Senate Majority Leader Mitch McConnell’s latest health care gambit risks spooking hospitals and doctors, destabilizing insurance markets and ripping coverage from more than 30 million people — and after all that, it still won’t fully eliminate Obamacare.
GOP leaders want to speed a straight repeal bill to the floor in the wake of the sudden collapse of their bid to replace Obamacare, in a last-ditch attempt to deliver on their long-held pledge to tear down the law.
The strategy revives a proposal to dismantle large parts of Obamacare that nearly all Republican senators voted for in 2015 — secure in the knowledge it was a symbolic gesture since it would be vetoed by then-President Barack Obama.
But times have changed. And with Republicans now in control of Washington, it’s a lot more risky to set changes in motion that policy experts warn would lead to a massive collapse of the nation’s Obamacare markets.
Already, several moderate Republicans from states that benefited from Obamacare are throwing up opposition to repealing it without a replacement plan.
“There’s been all this talk about possible death spirals,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation. “This would be an actual, real, death spiral.”
The blueprint that McConnell is offering his party would partially repeal Obamacare, with a two-year delay built in to give Congress time to come up with a new replacement plan.
The bill would scrap key parts of Obamacare, including the subsidies that help low-income Americans afford coverage, Medicaid expansion and all the taxes designed to help pay for those coverage programs. It would also effectively wipe out the individual and employer mandates — a top priority for Republicans — by eliminating the penalties for failing to offer or obtain coverage.
But just as significant is what the legislation would leave in place: all of the Obamacare insurance regulations and coverage rules that the GOP blames for skyrocketing premiums, and that drove conservatives’ revolt against the Senate Republican health care bill.
The 2015 bill needed to retain those regulations to pass muster with the Senate’s strict reconciliation rules, and Republicans will likely need to do the same this time around. That means that the GOP is left with legislation that would only partially eliminate Obamacare, while rendering its surviving provisions unworkable.
Absent a mandate, patients would have no incentive to purchase insurance until they got sick. Insurers still obligated to cover all enrollees under Obamacare’s regulations would flee the market for fear of steep losses, and the worry that Congress may never agree on a replacement. And the Obamacare markets — which are just starting to show signs of stabilizing — would devolve into a chaotic mix of skyrocketing prices and dwindling options.
The Congressional Budget Office in January estimated that a straight repeal without a replacement would leave 32 million more people without insurance over a decade. Premiums, the CBO said, would spike by as much as 25 percent.
“It kind of defies human nature, and it certainly defies political nature,” said Joe Antos, a health care finance expert at the right-leaning American Enterprise Institute. “I would say it’s a very poor strategy.”
Those perils prompted the GOP to abandon their brief flirtation with a straight up repeal plan soon after President Donald Trump’s election, concluding it would create too much uncertainty for the health care sector. And already, moderate Republicans who balked at rolling back benefits like the Medicaid expansion over several years are questioning the wisdom of pursuing a bill that would end those programs even faster.
Sen. Susan Collins — the only remaining senator to vote against the 2015 bill — immediately came out against McConnell’s latest idea and was joined soon after by West Virginia’s Shelley Moore Capito.
“I did not come to Washington hurt people,” said Capito, who voted more than 40 times in the last seven years to repeal Obamacare. “With that in mind, I cannot vote to repeal Obamacare without a replacement plan that addresses my concerns and the needs of West Virginians.”
Several other GOP moderates have yet to commit to supporting the start of floor debate on health care — a sign that McConnell’s bid could quickly tank. That’s likely to further anger the party’s right-most flank, which has pushed Republicans to follow through on their pledge to eliminate Obamacare “root and branch.”
Sen. Mike Lee, who’s opposition to the Senate GOP’s latest health care bill doomed its chances, is now planning to vote to open debate with the intention of moving towards a straight repeal. Sen. Ted Cruz also said he’d back a motion to proceed, even though the bill retains many of the Obamacare regulations he’s made it his mission to kill.
“What is critical is that we deliver on our promise,” he said. “I continue to believe we can get this done. We can honor our promises and repeal Obamacare.”
But after spending months in vain trying and failing to coalesce around a replacement that can get just 50 Republican votes, there may be less confidence within the health care industry and even among GOP senators that Congress can come together on a health care overhaul — whether it’s in the next two months, or the next two years.
“The meandering about for the past four months probably strengthens the view that if you can’t get an agreement on what a replacement is, then a repeal is going to be politically a bad idea,” Antos said. “It’s a political loss for Republicans in the Senate and in the House.”
Paul Demko and Brent Griffiths contributed to this report.