For those who wanted quick action on ObamaCare, their wish may get fulfilled by before the next legislative break in April, or even perhaps by late next week. For those looking for a full repeal in favor of a free-market system … maybe not so much. NBC News reports that two House committees will begin work immediately, but the lack of a CBO score might hold up the process:
House Republicans unveiled their plan Monday night to dismantle and replace former President Barack Obama’s signature health care achievement. But one key question remains unanswered: Just how much will this cost taxpayers? …
Two House committees — Ways and Means and Energy and Commerce — plan to start reviewing the legislation this week. The bill must also move through the Budget and Rules committees before the full House can vote on it. Republican leaders say they want that to happen before Congress’ spring break begins April 7.
A spokesperson for the Ways and Means Committee told NBC News it is a House rule that legislation must have a CBO score, which would indicate how much a bill would cost, on the way to the floor, but that the rule is sometimes waived if a score is unavailable.
That would be a Rules committee decision, but moving forward without a CBO score might be a political headache. OMB director Mick Mulvaney sounded very optimistic on NBC’s Today show this morning about how the CBO will score it:
“Everybody who’s looked at it knows this is going to save a dramatic amount of money,” Mulvaney said, adding that the costs associated with the plan would be shared publicly before a congressional vote.
“Once you repeal the mandate in Obamacare, repeal the taxes in Obamacare, repeal the penalties in Obamacare and get out of that government-centric system, the [Congressional Budget Office] score is going to be very positive and helpful long-term to the deficit,” Mulvaney said.
When challenged on whether this new plan meets Donald Trump’s pledge of universal access to care, Mulvaney spends a good deal of time explaining the difference between coverage and care. The problem with ObamaCare is that it provides the former — mandates it, actually — but that it escalated costs and deductibles so much that coverage no longer funds care for many enrollees, and more and more people only can choose one insurer, eliminating any choice they have in coverage. The comparison, Mulvaney insists, isn’t between this plan and ObamaCare, it’s between this plan and failure.
Mulvaney also insists that Donald Trump is fully on board with this plan. That’s why Paul Ryan promised on Friday that it would get passed in the House before the end of the month, and Mitch McConnell is pledging a floor vote as soon as the House passes it:
McConnell signals GOP ACA bill will go straight to the floor after House passage. "I hope to call it up when we receive it from the House"
— Bridget Bowman (@bridgetbhc) March 7, 2017
That’s still a very large if. Politico’s Rachel Bade reports on objections from House conservatives over a plan they’re calling “ObamaCare by a different form”:
Some House Freedom Caucus members dismissed the bill as creating a new “entitlement program” by offering health care tax credits to low-income Americans. A Republican Study Committee memo sent to chiefs of staff, obtained by POLITICO, echoed those comments and blasted the bill’s continuation of the Medicaid expansion for three years.
“This is Obamacare by a different form,” former Freedom Caucus chairman Jim Jordan (R-Ohio) told POLITICO. “They’re still keeping the taxes in place and Medicaid expansion, and they’re starting a new entitlement.”
Freedom Caucus member Dave Brat (R-Va.) piled on, telling POLITICO he’d vote against it in its current form because “the bill maintains many of the federal features including a new entitlement program as well as most of the insurance regulations.”
“Now [they] are saying we’re going to do repeal and replace but the bill does nothing of the sort,” he said. “[Speaker] Paul Ryan has always said the entire rationale for this bill is to bend the cost curve down, and so far I have seen no evidence that this bill will bring the cost curve down.”
Paul Ryan has apparently lost the Republican Study Committee, whose analysis is a must read for those looking to see the structure of the new system. They conclude that the new plan is “a Republican welfare entitlement program,” and essentially ObamaCare 2.0:
1. This is a Republican welfare entitlement
a. Writing checks to individuals to purchase insurance is, in principle, Obamacare.
b. It does allow more choices for individuals, and is more patient-centered, but is fundamentally grounded on the idea that the federal government should fund insurance purchases.
a. This is really an indicator of how severe Concern 1 is.
b. The higher the cost, the bigger the entitlement, and the greater long-term risk to the federal fiscal condition if things spiral
c. Has to be paid for
i. Some of this can be covered by using savings from repealing Obamacare, but that really just means enacting a Republican plan that deficit spends at the same rate as current law.
ii. If cost exceeds Obamacare spending, than either some of the Obamacare taxes must be kept, or new revenues raised in other ways. The released bill includes a further delay of repealing Obamacare taxes, likely to produce this necessary revenue.
The Club for Growth also opposes what it calls “RyanCare” in a statement this morning:
“The problems with this bill are not just what’s in it, but also what’s missing: namely, the critical free-market solution of selling health insurance across state lines,” said Club for Growth president David McIntosh. “Such an injection of competition would lead to hundreds of billions of dollars in savings, nullifying any argument by Congressional Republicans that this provision cannot be included in the current bill. If this warmed-over substitute for government-run health care remains unchanged, the Club for Growth will key vote against it. Republicans should be offering a full and immediate repeal of Obamacare’s taxes, regulations, and mandates, an end to the Medicaid expansion, and inclusion of free-market reforms, like interstate competition.”
Chris Cillizza also notes that the changes in this plan doesn’t amount to repeal or replace, but merely adapt:
On Monday night, House Republicans revealed the outlines of their plans to overhaul the overhaul of the health-care system completed by President Barack Obama. The coverage of the GOP proposals suggested that Republicans were keeping a promise to their voters to “repeal and replace” the Affordable Care Act.
Except, that’s not really what they’re doing.
It’s more accurately described as a revision or an altering of the Affordable Care Act. Republicans are keeping the most popular elements of the law — 1) no discrimination by insurance companies against people with preexisting conditions, and 2) children up to 26 years old can stay on their parents’ plans — while replacing the less popular elements such as the insurance mandate and subsidies to help people buy coverage.
This is not a full repeal. It is not even a full replacement. It’s more of a have-your-cake-and-eat-it-too bill.
Perhaps a better description would be a try-too-hard-to-find-middle-ground bill. There really is no middle ground here; either we have a federally controlled health insurance market with subsidies and tax penalties, or we don’t. The tell here, as the RSC points out, is the delay in repealing ObamaCare taxes, which seems designed to improve the CBO score. If that sounds familiar, it’s because Democrats pulled the same stunt in passing ObamaCare, only in reverse — imposing taxes for three years before delivering any benefits, which allowed them to show a deficit-neutral first decade. It’s a shell game, and shell games don’t exist to hide benefits.
Unfortunately, there’s no way to fix the problems created by ObamaCare without repeal, and without suffering some disruption. Republican leadership — and this apparently also includes the White House — has become too risk averse to short-term political consequences for the disruption they’ve promised for seven years. This middle-ground approach will only drag that pain out over a much longer period of time.
Right now, it doesn’t appear that the middle ground approach has much chance of success anyway. House Republicans seem ready to bolt, and at least four Senate Republicans have indicated opposition to this approach. Democrats won’t go along with this in either chamber. This may wind up being a speed bump on the way to true repeal and free-market choice.