The conservative and influential Republican Study Committee, a large caucus within the House Republican conference, has offered a balanced and level-headed assessment of the Trump/Ryan healthcare proposal. They're not demonizing the entire thing as a terrible betrayal (an unfair exaggeration, in my view), but they're not simply glossing over its real flaws. One of the keys to getting enough buy-in to pass the legislation will be to pay serious attention to serious suggestions for improvement. Not every good idea will be adopted, but each should at least be considered and debated. The RSC announced earlier today that its members have unanimously endorsed two changes to the Medicaid portion of the legislation:
These strike me as reasonable. As currently written, the bill would allow new Medicaid enrollments under Obamacare's expansion to continue through January 1, 2020. All of those people would then be grandfathered into the program at elevated spending levels. The RSC-backed change would shave two years off of the "continued expansion" timeline. How is this unfair or irrational? People who have already signed up for Medicaid are afforded protection and stability under this plan. The neediest (previously-ineligible) citizens would have been at the front of the line to sign up. And if there are additional eligible Americans in need of help (setting aside Medicaid's fundamental flaws for the purposes of this argument), and who've fallen cracks, states get another year to get them onto the rolls before the freeze is enacted. Phil Klein has written about this previously, noting that an enrollment freeze can eventually reduce the number of people receiving benefits in large government programs, through attrition. He cites an Arizona case study make the point. Remember, Medicaid was already stretched thin before Obamacare expanded it. As some recent enrollees lose their grandfathered status because they've taken jobs that offer coverage, or are making more money (good things!), Medicaid's resources can be better directed to the truly indigent -- which is the point of the program.
The other amendment would require that able-bodied adults with no dependents must be working, or actively seeking work, in order to receive taxpayer-funded Medicaid benefits. That seems common-sensical and fair to me, too. Of course, any changed details to the bill's Medicaid balancing act could be a political problem, in light of some moderates' public skittishness on that issue. Would Senators Portman, Gardner, et al really torpedo a bill because of these provisions? If so, why? What is the conservative, semi-conservative, or even nonpartisan reason why these changes would be unacceptable? For what it's worth, these two amendments were withdrawn during the committee mark-up in order to keep the process rolling on schedule, but RSC sources say they're still pursuing them with leadership and the White House. An important committee chairwoman has signed on to the effort. These amendments could be introduced or adopted in the Rules Committee, or on the floor. I'll leave you with this, regarding our former president, who just cannot help himself:
Yes, he hates the idea of people getting kicked off their plans. Except the millions of people his law kicked off their plans after explicitly promising that would not happen. We again return to the issue of credibility.