“It’s time to put up or shut up,” John Cornyn, the chief Republican vote counter in the Senate said of Mitch McConnell’s message to pass health care reform. “I think he’s right. We could talk about this endlessly and never reach a conclusion.”
Repealing and replacing Obamacare is hard. Fundamentally transforming an enormous entitlement like Medicaid is incredibly difficult. Doing both with a narrow 52-48 majority that demands near consensus is an onerous proposition. And somehow accomplishing all of those things while navigating the complex rules for budget reconciliation, which limits what can be addressed in the bill without being subject to a Democrat filibuster, feels nigh impossible.
But Republicans recognize that something must be done to shore up the increasingly untenable health insurance market that has resulted from Obamacare. With premiums continuing to soar and insurance options continuing to plummet there simply isn’t a choice. Republicans know they must act.
While the GOP have been working overtime to hammer out a plan, Democrats have refused to participate in the process. Juliana Darrow writes for National Review, Democrats aren’t exactly stepping up to the plate to clean up the mess they made:
[O]ne thing no one seems to be talking about is that Republicans are the only ones attempting to address the rising costs, declining quality of coverage, and increasing lack of choice in the health-care marketplace.
Democrats seem to be content with the status quo of the Affordable Care Act. Premium and deductible costs are rising and choice and competition are decreasing. As of now, over 1,200 counties will have only one insurance provider available on the individual market next year, and 35,000 individuals will live in counties with no options available at all. These numbers are expected to increase as insurers finalize their 2018 plans in the upcoming weeks, and yet, Democratic lawmakers have not introduced any major legislation to try and fix the system. They have taken the easy way out: showboating and complaining instead of working on a solution to stabilize the health-insurance market.
In spite of the odds that are stacked against them, Senate Republicans appear close to threading the needle in the form of the Better Care Reconciliation Act of 2017.
The bill builds off of many of the reforms contained in the American Health Care Act that passed the House in May. It eliminates Obamacare’s employer and individual insurance mandates, which required Americans to purchase more insurance than they needed or could afford. It repeals a raft of costly Obamacare taxes that were being passed on to consumers, further inflating the cost of insurance and healthcare. And it fundamentally overhauls Medicaid by devolving power back to the states, allowing them to choose between block grants or per-capita payments, either of which open up the program to innovative payment approaches.
The Senate version of the bill does make some important tweaks to the House language.
Namely, it replaces the House’s use of flat tax credits to help people purchase insurance with means-tested tax credits, which vary based on income. As Avik Roy explains in Forbes, this change allows near-elderly working poor to afford coverage, and eliminates the poverty trap, which created a financial disincentive to earn more money. And the bill also rethinks the idea of high risk pools for high-cost, low-income individuals, instead opting to expand the Long-Term State Innovation Fund as a way to improve the risk pool in the individual markets.
Unsurprisingly, with a bill this big and significant, not all Republicans agree. Some of that is likely by design. As Russell Berman astutely observes in The Atlantic:
“[I]n many ways, it appears McConnell’s draft is designed to be amended. The bill, for example, does not include funding for the opioid crisis that Senators Rob Portman of Ohio, Shelley Moore Capito of West Virginia, and others were demanding. Nor does it adopt their proposal for a longer, seven-year phase-out of the Medicaid expansion. But by omitting those provisions at the front end, McConnell could be inviting Portman, Capito, and other wavering senators to add them by amendment so they can claim credit for improving the bill when it comes to the floor. Similarly, the statement Paul, Cruz, Lee, and Johnson appeared to be a play for changes that could win their ultimate support.”
There is no doubt that Republicans will continue to work tirelessly to make the bill better. There are simply too many American families struggling under the weight of Obamacare for it to be any other way. Now if only Democrats had a similar sense of urgency.