The whole point of the so-called “skinny repeal” legislation that is now the goal of the Senate’s health-care debate is its svelte size and shape. It is the “lowest common denominator,” as HHS Secretary Tom Price put it, of provisions Republicans could call a “repeal” of Obamacare, just a vehicle to get to a House-Senate conference committee that will be expected to produce a big, fat, messy health-care bill along the lines of the House-passed American Health Care Act or the Senate’s defeated Better Care Reconciliation Act.
Accordingly, the worst possible development for “skinny repeal” would be a surrender to the temptation to fatten it up: to add unnecessary provisions that will lead advocates for other unnecessary provisions to start making their own demands for inclusion. Eventually, you’d just wind up with another sprawling bill that lacks 50 Senate votes.
This fattening of “skinny repeal” may already be happening. Vox reports there’s talk of adding money for opioid treatment, which might make certain “moderate” senators happy, but could also complicate the process by making the bill run afoul of budget rules dictating the legislation save as much money as the House bill that is technically still on the floor. The Washington Post reports provisions might also be added to “defund” Planned Parenthood (assuming there is some way to do that consistent with the Senate parliamentarian’s guidance), and to continue Obamacare’s Cost Sharing Reduction (CSR) subsidies that insurers say they need to continue participating in the individual insurance market.
All these add-ons make sense: The opioid gesture is going to happen no matter what version of health-care legislation is ultimately enacted; the extremely powerful right-to-life movement is not about to allow final passage of a health-care bill without its death-to–Planned Parenthood amendment; and CSR subsidies are essential to the short-term functioning of insurance markets. But the question remains: why this add-on but not that one, particularly since the party line is that everybody will get a place at the giant buffet when the dinner bell rings during the House-Senate conference.
The fear that will keep demands for add-ons pouring into the Capitol is that “skinny repeal” could wind up being not just a vehicle for a future health-care deal, but the only health-care deal Congress can reach. That seems less likely today than yesterday, now that key House members are publicly attacking “skinny repeal.” But still: Why risk missing what could be the last train leaving the station on a fast track to the president’s desk?
Another report suggests the deal on “skinny repeal” will go down very fast today:
Finalizing the “skinny repeal” at a lunch meeting is appropriate, given the hungry lobbyists and legislators who will be at the door begging for scraps. But as Mitch McConnell undoubtedly knows, every time he agrees to an add-on to get another vote for “skinny repeal,” he’s risking the whole shaky enterprise.