With a bill to repeal and replace Obamacare nearing a vote on the Senate floor as soon as this week, the GOP’s proposal to radically reshape the country’s health-care system is drawing strong opposition from two important constituencies: insurance companies and governors.
The latest major tweak to the Better Care Reconciliation Act, the GOP’s moral abomination of a health-care bill, is the Cruz amendment, which was unveiled on Thursday and bears the name of the Senate’s least-liked member. The provision would allow insurers to offer cheap plans that don’t comply with current Obamacare regulations, like protecting against preexisting conditions, as long as they offer one plan that does. This bifurcation, Senator Cruz reasons, will drive down premiums for those looking for bare-bones coverage, solving a problem Republicans have long promised to fix. Most health-care experts agree that this is a terrible idea, however, because under Cruz’s plan, sick people will flock to the only plan that covers them, with deleterious market effects.
On Friday, the CEOs of Blue Cross Blue Shield and American Health Insurance Plans sent an unusual joint letter to Senate Majority Leader Mitch McConnell and Minority Leader Chuck Schumer that included a blunt warning that the new provision “is simply unworkable in any form and would undermine protections for those with pre-existing medical conditions, increase premiums and lead to widespread terminations in coverage for people currently enrolled in the individual market.” The single-risk-pool idea, it went on, would “create two systems of insurance for healthy and sick people.”
When McConnell originally unveiled his health-care bill — written in secret, with no markups or hearings, just like the founders intended — he alienated many of his GOP colleagues on both the right and left, and quickly had to pull the bill altogether. His plan since has been to let his conservative flank dictate the terms and help win over hard-right ideologues like Ron Johnson, and then placate waffling “moderates” like Nevada’s Dean Heller, Alaska’s Lisa Murkowski, and others worried about the bill’s drastic cuts to Medicaid with payoffs that only apply to their states.
McConnell has already lost two Republicans — the most moderate, Maine’s Susan Collins, and one of the most conservative, Kentucky’s Rand Paul — both of whom have said they will vote “no” on a motion to even begin debate on the bill. A third defection would outright kill the BCRA in its crib, but the crucial senator willing to deal that fatal blow has not yet appeared.
McConnell’s strategy to buy off moderates may yet work, but a meeting of the nation’s governors on Friday, where the mood toward the bill was outright hostility, showed that it will be a heavy lift. Nevada’s Brian Sandoval, a popular governor and key figure in the repeal debate to whom Dean Heller has attached himself at the hip, expressed “great concerns” about the BCRA. (A closed-door meeting with Trump administration officials on Saturday morning did little to change his tune.) Ohio’s John Kasich called the bill “unacceptable,” which may or may not sway his state’s Republican senator, Rob Portman. Even some hard-core conservatives balked: Wisconsin’s Scott Walker endorsed a different, more generous version of repeal and said that “None of these plans right now do us justice.”
In a normal world, the next major news event on the road to a Senate vote would be the Congressional Budget Office’s score of the Cruz Amendment; the nonpartisan agency would likely find that millions of Americans stand to lose insurance as a result of it. But reports on Friday and Saturday indicate that Republicans may buck some more precedent and not even bother with the CBO, instead tapping the Department of Health and Human Services or the Office of Management and Budget to score the amendment. Given that these are White House agencies with a vested interest in passing the law, they’re almost certain to forecast a far rosier outlook.
But will such a plan work? Mitch McConnell enjoyed great success with his strategy of deceit and cynicism during the Obama years. Whether a similar approach can succeed with major GOP-led legislation will become clear in a matter of days.