Republicans have voted to vote on their plan to have a plan to repeal and perhaps replace Obamacare.
Now, as vague as that sounds, we actually have a pretty good idea what it means. Senate Republicans are letting all of their old health care plans that they couldn’t quite agree on get voted down before moving on to their new health care plan that, in the words of Health and Human Services Secretary Tom Price, would only appeal to “the lowest common denominator” to try to get the 50 votes it needs – at which point, they would go to conference with House Republicans to supposedly write their “real” bill.
And what would that be? Well, something a lot like their old plan that they weren’t able to pass.
That’s right: Republicans are rallying behind a new bill that hasn’t had any hearings, hasn’t gotten a budget score, and hasn’t even been written yet, all so that they can try to ram through their old bill that they just decided they don’t have the votes for. It doesn’t make much sense, but what do you expect when Republicans have had only seven years to think about this?
That leaves us with three possibilities. The first is that they aren’t able to pass anything at all. Maybe their new bill, what they’re calling “skinny repeal,” won’t even be able to make it through the Senate. Or maybe it will, but the House will vote it down. Or maybe they really will write another new plan in conference, but one of them won’t be able to pass it.
The second is that they end up passing something like their original plan, which, according to the nonpartisan Congressional Budget Office, would lead to 22 million to 23 million fewer people having health insurance in 10 years’ time. The idea is that passing “skinny repeal” would, as Sen. Bob Corker, R-Tenn., put it, be a “forcing mechanism” that would let them get to a conference committee where they could bring their previous plan back. Why would they pass that then when they couldn’t pass it now? Because Republicans think it would be harder to vote against repealing Obamacare at the last step of the legislative process rather than the second-to-last one.
It’s not impossible. In which case, we’d end up with a bill that would cut taxes mostly for the rich by $800 billion, cut Medicaid by $800 billion, cut middle-class health care subsidies in a way that particularly hurts older and poorer people, and, perhaps, undermine Obamacare’s protections for people with pre-existing conditions, if not eliminate them outright.
That last part isn’t clear, though, since the Senate parliamentarian has said that, at least as currently written, Republicans need 60 votes to get rid of Obamacare’s insurance rules instead of the 50 they do for strictly budget-related matters – something that redrafting that part of the bill might not be enough to change.
But in any case, one thing we can say for sure is that the poor and sick would be paying more for health care so that the rich and healthy could pay less. The only question is how much that would be.
The third and final possibility is that “skinny repeal” just becomes law. This would be a policy result that actually has nothing to recommend it, and yet it might be the most likely outcome. The bill, which is still being finalized, would reportedly keep all of Obamacare’s spending as well as its taxes. It also might keep all of Obamacare’s insurance rules.
That’s still up in the air, since Republicans are trying to tweak the language of their bill enough that the parliamentarian would allow them to ax those regulations with just 50 votes.
What the bill would definitely not keep, though, is the requirement that every individual buy health insurance, and every company with more than 50 employees do so for their workers.
This would be something between a catastrophe and a disaster. Obamacare, remember, is like a three-legged stool. First, it tells insurance companies that they can’t discriminate against people with pre-existing conditions; then, to make sure that people don’t just wait until they’re sick to get covered, it says everyone has to buy insurance; and finally, to make sure that everyone can afford the insurance they’re now required to buy, it gives people subsidies to help them do so. If you take out that first leg, you risk the whole thing toppling over.
Now, the good news, as far as there is any. The CBO doesn’t think that would quite happen. That’s because Obamacare’s subsidies go up as premiums do, so a lot of people would be insulated from the inevitable increases that would result from healthy people dropping their coverage. How many would? Well, according to the CBO, about 16 million fewer people would be insured 10 years from now under this Republican plan. Some of them would be people who would just choose to go without coverage, some would be people who didn’t realize they were eligible for free care under Medicaid, and others would be people who were priced out of the market after all of this had made premiums go up so much. Indeed, the CBO estimates that premiums would increase 20 percent more than they already would as a result of this plan.
In other words, millions more people wouldn’t have insurance, and it’d be more expensive for everybody else. It’s no wonder, then, that even the Republicans who are voting for this bill don’t want it to become law. Sen. Lindsey O. Graham, R-S.C., called it a “disaster” and a “fraud.” Sen. David Perdue, R-Ga., said “the only possible problem” with it is that the House might vote for it too. And Sen. Mike Rounds, R-S.D., wants a guarantee that the House won’t turn around and pass it.
They probably would, though. House Republicans are already being told to stay in town for a possible vote this weekend in case the Senate does pass “skinny repeal.” They could only vote that quickly if they were voting on the same bill. It would be a fitting coda to seven years of Republican self-delusion on health care.
They’ve never moved beyond having a plan to have a plan because they haven’t wanted to deal with the trade-offs inherent to it. After all, if you want rich and healthy people to pay less, then that must mean you want poor and sick people to pay more.
But admitting that is bad politics, so they’ve tried to stay in the realm of generalities. Even when they can’t anymore, like when it’s time to pass an actual bill. At every step, they’ve said that their plan isn’t really their plan since they’ll come up with something better later. Well, it is later, and it is not better.
Not that that’s going to stop them.
Republicans are going to vote for their health care plan despite the fact that they think it’s terrible, just like a lot of them voted for President Donald Trump despite thinking that he was.
It’s partisanship over policy. Good thing people’s lives aren’t at stake.
