Browsing the blog archivesfor the day Tuesday, January 10th, 2017.


Are Wheels Coming Off the ACA Repeal Bus?

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Bad Hair, Health Care

There are signs congressional Republicans are beginning to get a clue that repealing Obamacare without a good plug and play replacement already in hand might come back to bite them. Jonathan Chait writes,

Something big is happening in the Senate right now: The Republican plan, affirmed again today by Senate Majority Leader Mitch McConnell, is facing dire peril from Republican defections. Republicans need a House majority, 50 Senate votes, and soon-to-be President Trump to pass repeal and delay.

If Republicans lose three Senate votes, that drops them to 49, and repeal and delay cannot pass. At least three Republican senators (in addition to all the Democrats) now oppose repeal and delay. Rand Paul, of all people, has demanded that Congress repeal Obamacare at the same time it passes a plan to replace it. Paul has announced that he spoke with Trump and secured his agreement on this. Trump has not said so himself, confining his comments to date to a vague assurance, “That’s all gonna work out.”

Trump, of course, tends to change his mind frequently and agree with whomever he spoke with last. But other Republicans senators are taking the initiative. Fellow Republican Lamar Alexander says the same thing as Paul: “We have to take each part of it and consider what it would take to create a new and better alternative and then begin to create that alternative and once it’s available to the American people, then we can finally repeal Obamacare.” Senator Tom Cotton of Arkansas said on MSNBC, “It would not be the right path for us to repeal Obamacare without laying out a path forward.” And Senator Bob Corker is walking right up to the edge of the same position, asking Trump to tweet out confirmation of what Paul claims he promised. “If it is his view, it would be really good if he would consider tweeting it out very clearly. There’s more and more concerns about not doing it simultaneously,” Corker says.

Over in the House, Paul Ryan is pushing a bill that would use budget reconciliation to kill significant parts of the ACA. But on top of the three senators who oppose “repeal and delay,” four more Republican senators — Portman, Collins, Cassidy, and Murkowski — joined Corker in sponsoring a bill that would delay Ryan’s Obamacare repeal for a month. They say they just want to be sure everyone is clear about what comes next before they go forward with repeal.

(And since when do we ask presidents to “tweet out” what their intentions are?)

Conservatives hate Obamacare because it redistributes too much money from the rich and healthy to the poor and sick. But they don’t publicly attack the law on that basis. Instead they attack it for high premiums, high deductibles, and narrow choice of doctors and hospitals — all flaws that any Republican plan would have in much higher doses. Republicans have yet to unify around a single, concrete, scorable plan because it is conceptually impossible to design a health-care plan that meets conservative ideological goals and is also acceptable to the broader public.

Ryan is talking about making repeal and replace “concurrent” –

“It is our goal to bring it all together concurrently,” said Ryan. “We already show people what we believe in, what we believe Obamacare should be replaced with. so we’re going to use every tool at our disposal — through legislation, through regulation — to bring replace concurrent along with repeal so we can save people from this mess.”

Hmm. Well, what they believe in is that people without money should just die already. But we really haven’t seen what they think Obamacare should be replaced with. They make noises about various things — high-risk pools, tort “reform,” selling policies across state lines — that don’t add up to a comprehensive whole. There is no way they’re going to fund high-risk pools enough to make them work. That’s a symbolic fix only. Their other ideas barely rise to the level of “tweaks.”

But then there’s this:

On Monday night at Tortilla Coast, a Mexican restaurant on the Hill, the House Freedom Caucus – a group of fiscal conservatives with a reputation for rabble rousing–came to a consensus that they wanted more insight into what the GOP’s replacement is before they vote on a budget resolution slated to be taken up Friday in the House.

 If the House Freedom Caucus is getting nervous about repeal, this is serious. I would have expected them to push for repeal, period, and don’t worry about the replace. But I guess some of them want to be re-elected.

A reconciliation bill requites only a simple majority to pass the Senate, but you can do only so much with a reconciliation bill — change taxes and spending, and that’s about it. Actually changing the system requires a regular bill, which would require some Democratic votes.

The idea behind “repeal and delay” was that by setting a deadline for a replacement, Democrats might be pressured into writing the bill. Republicans, as you know, are congenitally incapable of crafting legislation without help from ALEC. But if there’s no delay, there’s no pressure.

And then there’s the Trump factor. Greg Sargent wrote this morning,

When Trump holds his news conference tomorrow, he will likely be asked whether he still thinks that Republicans should repeal and replace the Affordable Care Act “simultaneously,” as he said in a post-election interview. If he answers in the affirmative, it could throw the current GOP strategy — repeal on a delayed schedule with no guarantee of any replacement later — into further doubt.

 So, we’ll see.

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