The idealist in me believes that the Congress is focused on the plight of the American people, the people they ostensibly represent. The cynic in me believes that Congress is just a set of Kabuki performers, acting out a drama of heroism and betrayal with little care that the theater is on fire and their audience is going to die. The cynic, I’m afraid, is winning this week’s battle with the central theme being healthcare. More specifically, health insurance (because Congress rarely debates actual healthcare policy).

You might recall that the US government was “shutdown” for 43 days over the Democratic members’ insistence that the majority address the impending expiration of extended ACA premium subsidies with the same urgency that they provided wealthy Americans and corporations an extension of their expiring tax cuts back in July. They received a promise in the Senate (not the House) that a bill could come to the floor for a vote that would stop millions of Americans from having to pay double or triple this year’s health insurance premiums in 2026. Let the Kabuki begin.

The gracious host of the manor, Senate Majority Leader John Thune, welcomes the Democratic proposal to extend the expanded subsidies for the next three years. Needing 60 votes to avoid a filibuster (a silent one, since no Senators actually took the floor to force debate and a cloture vote), the bill only received 51 votes (yes a majority approved, but not enough to pass a bill). The host and his minions then proposed their own ideas (with the blessing of their sponsor, President Trump), bringing forth a bill of their own. This bill, written on rice paper that will dissolve at the first rainfall, contains nothing to compensate for the massive cost of insurance premium increases, but a small monthly stipend of between $83 and $125 per month to help pay for a bare bones insurance policy with the highest out-of-pocket expenses possible. The older you are, the more you pay – a 60 year old couple making $85,000 per year will pay over $22,000 more for their insurance next year. More than a fourth of their income before taxes. This too fails to advance on a 51 to 48 vote. End scene.

The Kabuki begins in the House of Representatives. The Democratic leadership desires the same three year extension that failed in the Senate and has no path to passing. Rather than join bipartisan alternatives that extend the subsidies for one or two years, and place some relatively high income caps on benefits (as much as 10 times the federal poverty level), the Democratic leaders sit pensively in the corner reviewing their options. The bipartisan proposals can pass the House, as they each have 11 Republicans signing a discharge petition (Discharge petition 12 and 13) to bring the bill to the House floor for a vote. The discharge petitions are needed because the Speaker will not allow the bills to be voted on. Instead, they have brought their own policy amendment to the ACA forward, a bill lacking any extension of the subsidies and generally wishful proposals unlikely to assist most people with their premiums. The next act of the play begins next week (before the House hibernates for one of its numerous recesses from working so very diligently to do nothing!).

Meanwhile, on the edge of the stage, Senator Rick Scott (former leader of admitted Medicare fraudster hospital chain Columbia/HCA) and Congressman August Pfluger have shouted that they have a solution. Dubbed the “More Affordable Care Act”, their plan allows the subsidies to expire, raising premiums for tens of millions, and take the remaining subsidies and place them in HSA accounts that could also be used to pay for insurance premiums (as long as the health plans would not cover abortions, tubal ligations, mastectomies, hysterectomies, vasectomies, and many other gender specific obsessions of these authors). The law would permit purchases of health plans across state lines (that no health plan will sell) and make some vague improvements in healthcare cost transparency (beyond the cost transparency that is already mandated by both federal and state laws). No actual costs are lowered in this performance.

And the national disgrace continues…