Opinion writer

Sen. Susan Collins (R-Maine) speaks during a news conference last year on Capitol Hill in Washington. (Evan Vucci/Associated Press)

CNN reports:

Two Republican senators introduced legislation Monday to replace Obamacare amid mounting pressure on the GOP to craft an alternative to the massive healthcare law.

Sens. Bill Cassidy of Louisiana and Susan Collins of Maine unveiled a bill that they are describing as an “Obamacare replacement plan.” The duo is promising that the proposal would give more power to the states on health care policy, increase access to affordable insurance and help cover millions of Americans who are currently uninsured.
At the core of their proposal: Any state that likes Obamacare can keep it.

They want states to be able to stay in Obamacare if they want, a clever way to get blue-state Democrats on board. As Cassidy put it, “A reasonable person can say, I live in California, I love Obamacare, this plan allows me to keep it. And I live in Arizona, my premiums just went up 100 percent and I have a chance to do something different.” But they also don’t want to see Medicaid expansion rolled back.

Collins has also been clear that President Trump has not helped much. “I think that the executive order is very confusing, we really don’t know yet what the impact will be,” Collins said, speaking for many politicians, medical providers and Obamacare watchers.

The senators’ bill borrows some elements from other Republicans’ plans that have floated around (e.g. health spending accounts, tax credits to purchase health care). Rather than the particulars of the bill, the Collins-Cassidy effort should remind us of several basic factors in the health-care debate.

First, getting all Republicans, let alone Democrats, on board with rolling back Medicaid benefits that were extended under Obamacare verges on impossible. If repeal of Medicaid expansion gets rolled into reconciliation, Republicans may lose votes from Cassidy, Collins and others.

Second, the multiplicity of ideas and the number of bills that will be circulating (Sen. Rand Paul promised his bill would be coming this week) should underscore that Republicans lack consensus and a quick path to “repeal and replace.” The more complicated the “replace” part is and the more plans in circulation, the harder it will be to pass repeal as a stand-alone measure. Senators like Collins and Cassidy — but more important, the White House — have made clear that the two things must happen essentially at the same time.

Third, we remain puzzled how Republicans are going to pick up eight Democratic Senate votes. Even on a plan like the Collins-Cassidy effort, Democrats may well balk for any number of reasons. They will argue that the credits won’t be large enough to cover more than a bare-bones plan, and so the problem of big deductibles will increase. If the same tax credit goes to rich and poor alike, Democrats will point out that regular taxpayers will be subsidizing millionaires’ insurance. There are likely dozens of other issues that will be red lines for most Democrats.

Fourth, one can see how vital the confirmation of Rep. Tom Price (R-Ga.) for secretary of Health and Human Services turns out to be. If he falters because of questions regarding his stock purchases and potential conflicts, the entire endeavor may collapse. Figuring how this will all work and gain sufficient votes will require someone of Price’s ilk.

While Trump’s pie-in-the-sky promises to cover everyone with better insurance at cheaper rates won’t help matters, moderate senators who have a variety of ideas will move front and center as Congress works through a plan. The wild card may be that no one will really know how Trump feels until he tests the political winds, figures out whether he should throw congressional Republicans under the bus (They’re taking away health-care insurance from poor people!) and decides whether he can support something that inevitably will fall short of his campaign promises.