Senate Majority Leader Mitch McConnell not only failed to whip up enough votes to replace Obamacare last week but achieved the same negative result when he shifted to a straight-up repeal as well. He lost by forfeit without counting a single vote.
The failure coming with a Republican occupying the White House, Republicans enjoying majorities in both houses of Congress, and Republican nominees outnumbering their Democratic colleagues on the Supreme Court struck as especially bitter.
If not now, when?
When President Trump tweeted, “The Republicans never discuss how good their healthcare bill is,” many observed that it struck a strange contrast with his characterization of an earlier incarnation of the bill as “mean.” But it said something correct atop the contradiction.
Nobody sold the Better Care Reconciliation Act to the American people the way Barack Obama sold the Patient Protection and Affordable Care Act. Sure, President Obama channeled Harold Hill when pushing his signature legislation. But at least he aggressively made his case. Neither Trump nor McConnell full-throatedly drummed up popular support for their bill. Just 12 percent of the public supported it.
The Senate bill failed in part because few knew what it contained and in part because what it contained impressed very few who knew.
The adage “you can’t beat something with nothing” applies as much to the replace effort as it does to the repeal attempt. The Better Care Reconciliation Act of 2017, despite its 172-pages, manages very little in the way of substantial reform regarding the health-care mess exacerbated by Obamacare but not caused by it. It tweaks without ambition of a turnaround.
The replace legislation wisely allowed all Americans the option to purchase simple, low-deductible, high-premium catastrophic plans that tend to act as a check on out-of-control spending. It essentially repealed the individual and employer mandates that worked as a gift to the insurance companies but not to consumers. It block-granted some Medicaid funding to states and capped per-person spending within the program as a means to control costs. It allowed individuals to use medical savings accounts to pay for premiums.
Alas, the Better Care Reconciliation Act continues to force plans to cover medical options deemed essential by politicians but neither wanted nor needed by consumers. The Senate replaces Obama’s subsidies with their tax credits. In reforming Medicaid over a period of years, the bill provides much wiggle room to allow those reforms to not occur. The Senate plan allocates tens of billions of dollars to bribe health insurance companies to continue to offer plans in unprofitable state markets.
In the wake of the exodus of insurers from Iowa, Wisconsin, and other markets, the Senate health bill spends money equaling or exceeding the budgets of Iowa, Wisconsin, and other state governments to reverse that exodus. The bill reads,
There are authorized to be appropriated, and are appropriated, out of monies in the Treasury not otherwise obligated, $15,000,000,000 for each of calendar years 2018 and 2019, and $10,000,000,000 for each of calendar years 2020 and 2021, to the Administrator of the Centers for Medicare & Medicaid Services (in this subsection and subsection (i) referred to as the “Administrator”) to fund arrangements with health insurance issuers to assist in the purchase of health benefits coverage by addressing coverage and access disruption and responding to urgent health care needs within States.
Like the bill itself, this section appears more concerned with covering up the intrinsic problems with Obamacare than with overhauling our health-care system to restore its health.
Policy rarely galvanizes but even the wonks appeared especially bored by what the Senate offered. Trump, McConnell, and others with skin in the game initially walked away from the table.
“We’ll be moving on to comprehensive tax reform and infrastructure,” a sheepish Senator McConnell initially told the press. “There is much work left to be done for the American people, and we’re ready to tackle it.”
In Washington, they hope to move on. Elsewhere, where Americans average more than $10,000 a head in medical expenses every year, “moving on” is unrealistic. Burdened by such a massive portion of our GDP drained by health care, the economy will remain stuck. The prolonged malaise endured in the 1970s seems a blip in comparison to our 21st-century sluggishness. Exploding health-care costs stand as a primary reason for this.
Public polling shows that a majority of Americans want the government to guarantee health care for all. Even if this were not the case, Obamacare, however imperfectly, already offers something approximating this. So, whether Congress punts and keeps the status quo or dreams up something new, reality dictates that health care stays with us as an entitlement of sorts.
The challenge facing Congressional Republicans is to reform health care in such a way that provides universal access but relies on market principles rather than a handout mindset. A second challenge, which also may strike some as a contradiction, involves simultaneously controlling costs with a plan that encourages universal access.
On this page in the coming weeks, we offer some ideas on how to achieve this. A Don Quixote quality admittedly colors such an endeavor. But one need not be a Jeremiah to imagine the outcome should the current system continue. The big problem calls for big ideas rooted in reality and pragmatic politics.
Infrastructure and tax reform, as Senator McConnell notes, deserve attention. But it’s no longer the 1950s or the 1980s. In 2017, health care, the largest drain on the federal budget and personal pocketbooks, ranks as the top domestic policy concern.
This is why Senator McConnell, in opening up debate on healthcare and holding votes this week, moved on from “moving on.”