The Republican Health-Care Fiasco
Senator John McCain cast the deciding vote to jettison Republicans’ latest Obamacare reform effort, handing a victory to Lisa Murkowski of Alaska and Susan Collins of Maine, moderates whose opposition to any substantive health-care reform has become nearly intractable. But the legislation for which Republican leaders asked their conference to vote was so unpalatable, and the process so objectionable, that it is almost difficult to fault him. The Congressional Budget Office suggested that the “skinny” health legislation on which the Senate voted would raise premiums by as much as 20 percent. It assumed that since the legislation ended the fines for going without insurance, many healthy people would drop coverage, and premiums would have to pay for a sicker population. The estimate may be too high, since the CBO has repeatedly overestimated the impact of the fines. But it almost certainly had the basic story right.
Senator McCain may have been taken aback as well by the CBO’s projection that the bill would result in 16 million fewer people having insurance coverage — something Democrats nearly unanimously portrayed as “taking away” insurance from all of those people. In fact, this projection is based almost entirely on the end of the fines. The CBO estimates that once they can make a decision free of the threat of fines, 15 million people will forgo coverage.
.. We are willing to bet that McCain didn’t know any of this. A lot of health-policy experts are unaware of it too. The legislation was unveiled, after all, only a few hours before the vote. There were no hearings on it. The CBO had only provided the relevant numbers the same day, with the inferences we have made above left unstated.
Republican leaders such as Mitch McConnell were asking senators to vote for a poorly understood bill that would likely raise premiums in the expectation that something better would emerge from a conference committee between the House and the Senate. But there was a chance that the House would end up just passing the skinny bill. And if the conference committee was capable of coming up with something better that could get 51 votes in the Senate, why couldn’t the Senate come up with that “something better” itself?
.. Here Senator McCain deserves criticism for naïveté. He believes that there should be bipartisan reforms to Obamacare (which is a far cry from what he had previously campaigned on).
But the Democrats have made it clear that the only “reforms” that interest them are increased taxpayer commitments to shoring up the program, including increased subsidies to the insurers. In practice, this option would amount to higher spending and, at best, a fig leaf of reform; it would become law through the votes of nearly all Democrats and a handful of Republicans.
.. Option three, the “let it burn” approach, is simply untenable.
.. Option three is likely, then, to be option two in slow motion.
.. Consideration of the alternatives should bring Republicans back to option one. Try, try again, but this time with more deliberation.