Analysis: Obamacare Replacement Debate Shifts to the Senate -- Now What?

Posted: May 11, 2017 10:30 AM
Now that the House of Representatives has passed an Obamacare replacement bill -- about which hysterical, willful distortions are whizzing around -- attention has shifted to the Senate, where a working group of 13 Senators is in the process of shaping the upper chamber's crack at legislation. That committee includes strong conservatives like Ted Cruz and Mike Lee, and more moderate members such as Rob Portman. The latest controversy du jour, led by the New York Times, has stoked the embers of identity politics: The task force excludes the majority's five females, as well as its only black member, who ran a successful insurance business prior to joining Congress. Expertise and ideological balance should be paramount in the formation of such groups (several of the women would fit the bill on this counts), but optics must also always be considered in politics. Having handed Democrats a turn-key attack -- "these Republicans are always against women, and now they're writing a healthcare bill without any women!" -- GOP leaders have invited West Virginia moderate Shelley Moore Capito to join in, although the permanency of her status is unclear.

In any case, the purpose of the makeshift committee is to bridge the gap between the right flank of the GOP caucus, which is pushing for a far-reaching repeal bill, and centrists who aren't eager to dramatically change various Obamacare protections and Medicaid provisions.  One thing that Mitch McConnell seems to understand is that while hitting a policy sweet spot that can attract at least 50 votes is obviously essential, messaging is an extremely important component to this process, too.  Republicans must do a much better job of explaining the changes they're seeking to make, and why they're making them.  A key to doing that is repeatedly framing their actions within the context of Obamacare's verifiableongoing, and worsening collapse.  To that end, McConnell gave a stage-setting floor speech on Monday.  His rhetorical style is not flashy, to put it mildly, but the content here is on point.  The relevant bit comes between the (0:45 and 2:50) marks:

Let me commend the House for voting to move beyond the pain of Obamacare. For years, the American people have suffered under this failed law. They watched their premiums soar. They watched their choices dwindle. Now, they’re watching as Obamacare collapses all around them. More than half of our states have counties with only a single insurance option on the exchanges, and a growing number could have no options at all — like, as we saw reported just last week, in nearly every county in Iowa. That means thousands more Americans could be left trapped, forced by law to purchase Obamacare insurance but left without the means to do so. Does that sound to anyone like a law that’s working? To those who would try to defend an indefensible Obamacare status quo, I ask you to consider what Speaker Ryan said last week:

‘[T]here is a fundamental and urgent choice at the heart of this debate. We can continue with the status quo under Obamacare, and we know what that looks like. It means even higher premiums, even fewer choices, even more insurance companies pulling out, even more uncertainty, and even more chaos.’ To those who’ve suffered enough already, my message is this: We hear you. Congress is acting. I commend the House and the administration for making this important advance last week. Now the Senate will do its work. The administration will also continue doing its part to deliver relief and stabilize the health markets as best it can. This process will not be quick or simple or easy, but it must be done — it’s the least members in both parties owe to the countless Americans who continue to suffer under Obamacare, and the countless more who will be hurt if we don’t act.

Meanwhile, conservative health policy wonk James Capretta is out with a new column urging Republican Senators to improve and alter the House bill in several significant ways.  Click through for the full piece, in which he touches on an idea for a Medicaid compromise, suggests needed improvements to the AHCA's incentives-challenged "surcharge," and recommends changes to other tax and spend provisions in the current legislation. We'll have more analysis on this front later in the week. And as you consider Medicaid-related questions, I'd remind you that the AHCA merely ends Obamacare's expansion of that troubled program after several years, grandfathering in people who have been, and will continue to be, enrolled during the expansion.  Only then does the reform of per-capita block grants kick in.  Finally, as opponents of Obamacare replacement endlessly cite the Congressional Budget Office's projection that an earlier iteration of the AHCA would take away coverage from 24 million people, I'd ask that you to read this analysis of why that lofty number is deeply misleading.  I'll leave you with this attack against the GOP bill:

In fact, regardless of color, rural citizens are among those getting hardest hit by Democrats' failing status quo.  More than 1,000 US counties, roughly one-third of those jurisdictions in America, are down to just one or zero coverage "choices" under Obamacare.  The method of repealing the law must take these areas into consideration, but let's not pretend that the status quo is working for rural Americans.  It's not.