Unless something very unlikely occurs in the next few days, the seven-year GOP campaign to repeal and/or replace Obamacare has ended for the time being. Most of the discussion over what happens next involves possible bipartisan measures that might stabilize individual insurance markets, if Republicans can bring themselves to “save” Obamacare.
But there are features in the House-passed American Health Care Act and the Senate-stalled Better Care Reconciliation Act that are not just going to go away. They may well pop up in different legislative vehicles very soon.
The most obvious “orphan” is the right-to-life movement’s chief federal legislative goal, the defunding of Planned Parenthood, to which the vast majority of congressional Republicans and a handful of Democrats are committed. Demands to kill all federal funding for the reproductive health services organization very nearly precipitated a government shutdown in 2015. And GOP leaders pushed it into this year’s health-care bills in no small part to keep it away from must-pass appropriations measures.
So anti-abortion activists will quickly find another avenue for continuing their crusade against Planned Parenthood. It could simply be shifted into the fiscal year 2018 budget bill that is designed to enact tax cuts and perhaps some major spending cuts. Or, more threateningly, its proponents could insist on its inclusion in must-pass debt-limit or year-end appropriations bills, raising the specter of a debt default or a government shutdown. The thing to understand here is that the RTL movement has a long-term mortgage on the soul of the GOP, and a big balloon payment is now past due. It will be very difficult for congressional Republicans to get through this year without defunding Planned Parenthood: The defunding would be too unpopular to pass as a stand-alone measure in an election year, and the RTL folk will not want to take the risk of Republicans losing the House.
A less urgent but still important AHCA/BCRA provision that will need a new home is the Medicaid per capita cap, which, like Planned Parenthood defunding, had nothing to do with Obamacare and everything to do with making conservatives happy. For the right, it was a little bit of heavenly “entitlement reform” folded into the hellish task of repealing and replacing the Affordable Care Act.
If Republicans decide to pursue serious domestic-spending cuts as part of their FY 2018 budget/tax bill, capping Medicaid might be more politically congenial than, say, going after Medicare or Social Security, as House Budget Committee chair Diane Black apparently wants to do. It would certainly generate more revenue than the $203 billion over ten years that Black’s committee is presently asking the House to produce, making more tax cuts possible with fewer loophole-closing offsets.
The final set of provisions left out in the cold by the demise of Trumpcare is the “Obamacare taxes” it would have repealed. According to CBO estimates, these amounted to $664 billion in the House bill and $541 billion in the Senate bill, with the bulk of the benefit going to top earners. They could certainly be added to the long list of high-end tax cuts in the GOP’s upcoming budget bill, though the pressure for offsets via loophole-closing or spending cuts would be accordingly increased.
Republicans may be tempted to insist that Trumpcare’s orphans be included in any bipartisan legislation to stabilize health-insurance markets. Democrats are unlikely to take that bait, insofar as the GOP has as much to lose from a meltdown in Obamacare coverage as they do, given the Republicans’ complete control of the federal government. But as Paul Ryan and Mitch McConnell navigate the troubled waters just ahead, it should be constantly kept in mind that RTLers, would-be entitlement “reformers,” and beneficiaries of Obamacare tax repeal will be tugging at their sleeves and demanding attention.
