Much of the criticism of the monstrous bill that passed the House on Thursday has taken a bird’s eye view. The bill is remarkably cruel and, even if a tenth of it survives the Senate, it will have devastating effects on hundreds of thousands, if not millions, of people. The passage of the bill, along with Donald Trump and Paul Ryan’s jubilant press conference, will have an impact on elections in 2017, 2018, and 2020, possibly costing Republicans Congress and even the presidency.
Much of the acclaim the bill has received, by contrast, has been startlingly myopic, fixated on the political realities of the exact moment in which the bill was passed. It should come as no surprise that, for the most part, the idea that this bill is a “win” has been pushed by 24/7 cable news outlets and others in the mistaking the forest for the trees business. Trump and Ryan were both badly damaged, this thinking goes, by the AHCA’s failure to pass in late March. Because the bill passed this time, it’s proof that they did a good job.
This line of thought leaves a lot out, however. It leaves out the fact that the CBO has yet to score the bill and will likely absolutely eviscerate it when it does—revealing that it will raise premiums and deductibles and cost millions their insurance. The AHCA’s backers will once again be forced to make the argument that this is not true, something that did not work at all back in March.
It leaves out the fact that this bill probably only passed because it was rushed to the floor pre-CBO score and that many House members don’t know what the bill even does. It leaves out the fact that the Senate is disregarding the House’s bill and that the AHCA becoming law is far from a sure thing.
Senate Republicans have made it clear that they have no interest in rushing through health care. Republicans will try to make this seem totally normal, but the road ahead for health care is going to be bitter and drawn-out. At the very least the Senate and House versions of the AHCA will not have much in common. There’s every indication that two contrasting bills—especially if the Senate preserves the Medicaid expansion, which it is likely to—will lead to a return to the same factionalism that doomed the AHCA back in March.
The better question for those praising Republicans for finally getting something done is this: How will the AHCA look a week from now? Donald Trump’s few triumphs have all been short-lived, largely because they’ve been castles made of sand—for all the salesmanship that’s gone into them, there’s no lasting foundation.