For the last seven years, six months, and four days, Republicans broadcast their raison d’être as the repeal of Obamacare. They possess just over three days to fulfill that promise before the Federal Trade Commission shuts down the party as a massive, 50-state conspiracy to evade truth-in-advertising laws.
Several senators who talked up replacing Obamacare don’t care to match their votes to their mouths.
Susan Collins came out as a solid no on Monday following John McCain placing himself in the “anti” camp last week.
“Sweeping reforms to our health care system and to Medicaid can’t be done well in a compressed time frame, especially when the actual bill is a moving target,” Maine’s senior senator said. “Today, we find out that there is now a fourth version of the Graham-Cassidy proposal, which is as deeply flawed as the previous iterations. The fact that a new version of this bill was released the very week we are supposed to vote compounds the problem.”
Collins cites cuts in Medicaid, allowing insurers to take into account preexisting conditions on pricing, and an imagined spike in premiums as reasons for opposing the bill. But because Graham-Cassidy waives Obamacare’s preexisting conditions stipulations, expect the rise in premiums to taper off.
By lifting taxes on medical devices, plans, and procedures, Graham-Cassidy makes health care more affordable. Waiving the individual and employer mandate, community rating, and Obamacare’s “essential health benefits” also serve to bring down health care costs for most. But for older, obese, or unhealthy freeriders whose costs Obamacare artificially depresses by overcharging the younger, fit, and healthy, premiums may indeed rise. Perhaps Collins refers to this small percentage of people in making her assessment. For everyone else, premiums likely decrease.
The Collins and McCain announcements mean Republicans cannot afford to lose another vote. Several within their caucus remain on the fence.
“Right now, they don’t have my vote,” Texan Ted Cruz admitted over the weekend. Kentucky’s Rand Paul explained his opposition thusly: “I’m just not for this block granting concept because, to me, that is an affirmative vote that I have agreed to keep Obamacare.” Utah’s Mike Lee remains similarly noncommittal.
That leaves Senator Lisa Murkowski, which leaves Alaska in a better spot to again benefit from a boondoggle. Robert Byrd did not die after a half-century in the Senate. He reincarnated in a slightly taller (in heels, at least) Alaskan woman’s body. But porking up a bill ostensibly intended to diminish the power of the federal government may alienate Lee, Cruz, or Paul.
Lindsey Graham and Bill Cassidy walk a loose tight rope. They cannot afford to lose another vote yet winning the vote of the moderate Alaskan may alienate her more conservative colleagues critical of the legislation and vice versa.
They must please the party’s right wing, as represented by the Lee-Cruz-Paul contingent, and satiate moderates such as Collins and Murkowski. As the bill’s backers do this, pressure groups, such as the protestors kicked out of a Senate Finance Committee hearing on Monday, and the media, seek to derail the bill.
Monday’s expelled unrulys chanted, “No cuts to Medicaid. Save our liberty.” But the bill does not cut Medicaid so much as it cuts off Washington from dictating the rules that govern it.
Rand Paul objects that the bill refrains from cuts but instead turns over the money from the federal government to the state governments. This creates flexibility. One provision, for instance, allows states to “to condition medical assistance to a nondisabled, non-elderly, nonpregnant individual under this title upon such an individual’s satisfaction of a work requirement.” One wonders if saving the freedom to remain a freeloader loomed large in the “save our liberty” chant at Monday’s hearing. Certainly their concept of liberty differs markedly from Rand Paul’s.
A disconnect exists not just between Capitol Hill and the White House but within the GOP caucus on Capitol Hill. Republican representatives and senators enjoy a majority yet do not achieve majorities on the most salient matters before them. Definite maybes don’t pass bills, particularly when 52 senators constitute your caucus.
Democrats cannot win elections lately. Republicans cannot govern.
Hunt Lawrence is a New York-based investor. Daniel Flynn is the author of five books.
