Seven years. Ryan and the GOP "Thought Leaders" have had seven years to come up with a replacement plan for ACA. And this was the best they could come up with? The new GOP plan takes away the structures that make ACA work, like mandates, because freedom. They take away the money that makes ACA work, like taxes on the wealthy, because freedom. They take away the restrictions on insurance company CEO pay, because freedom. They take away funding for Planned Parenthood, because sluts.
This is a perfect shitburger of a plan. As Krugman and other note, it has enough of the aspects of ACA to drive conservatives bonkers, while gutting important structures to drive wonks to distraction, while ending guarantees to the poor to enrage liberals. Unlike full repeal, which would kick about 20M Americans off health insurance, this plan will likely only drop 15M. Who said the GOP were heartless bastards? This is a plan that will help people who have money but don't want expensive individual plans. It will do almost nothing for the poor and working poor. At this point, we need to realize this is a feature, not a bug.
At the moment, the following Republican Senators have cold feet. Rob Portman, Corey Gardner, Lisa Murkowski and Shelley Moore Capito object to the cuts in Medicaid (along with most GOP governors who've taken the Medicaid expansion). Rand Paul, Tom Cotton and Mike Lee object to the tax cuts for the rich. Susan Collins objects to the cuts to Planned Parenthood. Only three of those have to continue to hold out against changes, and this is a dead letter. My guess is that Collins, Murkowski and Portman are the most likely to hang tough, but Gardner has a tough re-election ahead of him in 2020.
This presumes that the bill even gets out of the House, where hardline conservatives object to the government helping ANYONE get health insurance. Only 23 GOP hardliners would be needed to kill the bill in the House, and there are close to a hundred who object at the moment.
Of course, relying on the principled independence of GOP members of Congress is a fool's game.
Ryan's strategy is apparently to rush the bill through without a CBO score or adequate hearings. This, you may remember, was the GOP charge against Obamacare: that it was rushed through with unseemly haste. Those of us with functioning memories recall that it took over a year, was scored by the CBO and debated vigorously in both chambers. But once again, the GOP's alternate history takes precedence.
I said somewhere that the two defining psychological characteristics of the GOP were a stunning lack of empathy and a strong predilection for projection. This covers both. It strips health insurance from people who need it, in order to pay for tax cuts for the rich. And the method of passing it is intended to harken back to the ACA passage that never happened. They are retroactively projecting their own tactics on Obama that they have used under Tom Delay and now are seeming to use again under Paul Ryan.
As Krugman concludes above, the GOP is simply unable to come up with functional policy on any number of fronts. Even their good ideas wind up sucking before they are through with them.
This is because on a fundamental level, the GOP does not believe in governance. Or rather they don't believe in the social contract that makes governance possible. They want to strip the state of its ability to help all of us and turn it into a mechanism for helping the rich. View Paul Ryan through that lens and everything makes more sense. In becoming right wing anarchists, the GOP has lost the ability to craft policy.
They have also slowly degenerated into a party that rejects empirical truth. We saw glimmers of this under Dubya ("We create our own reality.") but as they became an opposition party to Obama, they slowly lost whatever moorings they had in facts. Once opposing Obama became, well, everything to them, they necessarily had to oppose the facts that he embraced or the new terrain his policies illuminated. In the fact-free world of the GOP, Obamacare and Social Security are causing the deficit and creating death panels. The reality of 20M people on health insurance at lower than expected costs is simply impossible, so you have to kill it. Why? Because you have to.
The Republican party is bound by chains to a failed ideology of laissez faire capitalism that is insufficient to the modern world. They can't escape it, but being in opposition meant they didn't have to reckon with it. Trump embraces all the fact free aspects of their world, without the ideological pillars supporting him. He embraces their delusions while injecting capriciousness into their process.
This was entirely predictable, not that this brings any comfort.
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