If the Republican attempt to repeal and replace Obamacare ultimately fails, it will be a lesson in the wages of political bad faith.
The bill has plenty of obstacles, including the sheer inertia of the Obamacare status quo and the fact that no one has made the public case for the Republican legislation. But the effort also suffers from a mismatch between the longtime public posture of Republicans (Obamacare must and will be fully repealed) and their private misgivings (do we really have to do this, even partially?).
It’s not just that Republicans have said for years that they would repeal Obamacare; they actually voted to do it. In December 2015, a bill passed the Senate that was more stringent than the version now struggling for GOP support. The 2015 bill only tried to repeal Obamacare (although it fell short of that goal), while the current bill attempts to repeal and replace, i.e., forge a Republican alternative.
Only two Republican senators voted against the 2015 repeal, Susan Collins of Maine, who is still a “no,” and Mark Kirk of Illinois, who is out of the Senate. Everyone else was on board, and celebrated a righteous blow against Obamacare. Winston Churchill said that nothing is so exhilarating as getting shot at without consequence. For Republicans, nothing was as exhilarating as repealing Obamacare without consequence.
The repeal bill inevitably got vetoed by President Barack Obama. Republican congressional leaders thought they could pick up where they had left off. They failed to account for the changed — and more difficult — dynamic with a Republican in the White House ready and eager to sign whatever gets to his desk.
The prospects of the current bill are clouded by the hesitance of the Medicaid moderates, Republican senators from states that accepted the Obamacare expansion of the program. The legislation is hardly Dickensian on this front. It allows states to continue the expansion, but, over time, brings the level of federal funding for the new population down to the levels for the rest of Medicaid (years from now, it also establishes a new per capita formula for all of Medicaid). The 2015 law was tougher on the expansion — it simply ended it after two years — and yet all of today’s hand-wringers voted for it.
Perhaps they are disturbed by the coverage numbers the Congressional Budget Office has produced about the current bill? According to the CBO, it would lead to 22 million fewer people having insurance. But the earlier repeal bill, per the CBO, would have led to 32 million fewer people having insurance.
Perhaps they think the current bill should be more generous? The fact is the Senate bill unveiled a few weeks ago spends roughly $600 billion on replacing Obamacare, or $600 billion more than the December 2015 bill. It has since been revised to spend even more, and scale back the tax cuts.
As the publication Health Affairs starkly noted of the 2015 legislation at the time, “it would end the premium tax credits, the cost-sharing reduction payments, the Medicaid expansion, and the small business tax credits — that is, all of the assistance that the ACA gives to low and moderate-income Americans.”
(Rand Paul, whose shtick is libertarian purity, is guilty of his own hypocrisy. He portrays the 2015 bill as preferable to the current version, which he opposes for not fully repealing Obamacare regulations. But the 2015 bill didn’t touch any of the major Obamacare regulations.)
All of this is why the Plan B endorsed by President Donald Trump — to revert to a repeal-only bill if the current bill fails — is a non-starter. If there aren’t 50 Republican votes for today’s relatively generous bill, there won’t be 50 votes for anything like what passed a year and a half ago. Unless, perhaps, Trump promises to veto it, and Senate Republicans can consider it once again a blissfully consequence-free vote.
— Rich Lowry is the editor of National Review. He can be reached via e-mail: firstname.lastname@example.org. © 2017 King Features Syndicate