Speaker of the House Paul Ryan shares a laugh with Republican members of Congress after signing legislation to repeal the Affordable Care Act, also known as Obamacare, and to cut off federal funding of Planned Parenthood during an enrollment ceremony in the Rayburn Room at the U.S. Capitol January 7, 2016.
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GOP health care push reflects a breakdown in American governance

Updated
Stakeholders from throughout the health care system – doctors, nurses, hospitals, patient advocates, et al – have condemned the Republicans’ health care plan is no uncertain terms. To date, GOP policymakers have decided those voices simply do not matter and deserve to be ignored.

Republicans have not, however, heard from their own Congressional Budget Office, as Vox’s Sarah Kliff noted late yesterday:
The House of Representatives will vote on the American Health Care Act, the bill to repeal and replace Obamacare, on Thursday in the early afternoon. House Republicans are hurtling toward a vote on a bill that is disliked by most Americans, opposed by nearly every major health care group, and not yet scored by the Congressional Budget Office.

This is an unusual situation, and a puzzling one.
As broken as our political system often appears, these circumstances are almost hard to believe: House Republicans are poised to vote on legislation that will have a life-or-death impact on much of the American population, but they have no idea what their bill costs, how many citizens will lose their health coverage, or how the deficit will be affected.

But this isn’t just a matter of lawmakers acting from a position of ignorance; this is an example of the Republican-led House embracing collective, willful ignorance. GOP lawmakers don’t know what their legislation would do, and more importantly, they don’t want to know.

As things stand, GOP lawmakers intend to legislate first and get an independent assessment of their bill second.

We’re obviously watching an important political fight unfold, but simultaneously, we’re witnessing a breakdown in American governance. It’s a national embarrassment on a profound and historic scale.

If House Republicans were scrambling to vote on a bill that overhauls the health care system before receiving a CBO score, that alone would be astonishing. But no one should lose sight of the fact that the Republicans’ American Health Care Act has also faced no meaningful scrutiny from lawmakers themselves: there have been no public hearings, no testimony from experts, and no public debate.

Adding insult to injury, the legislation that’s scheduled to receive a floor vote in about five hours wasn’t circulated to members yesterday or published online for Americans to review. Take a moment to consider why Republican leaders in the House wouldn’t want anyone – the media, industry experts, voters, or even their own GOP colleagues – to be able to read the legislation in advance.

This is a bill that, if implemented, would affect one-sixth of the world’s largest economy. It’s being rushed through the House in a way that wouldn’t meet the standards of an elementary school’s student government.

It’s not just the process that’s cringe-worthy. This is a cartoonishly malevolent piece of legislation that deliberately redistributes resources from the bottom up, slashing Medicaid, gutting protections for those with pre-existing conditions, and delivering massive tax breaks to the wealthy. The Affordable Care Act has pushed the uninsured rate to historic lows, and the GOP’s American Health Care Act is likely to push it higher than it was before the ACA became law.

And it’s poised to be passed in a way that will do lasting harm to U.S. policymaking.

No matter what one might think of the competing approaches to health care policy, fair-minded observers should consider this a proper scandal. Americans aren’t supposed to govern this way. We’re better than this. We have to be.

Health Care and House Republicans

GOP health care push reflects a breakdown in American governance

Updated