How the Health Care Debate Reveals the GOP’s Divisions

For a national health care plan, the GOP replacement for Obamacare has never looked particularly healthy. Moderate Republicans don’t like the American Health Care Act (AHCA) because it would balloon the ranks of the uninsured. Conservatives say it doesn’t go far enough to roll back federal subsidies and regulations. And that was all before the Congressional Budget Office (CBO), the closest Capitol Hill gets to having an actual scientific panel, delivered a blunt diagnosis on March 13, with hard numbers about who would be helped and hurt under the new bill.

It would shave $337 billion off the federal deficit over the next decade, while lowering average premiums for some after 2020 in comparison to current law. But other elements of the prognosis were jarring, including the estimate that 24 million more people would be uninsured by 2026. Many of the neediest Americans, particularly the elderly, would suffer dramatically increased out-of-pocket costs. For some lawmakers, the drawbacks swamp the benefits. It’s “cause for alarm,” said Republican Senator Susan Collins of Maine.

The question now is whether House Speaker Paul Ryan and President Trump, two politicians with sharply different visions for the Republican Party, can join forces to rescue the proposal. Ryan praised the CBO score as evidence of the bill’s intent to shrink government and increase market competition and freedom for people to choose. Trump, who pledged during his campaign that “everybody” would have coverage if he became President, sent out advisers to spin the forecast as misleading fiction.

No one has figured out how to integrate the two visions into the same piece of legislation.

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