to wonder if Trump even likes it, given that he doesn’t want his name appended to it. Since that seems as good a reason as any, rather than designating the Republican travesty that is self-professedly a healthcare bill by its official name, AHCA (which, fittingly, sounds like you’re hacking to death when you try to pronounce it phonetically), we’ll use it as an opportunity to grant pride of place to our current Commander in Chief by calling it Trumpcare. It just has a better ring to it than Ryancare, don’t you think? And it allows us to give credit where credit is due, which is very important.

All of this is to say that those of us opposed to Trumpcare do have a leg to stand on. Yes, unfortunately, it cleared the Ways and Means and Energy and Commerce committees yesterday, though not before Democrats on Ways and Means tried to change the bill’s name to the “Republican Pay More for Less Care Act,” as accurate a title as I’ve ever seen. But with so much opposition against it, we’re on reasonably substantial ground for our efforts.

Let’s review the basics of the process. Republicans want to dismantle the ACA via reconciliation, a parliamentary procedure by which the Senate can pass legislation related to the federal budget with only a simple majority (51) votes. That means, as Sarah Kliff from Vox explains, some of the provisions in Trumpcare might not hold water — such as that allowing insurers to charge people who lose coverage for just over two months 30% more. This one is key to Trumpcare’s functioning (click the link for a brilliant infographic!), since it’s intended — albeit not very well — to replace the individual mandate. As draconian as it is for people with preexisting conditions, and as much as it functions more as a penalty for purchasing insurance than for going without it, theoretically it’s the mechanism by which Republicans intend to convince people to sign up for coverage. But it doesn’t meet the criteria for reconciliation, so Republicans could well run into more than a slight snafu here thanks to the Byrd rule. That means it would need 60 votes rather than a simple majority, and that Democrats could filibuster.

Some other similar examples that Kliff cites that could pose a detriment to Republican ambitions include permitting insurance companies to charge seniors five times as much as younger people and defunding Planned Parenthood. Let’s pause a moment on “defunding Planned Parenthood,” since to speak of defunding the women’s health organization is the definition of a misnomer, given that there is no line item in the federal budget for Planned Parenthood. And here’s your regular reminder that thanks to the Hyde Amendment, no federal funds may pay for abortion anyway, so really all “defunding” Planned Parenthood would do is prevent women and men on Medicaid and other government-based healthcare from visiting a Planned Parenthood clinic for cancer screenings, preventive care, and family planning. And for many of these folks, Planned Parenthood is the only medical center physically accessible to them, so basically what this accomplishes is cutting women, predominantly women of color, off from medical care.

What do all of these instances have in common? They’re regulations pertaining to the private insurance market, not to the federal budget, a red light for the reconciliation process. And even in the event that Republicans manage to convince enough senators that any or all of those provisions actually do impact the federal budget, or ignore the parliamentarian and force Trumpcare as is through using the “nuclear” option, they only have 52 Senate seats. All we need to do is peel off a few Republicans opposed to Trumpcare for whatever reason — whether it’s Susan Collins and Lisa Murkowski, who have expressed their dismay with defunding Planned Parenthood, or Rand Paul who thinks the bill doesn’t go far enough, or Tom Cotton who wants the House to slow down.

In addition to all this, Trumpcare still lacks a CBO score. What’s the purpose of a CBO score? Aren’t you delighted that we finally have the rationale and opportunity to learn all about the wonky nuances of our federal government? The CBO score comes from the Congressional Budget Office (hence the name), which is a nonpartisan institution that “scores” pending legislation based upon cost and effectiveness. It tells our representatives in Congress and the American people how much a bill is likely to cost, and how it will impact people’s daily lives. Of course, it’s not foolproof, but it’s a critical piece of information to have before voting on legislation that’s literally as vital as healthcare. And based on what we know thus far, the outcome of Trumpcare’s CBO score when it comes down the pipes does not bode well. Trumpcare works according to the principles of reverse Robin Hood: it guts Medicaid and subsidies to grant a massive tax cut to the wealthy, insurers, and pharmaceutical and medical companies. The Washington Post put together an excellent overview here that actually manages to render a discussion of taxation compelling and comprehensible. A CBO score will reveal Trumpcare’s innate bias towards the rich and healthy, and against the poor, ill, and women. If that weren’t enough, a CBO score will also render apparent the millions of people — predominantly people with preexisting conditions and disabilities, low-income people, middle-class people, women (especially women of color), and seniors — who will lose their insurance due to being unable to afford it or to losing Medicaid. Remember, access to coverage (which is the professed aim of Trumpcare) is in no way, shape, or form the same thing as actually having coverage (which is the aim, and generally speaking the success, of the ACA).

So we’ve discussed some of the potential hurdles that Trumpcare may meet along its journey to the White House, should it make it that far, but what happens now? Trump plans to go on a mini speaking tour to try to sell the bill to the American people. Wednesday of next week, it’s set to go to another House committee, the Budget Committee, and then after that committee it moves on to the House floor for a vote. Should it pass the House, it then travels on to the Senate, where Republican leaders want to vote on it by early April before the Easter recess. Yes, we’re in a time crunch, but yes, I believe if we garner our strength and work together, we can do this.

What can we do right now? Funny you should ask! First things first, call your representatives. Not once, not twice, but daily. Call them often enough that staffers learn to recognize your voice. Call the committees voting on Trumpcare. Tell your story about how the ACA has benefited you if you have one. Tell multiple stories if you have them. Our stories are among the best tools our Democratic representatives have right now, because they enable them to hold Republicans personally accountable to each and every person Trumpcare will harm, as well as to extend debate and thereby delay voting on the bill. Write letters to the editor and op-eds. Publicize articles on social media and share them among your friends and family. Here are some suggestions for thorough and informative sources to follow, although please note that this list isn’t exhaustive. Like Caring for Us Indivisible on Facebook and Twitter and share and retweet our posts. We’re entertaining and informative, we promise! Here’s our latest tweet thread. Please use the hashtags #noscorenovote (until Trumpcare has a CBO score), #Trumpcare, #ProtectOurCare, and/or #saveACA when you share and retweet. Email us at caringforusindivisible@gmail.com if you want to join our group and/or if have a story about how the ACA has benefited you. We want to publicize your stories to make sure that Republican representatives know that it is fundamentally unacceptable to play games with people’s lives. Healthcare, and healthcare equity, are human rights. Please join us in affirming and devotedly working towards those beliefs.