The last few days there have been worried reports about how the Republicans had gone into a secret huddle and were rumored to be on their way to coming up with Obamacare “reform”. For instance, from the New York Times:
As they draft legislation to repeal the Affordable Care Act, Senate Republican leaders are aiming to transform large sections of the American health care system without a single hearing on their bill and without a formal, open drafting session.
That has created an air of distrust and concern — on and off Capitol Hill, with Democrats but also with Republicans…
The secrecy surrounding the Senate measure to repeal and replace the Affordable Care Act is remarkable — at least for a health care measure this consequential….
It is not unusual for lawmakers to draft major legislation in private, but they usually refine, debate and amend it in open committee sessions. The House bill to repeal the Affordable Care Act did not receive a hearing, where outside experts could have testified. But lawmakers dissected its contents and were able to propose changes at three stages: in the Ways and Means, Energy and Commerce, and Budget Committees.
Senate Republican leaders evidently think their back-room approach gives them the best chance to devise a health care bill that can squeak through the Senate, given their narrow majority and the policy differences in their conference.
Mind you, even though we have been critics of Obamacare (its clearest benefit has been Medicaid expansion, but residents of many states are left out), we do not underestimate the ability of Republicans to make it worse, particularly when that’s the point.
But our view has long been that anything that would satisfy the House Freedom Caucus
crazies extremists, who have enough seats to be able to deny Republicans a majority vote, would not fly in the Senate. Gerrymandering has created Congressional districts where elections are settled in primaries. Too often for Republicans, being more rabidly right wing is the royal road to victory. By contrast, enough Senators hail from big or biggish states with sufficiently diverse economic and social profiles that bowing to Freedom Caucus dictates would be political suicide.
But being the majority party isn’t necessarily a good position to be in if you have too many internal divisions. It now looks like all of that Republican “secret palaver will deliver a miracle baby” talk was pure hype. The latest news reports suggest that the Republicans can’t even get their act together in the Senate to agree on a bill.
Recall that the Republicans have only a two seat majority in the Senate. They can’t afford much in the way of defections. Even though Republican Senators were trying to craft a more moderate version of the bill than the one that passed the House, there are enough hard core conservatives in the Senate to make that difficult, if not impossible.
Negotiations over the bill’s contours remain fluid as Republican senators wrangle over its central tenets. No Republicans have taken a fixed position for or against the bill, in part because its language hasn’t yet been finalized. But President Donald Trump’s recent private disparagement of the bill passed by the House last month as too stingy suggests the Senate legislation is likely to only tilt more toward the chamber’s centrists.
That’s making it a harder sell for conservative senators including Rand Paul of Kentucky and Mike Lee of Utah…
Outside conservative groups, fearing that Senate GOP leaders are watering down the House bill’s Medicaid savings and rollback of ACA regulations, have meanwhile begun speaking out more forcefully in recent days. “Everything we’re hearing right now is frustrating and concerning to us,” said Jason Pye, director of public policy at FreedomWorks, a grass-roots-oriented conservative group.
Senate GOP leaders have said they hope to vote on a health overhaul by Congress’ July 4 recess. That prospect seems increasingly remote, though party leaders haven’t ruled it out.
Time weighs against getting a bill passed. Generally speaking, protracted negotiations are failure prone. And here, the Republicans know it behooves them to get their act together, yet they seem unable to. One conservative political junkie I know said months ago that the Republicans needed to pass an Obamacare bill because it was such a central campaign promise, and they needed to get it done by July at the latest or it risked denting election campaign dynamics. The plan as of a few weeks ago was to have a Senate bill passed by the July 4 break and then hammer out a compromise between the Senate and House versions before the month-long August recess. Missing the July 4 deadline increases the odds the bill will still be in play after Labor Day, when Republican Congresscritters will be under even more pressure to tell constituents they’ve gotten something done. That means they’ll feel pressure to pass less troublesome legislation, diverting attention from the ACHA bill.
Another potentially complicating factor is a block of Republican Senators, including Alaska’s Lisa Murkowski, are loath to end Medicaid expansion, which is something the “centrist” Senate plan apparently calls for. From The Hill:
Sen. Lisa Murkowski (R-Alaska), a potential key swing vote on an ObamaCare repeal-and-replace plan, isn’t sure she could support the emerging Senate Republican healthcare bill..
Murkowski wouldn’t commit when asked if she would support a seven-year phaseout of the Medicaid expansion, which some moderate GOP senators are pushing. Nor would she say whether she would support a slower phaseout or a faster one.
“My position on Medicaid expansion and my support for it hasn’t changed,” Murkowski said.
The Alaska Republican has previously said she wouldn’t vote to repeal the Medicaid expansion if the Alaska state Legislature wants to keep it. And she was one of four senators who sent a letter to Majority Leader Mitch McConnell (R-Ky.) in early March saying they couldn’t support a bill that didn’t have protections for people in the Medicaid expansion population.
Making things more fraught, insurers have until June 21 to decide what insurance they will sell on specific state Obamacare marketplaces. From Vox earlier this year:
The most important day for Obamacare is June 21, 2017. About three months from now — on, coincidentally, the very first day of summer — health insurers have to decide whether they will sell coverage on the Obamacare marketplaces.
“It will give us the first indication of what the ballpark rate increases are, what counties have insurers and which ones don’t,” says Robert Laszewski, an industry consultant who works with insurers that sell on the marketplace. “Insurers will have to make a statement.”
The Obamacare marketplaces are, at the moment, one of the most at-risk parts of the Affordable Care Act. About 12 million Americans who buy insurance on their own — through either a state marketplace or Healthcare.gov — currently rely on these online insurance portals for coverage. Eighty-five percent receive a tax credit to lower their monthly premiums.
The marketplaces only work if private health insurance plans show up and sell coverage. Last year, well before Trump’s election, some insurers dropped out of the marketplaces because they saw them as too small or unstable. June 21 is when we’ll get the first look at whether the marketplaces are in okay shape and have enough competition to survive 2018 — or whether they are, as President Donald Trump predicted, “exploding.”
Although if a bill were to pass, one would assume most of its provisions would phase in for practical as well as political reasons, uncertainty about the future of Obamacare can’t be a plus for insurers. And if more insurers withdraw from marketplaces and/or jack up prices, it’s not hard to see how both parties will try to spin that to their advantage.
So as hard as it is to tune out the short-term drama, the fight over Obamacare’s future has made “single payer” part of the lexicon. Hopefully bona fide reformers will find a way to use the likely collapse of the Republican’s “gut Obamacare” scheme to advance sounder and more beneficial programs.