This Is How the Legislative Livermush Gets Made

Leave sausage out of this. The ever-evolving Republican health care bills demonstrate how rancid legislative livermush gets made: a pudding of policy innards blended and baked with haste because the ingredients were up against their expiration date, or in this case the August recess. The concoction has spoiled each week that lawmakers have tried to vote on it, then put it back in the fridge, then pulled it back out to add some additional offal. Most Americans have pinched their noses every time the plastic wrap has been lifted from the platter.

Talk about ruining a dinner party. The GOP was finally given control of the White House and both houses of Congress, and it’s cooked up this: a Senate Obamacare repeal one Republican holdout says doesn’t do enough and another says does too much, leaving majority leader Mitch McConnell zero margin for error among his 52-member majority, more than a half-dozen of whom opposed the thing just a few days ago. But before he even corrals his caucus, there is a confirmed report that Republicans will attempt to meet a Senate requirement by having their own Department of Health and Human Services evaluate the legislation, since the Congressional Budget Office, the independent agency always tasked with such work, can’t finish on the majority party’s preferred time line. It is an insult to intelligence to not acknowledge that this process is a disaster.

The latest step came Thursday with the unveiling of the modified Better Care Reconciliation Act. The previous version suffered the same public problems the House-passed American Health Care Act did: an unfavorable CBO score, potent Democratic dissent, feeble GOP defense, and devastating poll numbers. Moderate Republicans like Dean Heller, an imperiled incumbent, and the more prominent Rob Portman disapproved of the original bill because of its changes to Medicaid. Conservatives like Ted Cruz and Mike Lee criticized the BCRA’s lack of action on Obamacare’s regulations, which are the foundation of the existing law. For McConnell to satisfy both party flanks without losing three votes—full-repeal-or-bust Rand Paul and centrist Susan Collins are no votes—almost would be Lincolnesque.

The new legislation adds $45 billion to combat the opioid crisis and $70 billion—on top of $100 billion included in the measure already—to help control insurance costs. It also preserves some Obamacare taxes on higher earners. Those are the major moderate sweeteners. The conservative ones are based on a proposal from Cruz: in broad terms, to allow insurers offering at least one Obamacare-compliant plan to offer non-compliant coverage, as well, potentially attracting more healthy consumers but also increasing premiums for higher-risk individuals. The billions on billions stand to offset the extra expense to those people. How effectively, who knows—there’s been no expert testimony on the matter.

Cruz approved of the draft, calling it “a substantial improvement” over the last one. One of his more rightward-tilting colleagues, Ron Johnson, also backed the “consumer freedom” option’s inclusion in the bill, and seemed to move away from his previous opposition. But there isn’t much in the legislation to entice the Heller and Portman types that wasn’t there before. The BCRA’s overhaul of Medicaid—which was a no-no to those two, as well as Collins and Shelly Moore-Capito—is untouched. And the Cruz provision opens up a fresh line of attack from Democrats and their media sympathizers, such as Vox’s Ezra Klein. It “attacks the core changes Obamacare made to build insurance markets that serve the sick, the well, and, crucially, everyone in between,” he wrote —that being attributable to what he expects is the segmentation of healthy people into cheap coverage and unhealthy people into expensive coverage. Obamacare was designed to make coverage similarly priced for all of them.