They Know Exactly What They're Voting On

The Senate will vote later this afternoon on whether or not to begin debate on a healthcare bill, though they haven’t decided which one just yet. Because of this, the consensus among Senate Republicans and credulous reporters is that they don’t know what they’re voting on.

But of course they know what they’re voting on. If the Senate can muster the 50-member majority necessary to proceed, there is no scenario in which any bill that’s debated or passed will do anything other than reduce the number of people with access to decent health insurance that actually covers necessary care in this country. They are voting to take something vitally necessary away from millions of people. The suffering is a given—the only mystery is in the margins: How many people, precisely, will be harmed.

According to a report from Axios that mirrors other sources on what happens if the motion to proceed passes, the Senate could take up the Better Care and Reconciliation Act, which would cut Medicaid by more than $770 billion over the next 10 years and throw 22 million people off of their insurance by 2026. If this version fails (and there are a number of scenarios in which it fails) then the Senate could move to straight repeal. This option would mean 32 million people lose coverage by 2026. Premiums would also double in this scenario, according to the Congressional Budget Office.

If repeal fails (and there are a number of scenarios in which it fails) then there remains the possibility that the Senate could vote to amend the House bill, which in its current iteration would mean 23 million people lose their insurance by 2026 and Medicaid is cut by $839 billion over ten years.

The most recent addition to the pile is something Senate leadership is calling “skinny repeal,” which would eliminate the individual mandate of the current healthcare law and throw the individual insurance market into chaos. So we have an assortment of bills that could mean 22 million, 23 million, or 32 million people lose insurance, and we have a last minute addition that could mean sabotaging the entire marketplace. The end result of every possible Republican plan is fewer Americans with good insurance and more Americans with no access to insurance at all.

All of this is on top of the 28 million people who remain uninsured because of gaps in the current healthcare law. Some of those gaps have been manufactured by conservative states that refused to expand Medicaid when given the chance, but some of them were built into the plan in the first place. In the absence of universal coverage, the amount of unnecessary suffering our elected officials can politically withstand is always what they’re voting on.