Today’s action by the Republican-controlled Senate gutted Obamacare by revoking the budget authority to fund federal health care exchanges, known as S. Con. Res. 13 (111th Congress). Under Senate budget reconciliation rules, no filibuster is permitted, and therefore the vote proceeded along party lines 52-47.
Let’s call Obamacare dead for all intents and purposes. Yay! Let’s celebrate!
From the crowing on Capitol Hill, you’d think we’ve got a brand new health care system ready to go.
“For too long, Democrats did everything to prevent Congress from passing the type of legislation necessary to help these Americans who are hurting,” Senate Majority Leader Mitch McConnell said on the floor. “Today, that ends.”
None of this is even close to being resolved. By knocking out the budgetary pillars of Obamacare, Congress has effectively ended the doomed system, but they haven’t replaced it with anything at all.
The strategy is called “repeal and delay,” meaning we’ll crash and burn the existing system, then figure out what to do with it. There’s a danger in that approach, in that (1) we don’t know what direction the future President Trump will lean; and (2) there’s no widespread agreement even among Republicans on the exact provisions of a new system.
Politically, this hairball is what put many Republicans, including Trump, into office, so it’s not something they want to screw up. But the worst possible thing is to repeal the ACA (which they’ve pretty much done) and then replace it with…nothing, locking out 20 million people from the health care system.
Let me take that back. Actually, the worst possible thing, politically, is for them to repeal the ACA, then replace it with the ACA, with a lemon twist and an umbrella. Don’t think this isn’t a possibility.
Trump himself is a softie on letting the market determine health care affordability. He doesn’t want people “dying in the streets.” NBC reported just days after the election:
But Trump told the Wall Street Journal he would consider keeping two of its most popular provisions — one that allows adult children to stay on their parents’ health insurance plans, and another that would forbid insurance companies from refusing to cover “pre-existing conditions.”
“I like those very much,” the newspaper quoted Trump as saying Friday.
Will Trump pick and choose from provisions in the existing ACA, while exhorting Congress to make tiny continuing resolutions to fund the exchanges while the details are hammered out? That would force Democrats to oppose Obama’s signature “achievement,” allowing Republicans to blame them for it crashing without something else to replace it.
Or will Congress use the template in the American Health Care Reform Act (AHCRA)? That bill was crafted by the Republican Study Committee in the days when Obamacare faced a Supreme Court challenge (before Justice Roberts went all wishy-washy).
There are serious unresolved issues that face the Republican-controlled Congress. How will they address liability reform and cost increases, for example? Will they eliminate the ban on interstate plan sales? Will they address the public trust conflict with profit-motivated drug companies, and give real incentives to innovate? Will they take one of Vice President Joe Biden’s ideas–the “war on cancer” and run with it?
The repeal is phased in over two years, with various amendments tied in. This doesn’t mean that this is bad news. It’s great news.
The best news is that the language eliminates federal funding for Planned Parenthood, something the Democrats at one point were willing (sort of) to shut down the government to protect.
It might just be a tad too early to spike the football. There’s a lot of politics, legislating, compromise, and undoubtedly bloviating and 4 a.m. tweeting to go. And we don’t know what we’ll end up with.
Still, it’s a giant step in the right direction. I’ll take a bill repealing the law that former Speaker Nancy Pelosi said “we have to pass the bill so you can find out what is in it,” even one we have to wait and see to find out what we’ll get.