The Corner

Politics & Policy

Kicking the Obamacare Repeal Can Down the Road, One More Time

Today’s Morning Jolt can’t hide the frustration:

The Obamacare Repeal Can Gets Kicked Down the Road, One More Time

After all this time, it increasingly appears impossible to get 50 Republican senators to agree on legislation to replace Obamacare.

Last night brought genuinely shocking news as two GOP senators, who up until now hadn’t appeared to be likely “no” votes, announced their opposition: Jerry Moran of Kansas and Mike Lee of Utah.

Moran:

“There are serious problems with Obamacare, and my goal remains what it has been for a long time: to repeal and replace it. This closed-door process has yielded the BCRA, which fails to repeal the Affordable Care Act or address healthcare’s rising costs. For the same reasons I could not support the previous version of this bill, I cannot support this one.

“We should not put our stamp of approval on bad policy. Furthermore, if we leave the federal government in control of everyday healthcare decisions, it is more likely that our healthcare system will devolve into a single-payer system, which would require a massive federal spending increase. We must now start fresh with an open legislative process to develop innovative solutions that provide greater personal choice, protections for pre-existing conditions, increased access and lower overall costs for Kansans.”

The problem is that “starting fresh” doesn’t change any of the dynamics in place. Republicans (and by extension, much of the country) want contradictory changes, changes that Moran lists as his requirements. Americans want lower premiums, but they also want insurance companies to keep covering preexisting conditions. They want to see the cost of Medicaid go down, or at least rise slower, but they also don’t want to throw anyone off of Medicaid. They want the number of uninsured to go down, and they want the mandate repealed.

To govern is to choose. The reason health care policy is so complicated and thorny is because so many people keep insisting that they can have the best of both worlds – more money coming out of the system in the form of innovative, top-of-the-line treatment and care with minimal waiting times, and less money going into the system in the form of premiums, copays, and deductibles.

Lee:

“After conferring with trusted experts regarding the latest version of the Consumer Freedom Amendment, I have decided I cannot support the current version of the Better Care Reconciliation Act. In addition to not repealing all of the Obamacare taxes, it doesn’t go far enough in lowering premiums for middle class families; nor does it create enough free space from the most costly Obamacare regulations.”

The recent decision to keep some of the Obamacare taxes in there – in particular, a 3.8 percent tax on investment income on high earners – was designed to defuse the easiest Democratic criticism that the bill takes away from the poor and gives tax cuts to the rich. That particular tax cut could be readdressed in the tax reform bill later in the year.

But no, these guys have to torpedo this particular bill, and its effort at improvement, in the name of some theoretical much better version that has yet to be written.

While recovering from eye surgery, Senator John McCain issued this statement:

“One of the major problems with Obamacare was that it was written on a strict party-line basis and driven through Congress without a single Republican vote. As this law continues to crumble in Arizona and states across the country, we must not repeat the original mistakes that led to Obamacare’s failure. The Congress must now return to regular order, hold hearings, receive input from members of both parties, and heed the recommendations of our nation’s governors so that we can produce a bill that finally provides Americans with access to quality and affordable health care.”

McCain and the likes of Ohio Governor John Kasich keep spouting this “input from both parties” happy talk, but that optimistic assessment ignores an ugly truth. The Democrats – the party that rammed this through and promised America they could keep their plan, keep their doctor, and they would pay $2,500 per year less than before – aren’t willing to go along with any significant conservative ideas for reform.

When Senate Republicans reached out to Heidi Heitkamp this spring to negotiate on health care, the North Dakota Democrat told Politico she had these demands: No per capita Medicaid block grants to the states and no rollback in ObamaCare’s Medicaid expansion. And that was merely “the price of admission for me sitting down.” Ms. Heitkamp is the second most conservative Senate Democrat after West Virginia’s Joe Manchin.

Ms. Heitkamp would never get a real chance to negotiate in any case. If their current effort fails, Republicans would then need 60 Senate votes to pass anything, and that gives Mr. Schumer the whip hand. His price for cooperating would include the Medicaid status quo; preserving the individual and employer mandates; tens of billions in higher subsidies to lure insurers back into the failing exchanges; and probably a limit on the policy flexibility the Trump Administration could allow states.

Some Congressional Democrats insist the main problem with the law is that the mandate is not enforced enough, and that if the administration and IRS would start cracking down on people who aren’t buying health insurance, everything would get better. Or they want higher subsidies for purchasing insurance. Or, like senators Tim Kaine of Virginia and Tom Carper of Delaware, they want to “provide funding to offset larger than expected insurance claims for health insurance companies participating in the state and federal insurance marketplaces.” (More taxpayer money getting sent to health insurance companies.) And quite a few Congressional Democrats want the public option – “Medicaid for all” which would allow any American at any income level set up insurance through the federal government.

Conservatives who oppose government mandates, subsidies, bailouts, and state-run health care won’t like any of that.

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