Of all the GOP proposals to gut Obamacare, the one that only takes out the most unpopular parts — the so-called Skinny Repeal — is potentially the most damaging of all.
Among the moderate Republicans who vowed to block even a motion to proceed to debate Obamacare repeal, only two followed through. John McCain is no moderate, yet he took to the Senate floor and forcefully proclaimed that he wouldn’t vote for the BCRA as written…before he voted for it unchanged.
McCain likes to style himself as a maverick, but more often than not he eventually caves to Republican orthodoxy in the end.
The fact is, time and time again moderate Republicans have stood before microphones to take what seems to be principled stances, only to cower under the demands of GOP leadership.
That’s exactly what Mitch McConnell have been banking on.
It worked with the AHCA, which tacked toward the conservatives while scattering chump change for risk pools in order to give House Republican moderates a cover story for their cowardice.
In the recent Senate Trumpcare debate, McConnell allowed Ohio’s Rob Portman to add a drop-in-the-bucket $100 billion stabilization fund for the states in exchange for his vote. The BCRA, fortunately, lost nine other Republicans of every ideological stripe.
Among the nay votes were Republican moderates Susan Collins (as expected), as well as Lisa Murkowski and Dean Heller.
Though President Trump singled her out for a Twitter thrashing, Lisa Murkowski doesn’t feel particularly beholden to the GOP leadership. She lost the Republican nomination to a Tea Partier. but came back to win her seat through a write-in campaign. Shelley Moore Capito, however, capitulated both in her promised vote against the vote to proceed and on the BCRA. Capito said previously, “I didn’t come to Washington to hurt people.”
But apparently she’s okay with other people doing it for her.
As for Dean Heller, while he voted yes on the motion to proceed, he stood by his word and voted against the BCRA. Heller — whose seat is in jeopardy in the 2018 midterms, in a state won by Hillary Clinton — will need all help he can get if he hopes to keep it. Yet Heller signalled on Wednesday that he will support Skinny Repeal, breaking ranks with his popular Republican
Meanwhile, the administration has been doing its best to twist the thumbscrew on Murkowski and her Alaska Senate colleague, Dan Sullivan. So far, Murkowski has been rock ribbed in opposing White House pressure. But for how long?
Murkowski’s and Heller’s objections have centered around cuts to Medicaid and the Medicaid expansion. Yet Skinny Repeal only affects Medicaid enrollment in that people won’t be forced to have insurance. Among those seeking insurance in the ACA exchanges, many are told that they qualify for Medicaid.
Under the skinny version, the largest additional segment of people without coverage in 2026 would be 7 million who otherwise would be on Medicaid, the public insurance program for low-income Americans. That’s even though the skinny plan would not touch Medicaid’s rules or funding.
All in all, the new CBO estimate projects that 16 million more people would be without insurance by 2026 and premiums would be 20% higher next year.
And this is the real danger with Skinny Repeal. It affords Medicaid expansion-state Republicans the appearance of honoring a campaign pledge they never thought they would have to address, while not gutting Medicaid or the expansion (directly).
Skinny Repeal wipes away the three most unpopular Obamacare policies: Mandatory insurance, employee coverage mandates, and ends a tax on medical devices for three years. Who would it hurt to remove those unloved provisions?How about everyone with a pre-existing condition. Or people who earn too much to qualify for tax credits.
Why? If the young and healthy drop out of the ACA marketplaces, the enrollees that remain will be disproportionately sick, in effect a giant risk pool. Premiums and deductibles soar, making it less and less affordable, so even more are pushed out.
That is the insurance industry definition of a death spiral.
Skinny Repeal: McConnell’s Trojan Horse or Bait and Switch?
Is Skinny Repeal really, as Chuck Schumer put it, “a ruse to get to full repeal?” Or, as the NY Times put it:
But the point of the narrow repeal measure would not be to enact it. Instead, Republicans are simply trying to get some measure to bring to negotiations with the House.
Indeed, if Skinny Repeal passes, the real damage could come out of the House-Senate conference. It’s being billed as a placeholder for whatever Frankenstein’s monster would be cobbled together from failed legislative parts. Then, of course, whatever emerges from that scrum would have to pass both houses of congress again.
And that’s been such pillar of unity so far.
But the real question mark is the GOP moderates. Nevada Governor Brian Sandoval and Ohio Governor John Kasich were among the ten state chief executives who signed a letter to the Senate opposing Skinny Repeal. Yet Nevada senator Dean Heller seems to be breaking ranks with his governor. Ohio’s Rob Portman again is willing to accept crumbs in exchange for his vote.
It’s probably safe to count Susan Collins as a nay. Likely, Lisa Murkowski as well. They’ve obviously been downing calcium by the handful. But the rest of the Senate moderates have shown themselves to be suffering from severe osteoporosis of the spine.
At every step of the way, moderate Republicans have shown they don’t have the backbone to stand up to GOP hardliners.
As if to prove my point, in a late-breaking story, four conservative Senators, including John McCain, issued an ultimatum to the Majority Leader. They announced that they would vote against Skinny Repeal unless they were assured it wouldn’t be passed unamended in the House and sent on its merry way to President Trump’s eager pen.
Don’t be shocked if they get their wants and many of the moderates don’t…but vote for the measure anyway. But they won’t be the real losers.
If the Skinny Repeal bill passes, it will be the healthcare of the American people skinned.
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