Here is a story about how you keep a healthcare bill from being pecked to death. That is, it's a story about that only if you want to defend a healthcare bill passed that's actually about healthcare, and not replace it with a massive and retrograde tax cut in surgical scrubs. Anyway, on June 29, 1965, there was a meeting in the West Wing of the White House. President Lyndon B. Johnson already had managed to get through Congress the amendments to the Social Security Act that would come to be known as Medicare and Medicaid. However, the American Medical Association was dead set opposed to the new programs, and there was serious talk that the leadership of the AMA was going to encourage its members not to participate. This would be a serious, if not lethal, act of sabotage, and Johnson knew it.

On this day, LBJ brought the leadership of the AMA over to his joint. He blew into the room, schmoozed them heavily about the kindly old angelic country doctors he'd known back in Johnson City. All of a sudden, he asked the AMA poohbahs if they would help with a new program that would establish a volunteer medical corps in Vietnam, which would bring modern medicine to the rice paddies and to all the villages in the jungles. Eager to show that they indeed were true sons of Aesclepius, and not merely tradesmen grubbing their way toward a new Mercedes, the AMA doctors leaped at the chance to be part of it.

Seeming to be overjoyed at their enthusiasm, LBJ ordered his staff to bring the press in. Naturally, since Medicare was one of the hot political issues of the moment, one of the reporters asked if the AMA was planning to support it. The president then leaped in and said:

"These men are going to get doctors to go to Vietnam where they might be killed. Medicare is the law of the land. Of course they'll support the law of the land."

Then he summoned the head of the AMA delegation.

Tell them, the president said to him, nodding toward the assembled press.

The head of the delegation told the waiting press that, of course, its members would obey the law of the land. Not long afterwards, the AMA announced that it would support Medicare. You pass a law and then you protect it from vandals. That's the moral of this story.

You pass a law and then you protect it from vandals. That's the moral of this story.

I don't believe there has been quite enough coverage of how the Republican Party, nationally, but out in the states as well, has conspired to do its best to vandalize the Affordable Care Act. When he was running for president in 2016, prior to taking his current job as a butler at Mar-a-Lago, Marco Rubio actually bragged about legislation he'd passed through a Republican Congress to eliminate the ACA's "risk corridors." From The New York Times:

Mr. Rubio's efforts against the so-called risk corridor provision of the health law have hardly risen to the forefront of the race for the Republican presidential nomination, but his plan limiting how much the government can spend to protect insurance companies against financial losses has shown the effectiveness of quiet legislative sabotage. The risk corridors were intended to help some insurance companies if they ended up with too many new sick people on their rolls and too little cash from premiums to cover their medical bills in the first three years under the health law. But because of Mr. Rubio's efforts, the administration says it will pay only 13 percent of what insurance companies were expecting to receive this year. The payments were supposed to help insurers cope with the risks they assumed when they decided to participate in the law's new insurance marketplaces.

The road to 23 million uninsured Americans began at Marco Rubio's doorstep. People should remember that.

Since the ascension of El Caudillo del Mar a Lago to the presidency, it's been full speed ahead on the vandalism front. A substantial part of it was due simply to the presence in the White House of a president* who didn't know anything about healthcare, and who wouldn't deign to learn anything about it, either. But the administration is actively undermining the law in several different ways, as Michael Hilzik of The Los Angeles Times illustrates.

The Trump effect includes continued uncertainty about whether the feds will make cost sharing reduction payments. These are subsidies payable directly to insurers that cover deductibles and co-pays for approximately 6 million families with incomes below 250% of the poverty line. House Republicans have sued to stop the payments on grounds that the Affordable Care Act provided for the subsidies but didn't appropriate funds for them. Trump hasn't said whether he will continue the Obama administration's policy of paying them until and unless a court decisively rules against them. Instead, he's even threatened to withhold them as a bargaining chip to force Democrats to negotiate an Obamacare repeal. Another aspect of Trump policy that unnerves insurers is the indication that the administration will stop enforcing the individual mandate, which requires every American to have coverage — a linchpin of the ACA system because it balances the ACA's mandate that insurers cover people with preexisting medical conditions without a surcharge.

And just today on the electric Twitter machine, Charles Gaba—an essential follow for information on all the nooks and crannies of the ACA and the current debate (@charles_gaba)—laid out in detail another cheap trick that the administration is trying to pull. Insurance carriers, explains Gaba, already have been warning that premiums might go up by double-digits next year. (Obamacare raises premiums!, scream the flying monkeys.) However, as Gaba also notes, this is due to a couple of factors: First, the administration, through Secretary of HHS Tom (The Wolf of Wall Street) Price, has threatened to not enforce the individual mandate; and second, they have threatened to withhold the ACA's Cost-Saving Reduction Subsidies to the carriers. Gaba then takes us to the very last page of Mitch McConnell's current dead fish, where we learn that, if the dead fish passes, the CSR reimbursements would be reinstated for two years, before disappearing entirely after that.

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The cynicism on display here is breathtaking. Republican sabotage makes the premiums go up. Then the Republicans put together a bill that partially repairs the sabotage for long enough that they can boast—during the 2018 midterms, let's say—that they brought down premiums. Then, of course, after the dust clears after the election, the patchwork repairs disappear and everybody gets screwed so that billionaires get their tax cut, which was the whole point of this exercise in the first place. And if, for some reason, the dead fish doesn't pass, they continue to decline to enforce the individual mandate, and they continue to stiff the carriers on the CSR payments. Premiums go up, and the 2018 campaign becomes a referendum on the cost of Democratic obstruction. I have no faith in the ability of the elite political press to see through this obvious charade.

But there's a bit of hope in that Democratic Senate leader Chuck Schumer seems to have discovered just a bit of his inner Lyndon. McConnell already has tried to spook his fellow senators and the administration by raising the awful specter of having to deal with Democrats to get a bill passed. (The High Broderite wing of the bipartisanship cult is conspicuous by its silence on this.) Meanwhile, Schumer is raising holy hell about what backroom deals McConnell might be cutting to get his caucus to 50 votes, and he is doing so at the same time in which he's extending the delicate hand of bipartisanship to his good friend from Kentucky, who is having such a bad week. From The Washington Examiner:

"I would make my friends on the Republican side and President Trump an offer: Let's turn over a new leaf. Let's start over," Schumer said on the Senate floor. He called for Trump to invite all 100 senators to Blair House — the president's guest house in Washington — to discuss the issue as former President Barack Obama did in 2010. "President Trump, I challenge you to invite us, all 100 of us, Republican and Democrat to Blair House to discuss a new bipartisan way forward on healthcare in front of all the American people," Schumer said, pointing to Trump's campaign promise to cover everybody.

I don't expect the Republicans to take him up on his offer, but he's put them in a jam it will be hard for them to escape except by simply bulling ahead and passing a bill with a 17 percent approval rating. A little touch of Lyndon goes a long way.

(The story about LBJ and the AMA can be found in Randall Woods' , his most excellent account of the rise and fall of Johnson and the Great Society.)

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Charles P. Pierce Charles P Pierce is the author of four books, most recently Idiot America, and has been a working journalist since 1976.

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