During a meeting with the nation’s governors, Trump quipped, “Nobody knew health care could be so complicated.” And he was right about the complicated part.
Ever since the Democrats crafted the Affordable Care Act (a.k.a. “Obamacare”) in 2010, Republicans have been gunning to repeal it with “Repeal Obamacare” serving as their battle cry. Of course, while almost every Republican agrees that Obamacare should be repealed, negotiations this year have shown that few agree on how exactly to repeal it, and even how or should they replace it. In fact, Republicans have now had complete control for six months and yet they still haven’t been able to put a “repeal and replace” proposal on Trump’s desk.
The first proposal in the House of Representatives, known as the “American Healthcare Act”, collapsed after the House’s far-right Freedom Caucus scuttled it. An amended version narrowly passed on May 4th, the tally being 217-213 with twenty Republicans voting against it for a variety of reasons. Last Thursday, the Republicans in the Senate led by Majority Leader Mitch McConnell (R-KY) released their own version which was slightly more moderate than the House version. However, as it stands now, that bill is facing the same fate as the first House version. Due to Congressional rules (details here), the repeal version being proposed by the Senate GOP can’t be filibustered and only needs a minimum of 50 votes to pass (the tie being broken by Vice President Mike Pence).
Currently, Senate Republicans have a 52 seat majority yet four Republican senators have already said they can’t support the current version, including Senator Rand Paul (R-KY), Senator Mike Lee (R-UT), Senator Ted Cruz (R-TX), and Senator Ron Johnson (R-WI). This means that if a vote was held today and no Democrat senators supported it, it would fail. But now Senator Dean Heller (R-NV) has come out against it and Senator Lisa Murkowski (R-AK) is giving subtle hints that she too is hesitant to support the bill.
With the likelihood of Democratic cooperation being extremely rare, McConnell may have to revisit the GOP proposal and to further complicate matters, these defections aren’t for the same reasons. Heller is concerned that the bill goes to far and makes too many drastic cuts, a position that Murkowski will probably stick to if she also officially comes out against the current proposal. But others like Paul, Lee, Cruz, and Johnson have a more conservative and libertarian view that believes the repeal doesn’t do enough and cut enough.
I do not at all envy the position McConnell is now stuck in which can be compared to someone trying to completely cover a table with a tablecloth that is too short. If he pushes a more conservative proposal, he will likely alienate more moderate senators like Murkoswki and Heller. But if he adapts the proposal to more moderate concerns, conservative libertarians like Paul and Cruz will continue to oppose it, perhaps even more vehemently.
There is guaranteed to be a lively Senate debate on this topic as the two Republican sides attempt to reconcile their positions amidst the likely disruptions from Obamacare’s loyal defenders. But when push comes to shove, senators like Cruz and Paul should be more than willing to swallow a partial repeal than kill Republican hopes of repealing Obamacare in vain hope of a better deal. The most destructive mandates of Obamacare like penalties for those who don’t sign-up and regulations that bear the brunt of the responsibility for jacking up premiums must be repealed, and the current version does just that
But what the Republican proposal also attempts to do is fix Medicaid which many admit is broken. The Republican proposal is to halt the reckless expansion of Medicaid and instead start reducing it, replacing it with tax credits that will be awarded on the basis of income. The Congressional Budget Office will release a full analysis of the Senate proposal tomorrow which shall be an interesting read, but as it stands, the proposal makes good steps towards fixing the mess Obamacare has caused.
In their statement, Paul, Cruz, Lee, and Johnson agreed that the proposal was an improvement over Obamacare, but they worried that it didn’t completely fulfill their promise to voters to repeal Obamacare and lower healthcare costs. They may be right in the fact that the results may not be immediate but substantial progress will be made and it will also allow for a transition for those who are on Obamacare and benefiting from the current system. If Republicans kill Obamacare to quickly push immediate and massive Medicaid cuts, that will have severe financial repercussions for millions of Americans which could hurt Republican chances in 2018.
In conclusion, whatever version the Senate passes will be a compromise and not every GOP Senator will be in love with the results. But what matters is that we take important steps towards repealing Obamacare and no senator should let their own goals blind them to the reality that sometimes, the perfect can be the enemy of the good.
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