After two failed attempts to reach the necessary fifty votes on a Senate version of health care reform, Majority Leader Mitch McConnell (R-KY) has now released yet another iteration of repeal and replacement of Obamacare. He believes this is the one and hopes to bring the bill to the Senate floor for a vote next week.
This latest version contains more new and revised provisions designed to thread the needle between the objections of both conservatives (e.g. Rand Paul (R-KY)) and moderates (Susan Collins (R-ME) in particular). Given zero support from Democrats, McConnell can afford just two defections in the ranks of his fifty-two GOP Senators. At least ten Republicans announced their opposition to the previous version of the bill.
To say this bill has become a balancing act - or perhaps a high-wire act - would be quite the understatement. But then, it should have been clear how difficult this process would be from the start. After all, it took Democrats – who controlled both chambers of Congress and the White House as the GOP does now – more than a year to force Obamacare upon a skeptical nation by the slimmest of margins. And looking at approval numbers from the latest polls, Americans appear equally skeptical of the Republicans’ attempt to come up with something better.
Lending new meaning to the expression “you don’t know what you’ve got ‘til it’s gone,” there has been a sudden surge in support for Obamacare, which was unrelentingly unpopular before a Republican controlled government threatened its existence. This may be simply because people prefer the devil they know to the one they don’t. It may be that people are misinformed in believing the bill will deep-six Obamacare’s most popular provisions - coverage of pre-existing conditions and keeping children on their parents’ plans until age twenty-six. Or it may just be that they don’t trust Republicans on health care any more than they did the Democrats.
The reality is that once Barack Obama won reelection in 2012, Obamacare effectively transformed health care insurance from a commodity into an entitlement. And it is an inarguable fact that entitlements are notoriously difficult – if not impossible – to remove.
The major addition to this new bill is the inclusion of so-called catastrophic plans, which would allow individuals to purchase limited-benefit, low-premium, high-deductible insurance. These plans were conspicuously absent from Obamacare. The new bill maintains most Obamacare taxes, but reduces subsidies for people earning up to $84,000 per year and still eliminates funding for Planned Parenthood for one year. In the end, it would unravel the one-size-fits all feature of Obamacare. It will cost more for older people than for young, and more for the sick than the healthy.
But the bill also expands Health Savings Accounts (HSAs), which together with the ability to buy catastrophic policies and join large buying groups or associations could represent a realistic and cost-effective model for millions of people over the long haul. A young and/or healthy person can start an HSA to use as needed, purchase a low-cost plan for major medical incidents, and join an association to drive down cost.
Given the Republicans’ unrelenting opposition to The Affordable Care Act and promises to repeal it for the last seven years, McConnell and his fellow congressional Republicans must understand that a failure to overturn Obamacare will place their prospects of holding their current congressional majorities in next year’s midterm elections in serious jeopardy. But then, if the Senate bill is as unpopular as polls suggest, it is still possible they will punt and move on to tax reform. They would do so at their own peril.
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