Of course the Ryancare bill before the House is neither as good as conservatives in our deepest (non-reconciliation-restricted) desires would want, and not even as good as it could be. But it does represent a number of major improvements under current law.
Somehow, I think everybody is missing the significance of the Medicaid changes.
For 20 years (!!!) conservatives have wanted to block-grant Medicaid to the states. It’s good for the federal fisc and great for the states. If it were so easy to do, we would have done it before. This bill moves a good way in that direction. It is a major, major accomplishment.
For the same 20 years, although with less urgency, we have wanted to put work and training requirements on every welfare-like federal program. We succeeded only once, with AFDC/TANF. This bill now does it for Medicaid, thanks to Representatives Gary Palmer and Morgan Griffiths.
For 25 years, we have steadily, steadily, steadily pushed to create and then expand health-savings accounts. This bill does it to an extent so much better than before as to be nearly fantastic.
For seven years we have complained about all the Obamacare taxes. Some of us have particularly fought the medical-device tax as one that is particularly cruel to suffering patients and particularly job-killing. This bill repeals almost every single Obamacare tax, including the medical-device tax.
And that’s not even to get into the insufficient, but still helpful, improvements in patient choice, market principles, and the like that this bill now contains. And it doesn’t include a number of further concessions to conservatives that the House leadership made overnight.
Put it this way: If this bill were labeled the “Improve Federal Health-Care Policy Act” rather than considered as the repeal/replacement for Obamacare, there isn’t a conservative alive who wouldn’t look at it, compare it to current policy, and say anything other than “Wow, what a great series of wins for us! Cool. Let’s do this!”
And then, having done it, go back to work at fully repealing Obamacare in subsequent legislative efforts (plural). This is a Madisonian system. Chip away, chip away, chip away. Achieve conservative improvements, bank them, and come back for more.
One last note: This vote is not for final passage. The bill will be altered by the Senate and, if passed by the Senate, returned to the House. I absolutely guarantee that the Senate will not pass a bad bill back to the House.
Why?
Because just three GOP senators can kill a bad bill by refusing to vote for it. And I absolutely do not believe that of the following long list, all but two would vote to send a crummy bill back to the House:
Ted Cruz
Rand Paul
Tom Cotton
Mike Lee
Ben Sasse
Jim Inhofe
James Lankford
Marco Rubio
Tim Scott
Pat Toomey
Whatever all but two of those senators pass will go back to the House — or nothing will move at all. If a bill does get back to the lower chamber, the House Freedom Caucus can judge it then.