Republican hopes of repealing or even drastically reforming Obamacare appear more bleak than ever after enough lawmakers emerged in the past day to scuttle an amended health care bill and sink a promised vote on a repeal bill.
Nonetheless, free market health advocates believe there is a way for this Congress to make headway while the GOP still controls the levers of power in Washington.
Moderates and conservatives are glum Tuesday. Senate Republican leaders were clinging to hopes of squeaking their amended bill through, even after Sens. Susan Collins, R-Maine, and Rand Paul, R-Ky., announced their plans to vote against the motion to proceed to the bill, albeit for completely different reasons.
However, on Monday evening, Sens. Mike Lee, R-Utah, and Jerry Moran, R-Kansas, publicly opposed the plan for not doing enough to eliminate taxes, reduce premiums, or kill regulations. With all 48 Democrats firmly opposed, four GOP defections spelled defeat for the legislation.
“I think there are just too many factions within this Republican caucus and with only two votes to spare, there just was not enough room for differences of opinion,” said Galen Institute President Grace-Marie Turner.
She says moderates were not willing to give up the federal Medicaid dollars.
“You’ve got the moderates who are very worried about losing the incredibly generous Medicaid match that their states are getting. Most of them are from states that expanded Medicaid. Remember, the federal government initially paid a hundred percent of the cost of the usually joint federal-state program if the states would put more people on their Medicaid rolls,” said Turner.
She says conservatives had their own reasons to balk at the larger GOP bill.
“Many conservatives are worried, rightly, about the regulations in Obamacare that are so difficult to reach through this narrow pathway that the Senate has to pass legislation with only a simple majority of votes,” said Turner.
“There’s some conservatives, like Rand Paul, who feel that any effort to try to do something else to provide subsidies to people going forward is really perpetuating Obamacare,” said Turner.
In response, Senate Majority Leader Mitch McConnell said he would bring forward a bill to repeal much of Obamacare and trigger a two-year sunset to give lawmakers time to craft a replacement. While hailed by conservatives, those hopes were also soon dashed as Collins and Sens. Shelley Moore Capito, R-West Virginia, and Lisa Murkowski, R-Alaska, revealed they would not vote on a repeal without seeing a replacement bill.
Both Capito and Murkowski voted for the same repeal bill in 2015 despite the absence of a replacement plan. President Obama vetoed the earlier repeal.
Turner says lawmakers act differently when a bill has no chance of becoming law than when it does.
“They knew President Obama was going to veto it, so there’s a difference between messaging and governing,” said Turner.
With Senate leaders unable to bridge the narrow divide between conservatives and moderates and the straight repeal apparently headed to defeat, many on the right believe it’s time to move on to other priorities.
Turner says that is not an option.
“They can’t not do something on repealing Obamacare. They have promised this for the last two election cycles. Every single member is going to have to go to his or her constituents and explain why, after all of this debate over Obamacare, they can’t get it done,” said Turner. “They known they have to do something.”
President Trump now suggests he may just let Obamacare collapse and blame Democrats since they did nothing to solve the problem. Turner says that strategy won’t work.
“They are going to be blamed for the millions of people that would lose coverage if nothing is done because these exchanges are failing, insurance companies are signing up to provide coverage next year because they are losing so much money providing so-called insurance under Obamacare rules that don’t work,” said Turner.
“Republicans own it. How can you have the White House and both houses of Congress and say that you don’t own this problem,” said Turner.
That being said, Turner is also slamming Democrats for asserting that Republican promises to repeal Obamacare are creating uncertainty among insurers and that is why premiums and deductibles are skyrocketing, rather than the Obamacare provisions themselves.
“That is just so completely beyond the realm of reality. The reason that costs are going up under Obamacare is because of the flawed structure of the bill that, for one thing, encourages people to wait until they’re sick to sign up for coverage and that provides all sorts of opportunities for people to drop coverage and game the system,” said Turner.
She still holds out hope that lawmakers will send power back to the states to address health care problems in the most effective way.
“Washington-centralized solutions are not the answer, whether Republicans are developing them or Democrats are developing them,” said Turner.