GOP dog catches the health-care car

The Republicans have finally rolled out their replacement for the Affordable Care Act, but the long-awaited health care fix may need some immediate resuscitation efforts.

Opposition from conservative Republicans in the House coupled with balking by moderate GOP senators could spell doom for the Obamacare replacement offered by House Speaker Paul Ryan. The bill is either too much or too little like the current law, depending on which side of the Republican caucus is talking.

The National Review’s Michael Tanner calls it “political malpractice in action,” saying Ryan and company have “managed to botch both the politics and policy” of the moment.

Rather than go all-in with a market-based approach, he says, “the Republican plan is essentially an effort to split the health-care baby in two.” That’s because, after Republicans pounded away at the Affordable Care Act for years, there are elements of it that more moderate Republicans are not now going to be willing to throw overboard.

Thanks to the penetrating insight shared recently by our new president, we now know that the original health care law is — like its proposed replacement — complicated.

Just to zero in on one central issue, the Republican plan seems to twist itself in knots over the issue of an individual mandate, which was once a cornerstone of conservative thinking, birthed by a Heritage Foundation plan that Mitt Romney then ran with in fashioning the 2006 Massachusetts law that become the foundation for Obamacare.

Requiring everyone to purchase insurance — rather than become costly free-riders should they face a high-cost condition for which others would be forced to pick up the tab — was put forward under the banner of “individual responsibility,” not as some crushing nanny-state edict.

It was considered a necessary companion to Obamacare’s provision against denying coverage to people with preexisting health conditions, because it would expand the insurance pool to include lots of healthy people and ensure that people don’t sign up for insurance only at the point when they need it.

The preexisting condition provision is incredibly popular with the public, and the GOP plan keeps it in place. But with the individual mandate having morphed from Heritage Foundation policy point to Freedom Caucus heresy, the plan dumps the mandate but tries to backdoor its way to the same outcome. The bill replaces the mandate with tax credits to spur people to buy coverage, and it allows insurers to charge those who let their coverage lapse for more than 63 days a 30 percent surcharge on premiums to renew coverage.

But many on the right say it won’t work. Avik Roy, a leading conservative policy thinker who has served as an adviser to Marco Rubio, Rick Perry, and Mitt Romney, says the incentive structure won’t deliver and that healthy people will eschew coverage, while sick people will be willing to pay the 30 percent surcharge in order to sign up to cover very costly care. He calls it a “recipe for adverse selection death spirals” — meaning the individual market will crash as it is increasingly dominated by high-utilization patients whose costs drive premium prices to unsustainable levels.

“This is the plan,” President Trump declared yesterday as he offered his backing to the House bill. “It’s a complicated process, but actually it’s very simple, it’s called good health care,” he said with his trademark breezy certainty.

But looking to stem the rebellion from Republicans who called the bill “Obamacare lite,” Vice President Mike Pence called it only the “framework for reform,” while Health and Human Services Secretary Tom Price, in a briefing yesterday with reporters, referred twice to the legislation as a “work in progress.”

For all his bluster, it is probably Trump who is most willing to shift and bend on an ultimate bill. But whether the Republicans can come up with one that wins passage seems to be an open question.

Trump is more performance artist than policy purist, and he often seems more concerned with the optics of a plan than with with its operation and actual effect. He’s a guy with a strong appreciation for Marxist ideology — that is, Groucho Marx’s view on unbreakable beliefs: “Those are my principles, and if you don’t like them…well, I have others.”

Trump is about the art of the deal, and is looking for a bill signing moment where he can declare that Obama’s disastrous law has been replaced with something really beautiful. He’s probably frustrated that everyone is getting caught up in all the details.

House Speaker Ryan pronounced yesterday, “The nightmare of Obamacare is about to end.”

But the declaration underscores the Republicans’ main problem: They have been far more fixated on demonizing Obama’s signature domestic legacy than on carefully crafting something that can win broad public and political support to put in its place.

–MICHAEL JONAS


 

BEACON HILL

A state commission looking at price variance among Massachusetts health care providers finds some common ground, but not much. (State House News)

Republican Rep. Paul Frost of Auburn explains why he voted against the legislative pay hike but now is pocketing the money. (Telegram & Gazette)

Sparks fly at an obscure state board wrestling with whether to require developers to include power lines for electric vehicles when they build new commercial buildings and residential homes. (CommonWealth)

State Sen. Adams Hinds of Pittsfield comes out against Eversource Energy’s proposed 10 percent rate hike, saying it’s “an absolute potential killer.” (Berkshire Eagle)

House Speaker Robert DeLeo says he would favor using revenues from pot to finance a substance abuse recovery program. (MassLive)

Josh Miller says signals that the feds may crack down on states that have legalized marijuana have left Massachusetts and its new law in “pot purgatory.” (Boston Globe)

The North Shore Chamber of Commerce comes out against Gov. Charlie Baker’s “fair share” health care assessment. (Salem News)

MUNICIPAL MATTERS

Westborough became the first community in the state to “opt out” of legal pot when voters went to the polls Tuesday to approve a ban on recreational marijuana businesses in the town by a 4-1 margin. (MetroWest Daily News)

