What The Hell America!

THE REPUBLICAN EFFORT TO slash Medicaid stalled on Friday, when legislation cutting more than $625 billion from the program failed to get through a key House committee.

GOP leaders said they hope to try again on Sunday night. That presumably means they are spending the weekend frantically negotiating in private, trying to secure votes from a handful of holdout Republicans—all in the hopes of keeping Donald Trump’s “big, beautiful bill” of spending reductions and tax cuts moving through the House.

Delays like this have plagued the Republican effort ever since House Speaker Mike Johnson first vowed to have legislation on Trump’s desk by Memorial Day. And if you’ve been following this saga in the press—or here at The Breakdown!—you’ve heard a lot about how the delays are a sign of internal GOP division, especially when it comes to the scale of those Medicaid cuts.

But the focus on the delays can be a bit of a distraction. Because right now the real question is not why the Republicans are moving so slowly but why they are moving so quickly—and what they don’t want you to see.

Consider where this process was just one week ago, with no legislative language and no commitment to specific proposals. The only indications of what GOP leaders had in mind were broad statements they made in speeches and other appearances, along with ambiguous leaks to the press.

When they released an actual bill last Sunday evening, they announced at the same time that the Energy and Commerce Committee would take it up on Tuesday—not even two days later, and so quickly that the Congressional Budget Office wouldn’t have time to produce a full, detailed cost estimate. Then came the hearings themselves: an uninterrupted, 26-hour run through deliberations (the “markup” of the legislation) that ended with a party-line vote to approve the bill and send it to the Budget Committee, where it now sits.

In all, lawmakers had less than 72 hours to digest, debate, and vote on deep Medicaid cuts that—according to CBO’s preliminary, partial estimate—will cause more than 7 million Americans to lose health insurance and millions more to face higher medical costs.

If that sounds at all normal—or appropriate—consider what deliberations looked like for another sweeping health care bill: the 2009 legislation that eventually became the Affordable Care Act (Obamacare).

By the time that legislation went in front of the Energy and Commerce committee in July 2009, there had already been months of public discussion about specific provisions, including policy-focused summits, speeches, and debates featuring not just House leaders but also their counterparts in the Senate and at the White House too.

Energy and Commerce—which was just one of three House committees working on the legislation that year—held eight separate hearings about health care reform. And that was before a markup that lasted two full weeks, with debate and then negotiations starting and stopping several times.

This time around, Energy and Commerce is the only house committee working on health legislation. Want to guess how many hearings it had in preparation for Donald Trump’s big bill?

Zero.

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AMONG THOSE WHO NOTICED the difference is retired Rep. Henry Waxman. “Republicans are rushing to get this legislation passed without giving it the time to get a full consideration of what it will mean,” Waxman told me in a phone interview on Friday.

Waxman would know better than anybody. The legendary California Democrat spent forty years in Congress, during which he was responsible for laws that rewrote wide swaths of federal law and basically turned Medicaid into the program it has become. When Energy and Commerce took up the Affordable Care Act in 2009 he was presiding as chairman.

The analogy to Obamacare isn’t perfect: The Affordable Care Act was a larger and more complex piece of legislation. And although the specific language in this year’s Republican bill was new to the Energy and Commerce members, plenty of the concepts weren’t.

“Many of these are also longstanding Republican policies and priorities so have been talked about for years,” Daniel Kelly, spokesman for the committee’s GOP majority, reminded me over email on Friday. As an example, he cited a 2024 hearing that focused mostly on issues related to long-term care.

But that particular hearing didn’t really touch on the cuts in the new Republican bill, or include all of the same people: One-third of the Republicans who now sit on the committee weren’t there last year.

More importantly, an honest review of the record makes it clear Energy and Commerce hasn’t even tried to do what it did when Waxman was in charge. There’s not even a pretense of trying to scrutinize the most important and controversial ideas, with experts ready to offer data and research, so that voting lawmakers—and eventually the voting public—can make an informed judgment.

“We had so many hearings, and then the markup,” Waxman said, adding that “I don’t think Republicans voting on this in the committee even understand fully what the impact of such a dramatic change to Medicaid will be.”

WAXMAN MAY BE RIGHT when it comes to Republican lawmakers and their grasp of the bill’s potential effects.

But, then, there’s reason to believe GOP leaders are trying their best not to make the legislation’s true nature clear to members—or the public, for that matter.

The polling on Medicaid cuts is clear: Voters oppose them strongly. GOP officials know this, which is why they have spent so much time denying they are making cuts to Medicaid—or, at least, framing them as a way to root out “waste, fraud, and abuse” and to strengthen the program for the “truly vulnerable.”

But the longer the debate goes on, the more indefensible those claims look. Every passing day gives analysts more time to publish damning information, like these analyses showing coverage losses by state and congressional district. And the more this information gets out, the easier it is for organizations and activists to press their case.

Something along these lines happened in 2017, when Republicans were trying to pass legislation that would repeal the Affordable Care Act. Every time a new projection showed big coverage losses, every time a major organization announced it opposed legislation, every time activists showed up at a congressional town hall, passing repeal became more difficult politically—until, finally, the effort failed.

As it happens, the GOP leaders from that time tried to do what the current GOP leadership is doing now: ram legislation through before the opposition could stop it. And they were doing so even after having, for years, insisted Democrats somehow hadn’t given the original Affordable Care Act enough time for debate.

Those of you watching at the time may recall Republicans demanding that deliberations on Obamacare be open and televised, culminating in a Blair House summit between President Obama and bipartisan congressional leaders. They also mocked a 2010 statement by then-Speaker Nancy Pelosi, in which she said, “We have to pass the bill so that you can find out what is in it.”

There is no summit being planned for this bill. And that Pelosi statement—taken out of context at the time—is a pretty good description of what Republicans were trying to do in 2017, and again now.

THE REPUBLICANS’ FAILED REPEAL EFFORT in 2017 is a reminder that while rushing legislation through Congress might seem like a smart expediency for the majority party, it has its downsides. Members who don’t spend time with legislation may not feel as invested in its success, making compromise more difficult. And they may miss out on alternatives that are better as politics and policy.

It so happens that alternatives exist now. If saving money is the goal, Republicans could switch their focus over to the Medicare Advantage program, in which even conservatives see hundreds of billions of dollars of what is essentially corporate welfare just waiting to be trimmed.

“There’s no need for them to be rushing this,” Wendell Primus, who was chief policy adviser to then-Speaker Nancy Pelosi in 2009, told me in a phone interview. “They really ought to take the time to consider what other spending reductions they could do.”

But that’s not what the Republicans are doing. In fact, the latest reports suggest leaders might change the bill’s timetable so that some of the cuts hit two years sooner.

That would generate larger budget savings, appeasing more conservative members who have said the bill wouldn’t do enough to cut Medicaid. It would also accelerate coverage losses.

Considering such a dramatic change over the weekend, with no hearings or expert analysis and with an eye towards a vote on Sunday night—to GOP leaders this a feature of the process, not a bug.

They know this bill’s political future may ultimately depend less on when the pain of its policies starts to hit, and more on how soon the public figures out what’s in store.

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