UPDATE at 2:18 p.m.:
With 217 votes, one more than required, the U.S House has approved a bill repealing and replacing Obamacare.
Let's recap the health-care situation through my "Prism of the Three P's": Process, Policy and Politics:
• The terrified House GOP -- trapped between the horror of doing nothing and doing something awful -- is about to vote on a major bill revamping the entire health-care system, a bill that was still being written and rewritten as of yesterday.
• The bill is being rushed through passage without even the minimum of analysis, which begins with a Congressional Budget Office scoring of its impact. Very few in Congress will have had the time to read it.
• Not a single committee hearing has been held on the bill; no public testimony has been allowed; no floor amendments will be permitted.
• House Speaker Paul Ryan, has scheduled all of 40 minutes of floor debate on the bill.
Those who remember the years of GOP complaints about the process by which Obamacare passed will recognize the scale of the hypocrisy being perpetrated. By comparison with the current process, the Obamacare process was a model of legislative diligence and deliberation.
• The previous version of this bill would strip 24 million Americans of health insurance, according to the CBO. Conservatives deemed that version too generous, so the current version was rewritten to make it even worse.
• By pushing more than 24 million Americans off of their insurance, the bill saves an estimated $880 billion. That money is then used to finance tax cuts that are very heavily tilted toward the rich. Put succinctly, it is wealth care, not health care.
• It is strongly opposed by the American Medical Association, the AARP, the American Hospital Association and just about every other health-care provider group in the country, all of whom argue that it will significantly reduce the ability of Americans to access their doctors and get health care. The impact on Americans aged 50-64 will be especially onerous.
• The hard-won guarantee that Americans with pre-existing conditions can't be charged exorbitant rates is gone. That change was a major demand of House conservatives, and they won that fight. The mechanism created as a substitute -- state-run high-risk insurance pools -- had been implemented in 35 states prior to passage of Obamacare, including Georgia, and it proved a dismal failure in all 35. In fact, the gross inadequacy of high-risk pools helped drive passage of Obamacare in the first place.
• As the Wall Street Journal and other outlets report, a last-minute change to the bill even weakens employer-provided health insurance, including coverage of maternity care, prescription drugs, mental health treatment and hospitalization. That change -- also demanded by conservatives -- allows insurers and major employers to pick a state they want to be regulated by. They don't even need to have operations in that state. If Alabama or Mississippi adopts lax regulations, employers in Georgia or Minnesota could choose to be covered by those rules, saving themselves billions. (I suspect that similar little "Easter eggs" still remain hidden in the legislation.)
• The previous, more generous version of the bill polled at a 17 percent approval rating. That was before the legislation undermined the highly popular guarantee regarding pre-existing conditions. Democrats say they are elated with today's vote, because it puts Republicans on record in support.
• Support for Obamacare, on the other hand, is at an all-time high now that voters have seen what the Republicans propose as an alternative. In a Gallup poll taken last month, 55 percent approved and 41 percent disapproved. Just 30 percent said they still wanted to repeal and replace Obamacare.
• Many of those hardest hit by the loss of insurance will be older, working-class Americans in states carried by Donald Trump, the very people whom he promised to protect. Those who would benefit the most are the wealthy and powerful, the very elites whom Trump railed against on the public's behalf. At some point, such betrayals are going to be noticed.
• “Trump and Republicans will own every preventable death, every untreated illness, and every bankruptcy that American families will be forced to bear if this bill becomes law and millions lose access to affordable health care," as DNC chair Tom Perez puts it. "The 24 million who would lose access to health care is not just a number—it represents fathers, mothers, sisters, brothers and even newborn babies with heart diseases or cancers that are too costly to treat without affordable insurance."
That last point is critical. Regardless of what happens in the Senate, Republicans now fully own responsibility for the nation's health-care system. They have already created chaos in the health insurance industry by refusing to honor the federal government's commitment to help offset losses, and with this vote they have created immense uncertainty about what the health-care marketplace will look like next year.
They broke it, they own it, and they have no idea whatsoever about how to put it back together with any semblance of functionality. A lot of people are going to be hurt as a consequence.