Healthcare horse-trading: Who’s getting what for a Trumpcare vote?

How much horse-trading is going on in the secret negotiations to kill Obamacare?

The U.S. Senate is racing toward an artificial deadline for a vote on the magical, mystery thing known as Trumpcare. The whole sordid, secret affair is designed more as an opportunity to give Trump a win than to actually improve the American healthcare system. It’s another ploy to erase everything Obama—no matter the cost to the country’s overall well-being. And it’s also a way to deliver billions of dollars of “savings” that will form the economic justification for a huge tax cut for the top one percent.

While virtually no one has seen evidence of an actual bill yet, no hearings have been scheduled or held, and no proposed provisions have been made public, every Republican Senator is under intense pressure to just say yes, sight unseen. Some—having seen what passed for a healthcare bill in the House of Representatives—are not totally on board.

So, how are the Knights of the Secret Healthcare Society convincing reluctant Senators?

We can only guess. Members of the gang of 14 all-male Senators hashing out the provisions of this so-called bill aren’t talking publicly. [That closed-door mentality is, in itself, a problem, of course.] But political horse-trading is a time-honored tradition in US politics. and we can look to recent history to get some examples of how it works in the sausage-making world of US politics.

Some of the wrangling can be legitimately related to the proposed workings of the law, making it either better or worse. But some horse-trades are about issues unrelated to the purpose of the bill.

We know, for example, that when Trumpcare came up for a vote in the House of Representatives in March 2017, many Republicans balked. That’s when the arm-twisting and horse trading began. Talking Points Memo reported on several Congressmen who held out for inclusion of issues important to them:

Congressman Paul Gosar [R-AZ] is reported to have demanded a vote on his pet project—an anti-trust provision for health care companies—in exchange for his support of the House bill.

Rep. Lou Barletta (R-PA), who previously opposed the American Health Care Act out of fear undocumented immigrants could somehow receive tax credits to purchase health care, said that his vote has been won over by promises from President Trump and GOP leaders that they will advance a separate bill this month that “will require that a person’s Social Security number is verified before we give them a tax credit.”

[Barletta says he was won over by a promise given to him by Donald Trump, who said a separate bill addressing his concern would be brought up in the near future. Haven’t we heard promises like that before?]

The Springfield News-Leader reported in May that Missouri Republican Billy Long reversed his position on the House GOP bill to repeal and replace Obamacare, saying he was now on board with the measure after Republican leaders promised to plump it up with $8 billion to help those with pre-existing conditions. “The issue hits close to home for the congressman,” said the News-Leaer,  “because his daughter is a cancer survivor.”

On the demands-unrelated-to-the-bill spectrum, the Miami Herald reported that, when Trumpcare was up for a vote in the House, Florida Republican Mario Diaz-Balart—a hard-liner on Cuba—may have traded his Trumpcare vote for a Trump administration commitment to rescinding Obama-era easing of restrictions on travel and commerce with Cuba.

All the while, Diaz-Balart — enjoying the courtship of the White House and GOP leaders on account of his “lean no”[on Trumpcare] stance — was circulating a memo of his vision for a Trump policy toward Cuba that would eliminate the Obama guidance to federal agencies on normalizing relations with Cuba and set up terms for Cuba to comply with — or else…Diaz-Balart cast the tie-breaking vote…in the Budget Committee to approve the AHCA and bring it to a full House vote.

Diaz denies the quid pro quo. But then again, this happened. “Trump Reverses Pieces of Obama Era Engagement With Cuba [New York Times, June 17, 2017]. Just a coincidence, of course.

The Atlantic also reminds us about the “Buffalo Bribe” (or, if you prefer, the “Tammany Haul”)—a provision the House leadership added to the AHCA at the urging of five members of the New York delegation that would shift the Medicaid tax burden away from upstate counties.

Now,don’t get me wrong. I’m not saying that pork-barreling and horse-trading are unique to Trumpcare. In all fairness, we should remember the Cornhusker Kickback proposed during negotiations to pass Obamacare eight years ago. [It was a deal created for Nebraska Republican Senator Ben Nelson, which included $100 million in the Obamacare bill that only Nebraska would get in added federal Medicaid assistance. The special provision was ultimately deleted from the bill.]

And now, just for a final note of perspective, there’s this, according to the Los Angeles Times:

To most political analysts, the late President Lyndon B. Johnson remains the modern standard by which presidential horse-trading is measured. When the Texan was in power, lawmakers were plied with everything from military bases and dam projects to first say in choosing judges and federal appointees in exchange for their cooperation on Johnson’s programs.

Indeed, Johnson was so adept at political deal-making that his machinations became known irreverently as “the Johnson treatment.”

Donald Trump is no Lyndon Johnson: He knows nothing about healthcare policy or legislative tactics, and he reportedly cares very little about Trumpcare itself –except as a potential political win to assuage his ego. So, in trying to convince Senators to vote for Trumpcare, he’s incapable of jaw-boning about meaningful policy changes — for the good or for the bad.  That means, unfortunately for America, that he’ll have to resort to deals unrelated to the bill — things like, say, ambassadorships, favorable government contracts and special privileges. A terrible healthcare law bought with the lowest form of horse-trading is one of the worst-case scenarios one can imagine.