The Washington PostDemocracy Dies in Darkness

Opinion Defeated on Obamacare, the GOP struggles to save face

Senate Majority Leader Mitch McConnell. (Carlos Barria/Reuters)

Before delving into the particulars of the GOP’s failed health-care bills or the destructive and purposeless “skinny repeal” plan, we should not lose track of a defining, historic moment for the Republican Party: The GOP is unable to repeal the Affordable Care Act or replace and repeal the ACA after seven years of histrionics and with control of the Senate, House and White House. Take that in. The GOP has failed to make good on its “promise” — not because the party is cowardly but because what it promised is so objectionable even to its own members. To lose 43-57 and then 45-55 on two versions of repeal is a remarkable display of intellectual and political decrepitude.

The Post recaps:

The Senate rejected a proposal Wednesday that would have repealed major parts of the Affordable Care Act, but Republican leaders were growing more confident about their chances of passing a more modest overhaul of the health-care law later this week. …
More than half a dozen centrists from states that expanded Medicaid under the Affordable Care Act objected to the original Senate draft that was considered on Tuesday night. It would have cut the program for low-income Americans by $772 billion over 10 years and curtailed its long-term growth rate.
Yet even if Republicans agree on a minimalist plan to alter the ACA, uniting with their House colleagues to enact a bill would be far more challenging. On Wednesday — even before the skinny repeal came up for a vote — some House conservatives were calling it untenable.

At least Republicans now have clarity: The efforts to slash Medicaid, a position taken by a majority of House Republicans (including many moderates); to give huge tax cuts to the rich; and to eliminate the protections for preexisting conditions and the requirement for a minimum set of benefits have failed. The touchstones of conservative health-care policy have taken Republicans into a legislative cul-de-sac. They are left spinning their wheels as the reality of their political predicament sinks in. (The Post explains that “in two votes over the past 24 hours, lawmakers rejected differing approaches to rewriting the landmark 2010 law. The open voting process — which is likely to drag on for the rest of the week — has laid bare the fact that Senate Republicans haven’t been able to find a comprehensive replacement for the law they have relentlessly lambasted.”)

Before addressing the skinny repeal, let’s note once again that moderate Republicans who voted to “get on the bill” had no viable plan to replace Obamacare. One must ask once again how lawmakers such as Sen. Shelley Moore Capito (R-W.Va.) — who expressly promised not to “hurt people” and not to proceed without a replacement plan — rationalized their vote on Tuesday afternoon to proceed with debate.

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Senate Minority Leader Charles E. Schumer (D-N.Y.) went to the floor late in the day on Wednesday to review the bidding. “Clearly the Senate Republican bill — repeal and replace — has failed. Sen. Paul’s bill — repeal without replace — has failed. We know the Republicans are not going to take a final vote on the underlying House bill, which is still the pending legislation,” he said. “And now the Republican leadership team, unmistakably at the direction of the leader, has been telling the press about a yet-to-be-disclosed final bill. If the reports are true, the Republicans will offer a ‘skinny’ repeal plan. We just heard from the nonpartisan Congressional Budget Office that under such a plan, as reported in the press, 16 million Americans would lose their health insurance and millions more would pay a 20 percent increase in their premiums. At least 20 percent.” Huh?

Yup. The GOP can no longer do what it promised or do what it wants, so it’ll do something no one wants that will have nothing but negative results. According to reports, the plan would repeal the individual and employer mandates and the medical device tax. That’s it. It knocks out the individual mandate, thereby making the adverse selection problem more acute and hastening the death spiral they falsely claim is already happening. Rather than lower premium costs, lower deductibles, lure insurers back to the exchanges or improve access to coverage, the GOP’s repeal of the individual mandate will raise premium costs, raise deductibles, chase insurers from the exchanges and price millions of people out of the individual market. In sum, it cannot repeal or repeal and replace Obamacare, so it will destroy health-care insurance coverage for millions.

No wonder governors of both parties reacted angrily. In a letter released Wednesday night, a bipartisan group of 10 governors stated:

We agree with Senator John McCain that the Senate should “return to regular order,” working across the aisle to “provide workable solutions to problems Americans are struggling with today.”
Congress should be working to make health insurance more affordable while stabilizing the health insurance market, but this bill and similar proposals won’t accomplish these goals. The bill still threatens coverage for millions of hardworking, middle class Americans. The bill’s Medicaid provisions shift costs to states and fail to provide the necessary resources to ensure that no one is left out, including the working poor or those suffering from mental illness or addiction. The Senate should also reject efforts to amend the bill into a “skinny repeal,” which is expected to accelerate health plans leaving the individual market, increase premiums, and result in fewer Americans having access to coverage.

They pleaded with the Senate “to work with governors on solutions to problems we can all agree on: fixing our unstable insurance markets. Improvements should be based on a set of guiding principles, which include controlling costs and stabilizing the market, that will positively impact the coverage and care of millions of Americans, including many who are dealing with mental illness, chronic health problems, and drug addiction.”

No one who understands health insurance thinks the skinny repeal would actually improve the health-care insurance market. The Wall Street Journal reports:

Health insurers came out strongly against the idea of any bare-bones health-care bill that would repeal the ACA’s coverage mandate without other measures aimed at stabilizing the law’s insurance exchanges.
“If there is no longer a requirement for everyone to purchase coverage, it is critical that any legislation include strong incentives for people to obtain health insurance and keep it year-round,” the Blue Cross Blue Shield Association said in a statement. “A system that allows people to purchase coverage only when they need it drives up costs for everyone.”

We find interest in the skinny repeal inexplicable. It solves no problem; it makes insurance coverage more expensive. It does not create cheaper options for coverage. It serves only one purpose: to provide a fig leaf for Republicans bereft of ideas as to how to improve health care. The notion that passage of unworkable skinny-repeal legislation would at least result in a conference with the House reveals how unseriously GOP senators take their job. (What if the House simply approves the Senate bill?) Moreover, supposing there would be a conference, Republican senators’ approach  begs the question: If they get to conference, what kind of bill could they possibly agree upon? To accomplish what?

Republicans’ health-care efforts no longer have any coherent purpose. They take votes for the sake of voting. They need to stop before real people suffer.