If you’re a Republican, you might feel disappointed that the Senate has hit a logjam and will postpone a vote on its bill to remake the Affordable Care Act. But maybe you should feel relieved instead.
The Senate bill, known as the Better Care Reconciliation Act, isn’t really meant to fix anything about the healthcare system. It’s meant only to fulfill a rash pledge Republicans never should have made—to kill the Affordable Care Act the first moment they got the chance. Well, they’ve now got the chance, and they’re discovering that the harm caused by repealing the ACA is likely to outweigh any good that might come from fulfilling the pledge. And that’s political harm as much as anything.
The ACA, aka Obamacare, is certainly problematic. If Congress were interested in fixing what’s wrong with it, they’d focus first on making all healthcare more affordable. People who buy their own policies and don’t get ACA subsidies need better choices and lower premiums. Drug prices are too high, and Americans use too much care, with inadequate return on that spending.
Instead of trying to fix the problems that affect the most people, however, Congressional Republicans have mainly focused on how to slash funding for Medicaid, because they don’t like “entitlement” programs with open-ended spending. There are bona fide problems with those programs, too—but the solution isn’t slashing funding and kicking people out in short order, as both the Senate bill and a similar House bill would basically do. The solution is a complicated one, involving gradual change that improves efficiency and transparency, slowly shifting more responsibility onto patients, so they make more cost-effective choices. But that’s difficult and boring, and not what irate Republicans promised when the ACA passed in 2010.
So Congressional Republicans, with sporadic support from President Trump, have come up with bills that would leave millions more Americans uninsured, raise costs for the elderly and price many poor people out of the insurance market. AARP, which represents 38 million Americans, hates both bills. So do the American Medical Association and the American Cancer Society. Forty prominent economists, including six Nobel prize winners, wrote a letter to Senate Majority Leader Mitch McConnell saying the Senate bill “will expose millions to increased out-of-pocket health care costs” and “reduce assistance for the millions of people who buy coverage through the state and federal marketplaces.” Here’s who favors the bill: the US Chamber of Commerce and other big-business interests. This is not the populism that brought Donald Trump to Washington.
If the Republican Congress actually passed one of these bills, and Trump signed it, it could be the worst thing to happen to Republicans since Sarah Palin joined John McCain’s presidential ticket in 2008. “I’ve never seen legislation like this,” Drew Altman, CEO of the nonprofit Kaiser Family Foundation, told reporters shortly before the Senate postponed a vote, on June 27. “It fulfills the promise of repealing Obamacare to the Republican base, but it also produces 22 million uninsured, raises premiums, and raises deductibles. It would produce many more losers than winners, which is pretty unusual and could come back to haunt Republicans in the upcoming elections if it passes.”
The Senate measure isn’t dead. McConnell and other Senate leaders hoped to get it passed before an upcoming recess, so senators would face less pressure on the bill when they head home to face constituents. Now they’ll have to face the heat at home. But it’s still possible McConnell could twist arms when the Senate reconvenes the week of July 11. One thing he can do is dole out billions in available funding to the states of key holdouts, offsetting their concerns on certain parts of the bill with new funding for favored programs.
It’s also possible McConnell knows this bill is a dog, and is simply going through the motions while discreetly guiding it toward failure. If the Senate’s Obamacare-repair bill dies, then there’s nothing to reconcile with a House bill that passed in May, and Obamacare repeal will be over and done with for the time being. Obamacare will remain in place, presenting its own series of problems the government will need to address–but at least Americans won’t be losing insurance left and right, with Republicans stuck trying to explain the damage.
That would be a blow for the GOP, but Congress would then turn to tax-cut legislation, which might offer a chance at redemption. Republicans wanted to repeal Obamacare first, because they’d get rid of tax hikes that were part of the ACA, which could be used to finance new tax cuts the GOP wants now. But there are other ways to cut taxes, even if there’s less wiggle room. Tax cuts will be politically and legislatively tricky too, but nowhere near as sticky as Obamacare, which seems to singe every politicians who touches it.
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Rick Newman is the author of four books, including Rebounders: How Winners Pivot from Setback to Success. Follow him on Twitter: @rickjnewman