A gay veterans group that has marched in the last two annual St. Patrick’s Day parades in South Boston says the veterans organization that sponsors the parade voted against allowing the gay group to march this year, a sharp turnaround from the parade’s move toward inclusiveness. (Boston Globe)

Brockton Mayor Bill Carpenter is calling on the Zoning Board of Appeals to reject a request for a variance to open a medical marijuana dispensary at at Westgate Mall. The variance is being pushed by the city solicitor, who owns the mall property. (The Enterprise)

The Groton Board of Selectmen reject a resolution requiring the police to ignore President Trump’s executive order on immigration. (Lowell Sun)

Three Quincy city councilors have proposed ordinances cracking down on absentee landlords who don’t maintain their properties or police their tenants. (Patriot Ledger)

WASHINGTON/NATIONAL/INTERNATIONAL

US Attorney General Jeff Sessions shows up unexpectedly at an event in New Hampshire and declares a war on drugs. (Eagle-Tribune)

Wikileaks has unveiled its latest trove of hacked records which appear to be internal CIA documents that show how the agency breaks into cellphones, computers, and can even use smart TVs to eavesdrop. (New York Times)

Texas lawmakers hold a marathon hearing on a “bathroom bill” that would require people to use public facilities as locker rooms and bathrooms that align with their biological sex. (Time)

Jeff Jacoby pens a powerful rejoinder to Trump’s effort to paint immigrants as criminal dangers, pointing out that scores of studies have shown immigration is correlated with lower crime rates, and calling it “raw demagoguery” to scapegoat immigrants and “incite fear and hatred.” (Boston Globe)

Two Greater Boston Jewish day schools and the New England office of the Anti-Defamation League were targets of bomb threats yesterday, as the wave of threats against Jewish institutions across the country continues. (Boston Globe)

ELECTIONS

Mayoral connections: The battle for the Boston district city council seat being vacated by Bill Linehan could come down to a showdown between Michael Kelley, a former aide to the late Tom Menino, and Ed Flynn, a son of former mayor Ray Flynn. (Boston Herald)

EDUCATION

UMass Dartmouth trustees unanimously selected Robert Johnson, president of Becker College, as the new chancellor. (Standard-Times)

In a volley that seems well-timed for today’s International Women’s Strike, Richard Stutman, the outgoing president of the Boston Teachers Union, charged that contract negotiations that have dragged on for more than a year would have long ago settled on a new contract but if the union membership was three-quarters male rather than female. (Boston Globe)

Joe Battenfeld questions the hiring of a new deputy chancellor earning $250,000 a year at the University of Massachusetts Boston as the campus deals with a $26 million budget gap that prompted tuition hikes and faculty cuts. (Boston Herald)

New in our feed: Harvard dropout Mark Zuckerberg will deliver the commencement address there in May. (Boston Globe)

HEALTH/HEALTH CARE

Here’s a good explainer on what the Republican health care proposal would do. (Health Affairs Blog) The Globe has a primer on how the measure would affect Massachusetts. (Boston Globe)

A state commission is divided over how aggressively to manage health care prices in the state. (Boston Globe)

A retired Cape Cod physician suffering from prostate cancer who has filed a right-to-die lawsuit may not be as close to dying as he thought. (Boston Globe)

TRANSPORTATION

Crime on the MBTA last year was at a 20-year low, a mark being credited to a shift in how Transit Police are deploying resources and and a crack-down on minor offenses. (Boston Globe)

Commuter rail trains on the Fitchburg Line were delayed Tuesday night by a brush fire along the tracks and the discovery of flammable chemicals. (Lowell Sun)

Edward Tutunjian, the so-called “taxi king,” whose alleged exploitation of cab drivers for his company came in for scathing coverage in the Globe, is selling his 362 Boston taxi medallions and properties in the Fenway neighborhood to developer Jay Doherty for approximately $145 million. (Boston Globe)

ENERGY/ENVIRONMENT

David Cash analyzes President Trump’s puzzling ambivalent clean energy stance.  (CommonWealth)

A new Haverhill trash program has driven down waste generation by nearly 20 percent and resulted in savings for the municipality. (Eagle-Tribune)

Quincy has joined the fight against a proposed controversial compressor station on the Fore River and has pledged to pay for part of the legal costs by a group of Weymouth residents appealing the permits. (Patriot Ledger)

The National Park Service has relented and will allow kitesurfing along a 1-¾ mile stretch of the Cape Cod National Seashore in Wellfleet that had been closed to the sport because of shorebird nesting. (Cape Cod Times)

CRIMINAL JUSTICE/COURTS

The head of Greyhound Friends, a group that rescues the racing dogs, has been charged with animal cruelty over unsanitary and unsafe conditions at the organization’s Hopkinton shelter. (MetroWest Daily News)

MEDIA

Meet the Author

Two local-focused news website companies are merging, and the focus is heavily on events. (Nieman Journalism Lab)

The Globe ran a paid ad on its Tuesday Page 1 at the top rather than the bottom of the page, a placement that prompted editor Brian McGrory to send a memo explaining the reasoning to staffers. (Media Nation)