Trumpcare Dies in the Senate. Cause: Pre-Existing Conditions

In recent days and weeks, the debate over the future of Trumpcare in the media has generated a kind of Health Metaphor Full Employment Act. You’ve read the words: Trumpcare was On Life Support. It was in Critical Condition or Guarded Condition. It was hashtagged with #Emergency Room or it was Flatlining. Its declining fortunes dovetailed with the phrases available to describe it.

Finally, on July 18, the medical language ran out about the same time the bill did: Trumpcare, aka the American Health Care Act, was dead at the age of four months and 12 days. Time of death? Depends on who you asked. Some say it died that day, when Republican senators Susan Collins of Maine, Lisa Murkowski of Alaska, and Shelley Moore Capito of West Virginia announced plans to vote against the legislation.

Others think it died the day before, when GOP senators Jerry Moran of Kansas and Mike Lee of Utah stated their opposition. Some have even said the legislation to repeal and replace Obamacare was in dire straits back in June, when Senators Ted Cruz of Texas, Dean Heller of Nevada, and Rand Paul of Kentucky expressed their opposition (and despite the passage of the bill in the House on May 5).

But there’s not much debate over the cause of death: Trumpcare died from complications of its own elitist history; an inability to improve on what it was meant to replace; and the passionate and ecumenical reaction to the Trumpcare bill in social media, editorials, petitions, months of sour polling data, phone calls and — especially — in angry, deeply personal reactions from citizens at town halls across America.

For the weeks beforehand, we were never entirely sure what Trumpcare’s fate would be. There’s a trope common to horror movies: Just when you think the villain has been permanently defeated, the evil vanquished never to return... the strings on the soundtrack quiver with intensity and... the hand of the evildoer slowly creeps back into the frame, not quite dead after all.

Senate Majority Leader Mitch McConnell, who could have no more than two “no” votes for the Trumpcare bill to pass, did his very best to make Trumpcare deliberations as close to a horror thriller as he could. After Moran and Lee stated their intention to vote “no,” McConnell came forward to say (cue the quivering string section) that he would go all in with a motion to proceed to consider, to repeal the Affordable Care Act without an immediate replacement — something Republicans tried in 2015. Oh, he assured us, they’d find a way to replace it at some point... two years down the road. The Tuesday statements from Capito, Collins and Murkowski made short work of that.

With that hail-Mary move, McConnell may have intended to embarrass any wayward Republican senators, hoping to compel a straight party line vote that would publicly indicate where his colleagues’ deepest loyalties lie: with the party or their constituents.

If so, that was a waste of time. Any dissident senators had plenty of cover for voting against the measure. Everyday people had been regaling senators (and House members) for months at town halls and online, demanding that the Affordable Care Act, the centerpiece of President Obama’s domestic agenda, be kept in place.

The nonpartisan Congressional Budget Office had scored the various versions of Trumpcare, finding it would have thrown at least 22 million Americans into economic perdition, with higher premiums, eliminated tax credits, and an insurer option to charge older people up to five times more than their younger counterparts.

Dozens of polls released between early March and mid-July, sampling opinion across the political spectrum, were consistently downbeat. And in a June 26 letter, the CEO of the American Medical Association expressed a vote of no confidence in Trumpcare, saying it failed the first test of modern medicine: Primum non nocere — “First, do no harm.”

Senators inclined to vote “no” didn’t need any more cover than that.

But more than anything else, the Trump-inspired American Health Care Act failed because of a basic greed, a naked selfishness that was impossible to ignore. It was bad enough that a bill promulgated by a billionaire novice politician and championed by his proxies and enablers would have shredded the social safety net.

Then we found out how bad that shredding would have been: The Center on Budget and Policy Priorities declared in May that “[t]he House bill would represent the largest transfer in modern U.S. history from low- and moderate-income people to the very wealthy. ...millionaires would gain roughly $40 billion in tax cuts annually...roughly equivalent to the $38 billion that 32 million households in poverty would lose from cuts to their tax credits and Medicaid."

Trumpcare died because it did nothing, or certainly not enough, to change its own pre-existing conditions: an indifference to the challenges to the middle class, a moneyed arrogance that reflected the wealth of Trump, his Cabinet and closest associates; and an unwillingness to moderate that greed for the good of the nation as a whole.

Leave it to Stephen Colbert to offer the perfect grace note in a tweet that doubles as a call to action: “RIP Republican Health Care Bill. In lieu of flowers, please send new Representatives to Congress in 2018.”