Bless Senate Majority Leader Mitch McConnell’s heart — he just keeps trying to come up with a replacement for Obamacare that can unite the varied factions of his fractured Republican caucus. But even before his latest revision left the printer, GOP senators were turning up their noses.
As many as 10 Republicans from both the far right and the middle are suggesting they will not support the new plan. McConnell can only afford to lose two, since Democrats are unanimous in their opposition and the GOP majority is 52 seats.
With help from President Donald Trump, the senator from Kentucky will spend the next several days whipping and wheedling members in hopes of getting to 50 votes. But that seems a long shot, even though the current version is already loaded up with concessions and changes aimed at appeasing conservatives and moderates.
To soothe moderates worried that voters will oppose provisions that favor the rich, the plan keeps the 3.8 percentage point surcharge imposed by President Barack Obama on investment income, jettisoning a priority of those who believe such taxes on investors are keeping economic growth sluggish.
The funds will now go to expand eligibility for federal insurance subsidies and to higher upfront Medicaid spending.
Obama already added 29 percent more Americans to the Medicaid rolls, so that now nearly one in four people nationwide receive the benefit that was originally intended to help poor women with children and the disabled. Conservatives are rightly concerned the explosion in Medicaid spending will wreck both state and federal budgets.
Still, even with that modification, McConnell’s proposal is better than the status quo.
Conservatives gained some ground, too. The new plan will allow individuals to use tax-free health savings accounts to pay for insurance premiums, and adds $70 billion to help states put in place cost-saving Medicaid reforms.
A change offered by Texas Sen. Ted Cruz, who has been a solid no vote on the previous versions, would let insurers that sell Obamacare-compliant plans also market bare bones catastrophic policies with appeal to the younger and healthier who don’t feel they need the expansive coverage mandated by the Affordable Care Act.
McConnell kept in place many of the best pieces of the original Obamacare replacement, including a key reform that will ultimately switch Medicaid to block grants administered by the states. This will encourage innovation and help control costs.
In truth, this is more of a 20,000-mile tuneup than the complete overhaul Republicans had promised. But at least it will head off the implosion of Obamacare, which has seen premiums soar and insurers bailing out of the exchanges.
If it fails in the Senate, as appears likely at the moment, McConnell and Republicans should admit repeal and replace is not going to happen and shift the conversation to “fixing” Obamacare, which will require them to work with Democrats.
That won’t be easy. Minority Leader Chuck Schumer, who is getting a free pass for waging total resistance, knows there is little consequence for Democrats if Obamacare explodes, even though his party made the Obamacare mess, and has an obligation to fix it.
For Republicans, not passing a repeal and replace package will mean they’ll have to pour tens of billions more into Obamacare to shore up the state exchanges. They also likely will have to live with the Medicaid expansion.
But perhaps they can get some key reforms, including measures to keep those with pre-existing conditions from jumping onto the exchanges only when they need treatment, creating subsidized high-risk pools for the sickest Americans to lower premiums for everyone else, and some flexibility for states to control Medicaid costs.
They won’t get much. But that’s the consequence of their failure to exploit their majority.