While Washington remains focused on that big Russian cloud over the Trump administration, Republicans are proceeding apace with their plan to dismantle the Affordable Care Act and deprive millions of Americans of their health care coverage.
Mirroring the ways of House Republicans, Majority Leader Mitch McConnell and his wrecking crew of a dozen male GOP senators are reportedly nearing completion of their version of a bill to “repeal and replace” the Affordable Care Act.
The GOP leader is being aided and abetted by President Donald Trump’s effort to pull the props out from under the ACA by creating enough uncertainty about future federal support enabling recipients to pay their premiums that insurance companies either drop coverage or announce massive premium increases.
Like the House, the Senate held no hearings or open committee markups. McConnell hopes to bring a bill to the floor in two weeks and pass it the same way House leaders passed their version, by putting enough pressure on fellow Republicans to satisfy the GOP base by redeeming their repeated promises to scrap Barack Obama’s landmark health law.
Though the prospects remain uncertain, Trump predicted while meeting with GOP senators Tuesday they would produce a bill that is “phenomenal,” “fantastic” and “kind.” But it faces the same problem as the House version since it would likely deprive millions of their health care coverage – including many rural white Trump voters – by slashing funds, though more slowly, for the Medicaid portion of the Affordable Care Act’s expanded coverage.
Though only snippets have leaked, the GOP leader seems to be trying to appease more moderate GOP senators by delaying the House’s 2020 cutoff for the provision that has provided more than 11 million Americans with health care coverage. He would also remove some of the state waiver authority on coverage and pre-existing conditions that was added to win House support from its most conservative members.
McConnell reportedly wants to delay the Medicaid phase-out until 2023. But it remains unclear whether that alone would attract enough GOP senators from states where large numbers would lose coverage. Some reportedly favor an even longer phase-out period to give states more time to pick up the slack.
But McConnell also has to deal with GOP conservatives like Utah’s Mike Lee and Kentucky’s Rand Paul who don’t think the House bill went far enough in scrapping the Affordable Care Act.
Because he is trying to pass the bill with only GOP senators, in order to avoid a Democratic filibuster, McConnell can only afford to lose two of the 52 Republicans. That would create a 50-50 tie that could be broken by the Senate’s presiding officer, Vice President Mike Pence.
Meanwhile, administration officials and their Capitol Hill allies are sounding the same false note that, as Pence put it, “Obamacare is collapsing and taking the American people down with it.” In fact, the nonpartisan Congressional Budget Office concluded that maintenance of the current law’s subsidies and required coverage would be enough “for the market to be stable in most areas.”
Trump staged events Tuesday in Wisconsin and last week in Cincinnati with “victims of the Obamacare catastrophe created by congressional Democrats,” trying to take advantage of Anthem’s announcement it was withdrawing its Affordable Care Act participation in Ohio.
However, when Anthem announced that decision, it seemed to blame the administration by citing “the lack of certainty of funding for cost sharing reduction subsidies, the restoration of taxes on fully insured coverage and an increasing lack of overall predictability” for its action.
In North Carolina, the head of another insurance company was more explicit.
“The information coming from the administration actually creates more uncertainty rather than creating greater certainty,” said Brad Wilson, chief executive of Blue Cross Blue Shield North Carolina, which filed a 22.9 percent Obamacare increase for 2018. If the administration guaranteed it would pay the subsidies, the increase would have been just 8.8 percent, he said, telling Vox’s Sarah Kliff that the North Carolina market has actually been stabilizing “in terms of price, utilization and the customer base.”
Given the public’s poor reception of the House bill – recent polls showed more than half opposed it, and less than one-fourth supported it – you’d think Senate Republicans would be reluctant to follow a similar path. But it may well still happen, though any bill passing the Senate would have to be reconciled with the different House version.
Most GOP senators don’t face re-election in 2018, making them less vulnerable to a voter backlash. And one should never underestimate McConnell’s legislative skill or the tendency of even the more sensible Republicans to act like Republicans when the pressure is on.