It’s getting to be crunch time [for Republicans] on the effort to [repeal and] replace ObamaCare. Senate Republicans have met with Mitch McConnell in advance of the latest [and final] version of the the Better Care Reconciliation Act (BCRA), which has [good] news for conservatives. Axios’s Caitlin Owens called this critical to retain conservative support:
The Consumer Freedom Option allows insurers selling plans compliant with Affordable Care Act regulations to also sell non-compliant plans. The provision will be in brackets, the sources say, meaning it’s incomplete and subject to edits — or removal. However, the Congressional Budget Office is still analyzing two versions of the bill — one with the provision and one without.
Don’t get too enthused. Politico reports that the amendment has indeed been retained … [for now, anyway]:
The Senate Republicans’ draft Obamacare repeal bill due to be released on Thursday will tentatively include a controversial amendment from Mike Lee and Ted Cruz, according to sources familiar with the matter. …
The Congressional Budget Office is analyzing two versions of the bill, one with the amendment and one without. That score is due Monday. The Lee-Cruz amendment will be in brackets on Thursday, indicating it is subject to change.
However, Lee disputed those reports, and said that a version of their proposal remained in the overall bill — and he’s not sure he can support it:
Just FYI – The Cruz-Lee Amendment has not been added to BCRA. Something based on it has, but I have not seen it or agreed to it. 1/2
— Mike Lee (@SenMikeLee) July 13, 2017
I am withholding judgment and look forward to reading it. 2/2
— Mike Lee (@SenMikeLee) July 13, 2017
Lee hasn’t tweeted anything since at this point, so … we’re not necessarily seeing the final version of the BCRA. We knew that anyway from the brackets. If the CBO analysis of the Lee-Cruz amendment shows a market meltdown that will wipe out the individual-coverage markets, then McConnell will likely have to dump it in order to get the rest of the caucus on board. They’ve already mainly lined up against it; supposedly only 15 of the Republicans expressed any support for it even in the abstract. This looks like McConnell’s way to keep Cruz and Lee in the game for a fair hearing on their proposal, and nothing more.
If the proposal survives the CBO score, it may well provide enough of a compromise to get everyone on board except for Rand Paul, who began blasting the new version of the bill yesterday with or without the Lee-Cruz amendment. Without it, though, it’s tough to see how Lee and Cruz stick around. The bill now offers a number of moderate priorities, such as a haircut for wealthy earners and government “support” for low-income insurance payments, plus the money to fight the opioid-abuse epidemic that has broader support within the caucus. Even with those concessions, it might take a retreat on the effort to defund Planned Parenthood to keep Susan Collins and Lisa Murkowski in the yes column, and that might be enough to chase more than one conservative out of the deal.
Here’s one of the taxes from the ACA which will be retained:
BREAKING: Revised Senate healthcare bill will retain Obamacare taxes on investment income to help finance Medicare – source pic.twitter.com/Xa7o1Dnkzl
— Reuters Politics (@ReutersPolitics) July 13, 2017
If conservatives bail out, moderates want to start looking for Democrats as partners on more modest fixes to the status quo. Conservatives on Capitol Hill balked at that idea yesterday:
“When [Senate Democratic Leader Charles] Schumer [N.Y.] talks about doing something bipartisan if this is unsuccessful, really what he’s offering is a multibillion dollar insurance company bailout with no reform,” said Senate Majority Whip John Cornyn (R-Texas). “And I can’t imagine me ever being in a position to support that, and I frankly wouldn’t recommend it to any of my colleagues.”
The House could be even more of an obstacle than the Senate.
“To suggest that Chuck Schumer is actually going to help out on a repeal bill defies not only his own rhetoric, but his commitment to his constituents,” said Rep. Mark Meadows (R-N.C.), chairman of the conservative House Freedom Caucus. “He said he’s not going to help us. So are we going to fix ObamaCare? The answer to that is no.”
The “bipartisan compromise” on ObamaCare is a pipe dream, as I write in my column at The Fiscal Times today. Democrats and Republicans want diametrically opposed outcomes, and there is no common ground on which to work:
Even renegade Democratic centrists don’t offer much hope for peeling off enough for a bipartisan compromise. A handful of House Democrats issued a proposal called, “Solutions over Politics” (SoP) to redirect the debate over health-care reform. “We are proposing real, concrete solutions that will stabilize and improve the individual market,” Rep. Kurt Shrader (D-OR) declared, “making Obamacare work better for everyone, and getting us closer to universal coverage for all Americans.”
Unfortunately, this agenda looks very close to the same laundry list Schumer has pushed in the Senate. Shrader wants a permanent subsidy for insurance companies to make up for the losses they incur, guaranteeing a perpetual river of red ink from Obamacare. The original reinsurance funds were time-limited because Democrats insisted that markets would stabilize after the first few years and would become self-sufficient. This “solution” concedes the Republican argument that Obamacare is unsustainable without heavy government spending, and is structurally unsound.
Even where it differs from the official Democratic Party line, the SoP proposal doesn’t stray very far. It endorses health-savings accounts (HSAs), but only for “plans compliant with the ACA,” where Republicans want to expand the use of HSAs to allow for non-compliant innovation. The SoP proposal retains all of the mandates while allowing for “catastrophic health insurance plans … for younger enrollees,” without acknowledging that Obamacare’s high-deductible plans already act in practical terms as catastrophic coverage at high premium levels. Their solution for poor enrollment figures is not to repeal the unsound structure of mandates and narrow choice of coverages that creates it, but “robust marketing around open enrollment periods.”
Simply put, there is no basis for compromise between one side that sees Obamacare as an abject failure in need of repeal, and another that sees a lack of government funding and a better PR campaign as the only problems in need of solutions.
Republicans have wound up with a Hobson’s choice at this juncture. Either they take this opportunity to at least move in the direction of freer markets and personal choice, or they will get nothing at all — and saddled with the result either way. It may look grim, but this is a trap they set for themselves. The best way through it is to take control of the situation, rather than let the situation take control of them for the next two years in the collapsing markets.
Addendum: This isn’t going to go anywhere, but it’s indicative of the prospects for passing the new version of the BCRA:
With the prospects for passing the current Senate Republican health care bill still in jeopardy, Sen. Lindsey Graham, R-South Carolina, and Sen. Bill Cassidy, R-Louisiana, are working with their GOP colleagues on an alternative approach to replacing Obamacare: keeping much of the federal taxes in place and sending that money to the states to control.
Graham and Cassidy, who have been working closely with former Sen. Rick Santorum, argue that one of the main reasons that Republicans are having such a hard time agreeing is because they are working from the Obamacare template — particularly federal control of health insurance.
“The reason we can’t pass a bill is because we are trying to do it in Washington, so stop it,” Santorum, a CNN contributor, told CNN.
That’s a silly statement. You have to at least repeal it in Washington, and Medicaid changes have to take place there too. A straight repeal would take the health insurance jurisdiction out of Washington entirely without retaining any of the taxes, so why not just do that? If anyone thinks Democrats will sign up for a plan that takes all of the money from Washington and hands it to the states without any control over how it gets spent, well … [good luck with that].
Update: Here are the bullet points from the GOP:
JUST IN: Senate GOP releases revised health care bill, which includes more resources for opioid epidemic, more help for out-of-pocket costs pic.twitter.com/MKLuBeCKIl
— ABC News (@ABC) July 13, 2017