A laser-guided truth bomb courtesy of a prominent TrumpCare skeptic at 11:10 of the clip below. The “three-step process” has been a key talking point of the bill’s defenders; Tom Price mentioned it in his press conference yesterday outside the White House after the CBO score dropped. Step one is passing the current health-care bill. Step two is Price implementing new regulations under his power as chief of HHS. And step three is Republicans passing a second bill that would let insurers sell plans across state lines, something that would make a lot of free-market conservatives happy — but which would require 60 votes to pass the Senate. Because that bill isn’t budgetary, the GOP can’t use reconciliation to ram it through with a simple majority. They’ll need eight Democrats. Where are those Democratic votes coming from?
They’re not, said Cotton to Hugh Hewitt:
HH: So what can be done? I’ve talked to the Speaker, I’ve got to the Leader. I’ve talked to Cathy McMorris Rodgers is on today, Mick Mulvaney, Tom Price. They all say it’s a three-step dance because of the Senate reconciliation rule. So you know those rules. Working within the rules, how can the Senate improve its bill, or how can the House send to the Senate a bill that fits within the guardrails of reconciliation and allows for 51 votes that improves the individual market?
TC: Hugh, there is no three-phase process. There is no three-step plan. That is just political talk. It’s just politicians engaging in spin. This is why. Step one is a bill that can pass with 51 votes in the Senate. That’s what we’re working on right now. Step two, as yet unwritten regulations by Tom Price, which is going to be subject to court challenge, and therefore, perhaps the whims of the most liberal judge in America. But step three, some mythical legislation in the future that is going to garner Democratic support and help us get over 60 votes in the Senate. If we had those Democratic votes, we wouldn’t need three steps. We would just be doing that right now on this legislation altogether. That’s why it’s so important that we get this legislation right, because there is no step three. And step two is not completely under our control.
It’s a good argument, but is that boldfaced part true? Cotton’s right that there’s no way they’d get Democrats to vote for a single bill that combined the repeal/replace measures in step one with the new rules about selling insurance across state lines in step three. The left wants to deal Trump and Ryan a crushing early loss on this and expects unanimous opposition in defense of ObamaCare from their party — and it’s working. Even Joe Manchin, the Democrat most likely to vote with Republicans on legislation, sounds like a hard “no” this morning:
“I got an older population, I got a poorer population, and I got an opiate issue we need to clean up,” Manchin said. “And now, talk about insult to injury. You’ve got to have a moral compass inside of you. You can’t do that. Look at the elderly, look at the poor, look at the sick. How can you look at yourself and say, ‘Okay, I’ll help the person who needs help the least, the wealthiest people, with more tax cuts, because I’m going to be taking away from the elderly population?’”
Not 10 days after progressive activists demanded that Manchin be expelled from Senate leadership, the AHCA has brought him back in line with Democrats, fully opposed to Republican repeal efforts
This is why step one, the nuking of ObamaCare (and by “nuking” I mean “tinkering around the edges”), needs to be done exclusively through reconciliation. There are 52 votes for that in the Senate at best. But … what if Republicans get it through? Will Manchin continue his rejectionist stance once ObamaCare has in fact been successfully replaced? The GOP will sell step three to the public as the linchpin of their strategy for lowering premiums: The more options you have in choosing a plan, the more likely it is you’ll find one at a price you’re comfortable with. What incentive does Manchin or McCaskill or Jon Tester or Heidi Heitkamp, etc, have to oppose a bill like that once the initial battle over O-Care has been lost? The Republican gamble here is that red-state Democrats secretly do want to work with them to make health insurance better, if only to protect themselves in their 2018 elections. The politics make that impossible so long as ObamaCare is on the chopping block, but once it’s been chopped and the GOP moves on to secondary reforms of the market, there’ll be less pressure on them to toe the party line. And if that’s true, then Cotton is wrong. There is strategic sense in splitting off the reconciliation parts of ObamaCare from the non-reconciliation parts and trying to pass them separately. But it’s a crapshoot. If the left forces Democrats to hang together, the GOP may pass step one and succeed in implementing step two before getting stuck on step three. What happens to Tom Price’s projections of lower costs and better access to insurance for Americans if the effort to let people buy plans across state lines ends up dying via a filibuster?
As an antidote to Cotton’s pessimism, read this Avik Roy analysis of yesterday’s CBO score, which most people are interpreting as doom for the bill but which Roy reads as (somewhat) encouraging. CBO predicts the insurance market will be stable under the GOP plan, Roy notes, and also projects lower costs to the federal government over the next 10 years. Best of all, the most dramatic criticism — the number of uninsured in the near term — can be blunted by simply delaying the repeal of the mandate until 2020 while the new system is implemented, easing the transition between the two and producing lower premiums three years from now once the mandate finally disappears.