Line of the Day (Better Care Reconciliation Act of 2017 Edition)
Peter Suderman writing about the Senate health care bill at Hit and Run:
In other words, it is exactly what critics predicted: a bill that, at least in the near term, retains weakened versions of nearly all of Obamacare’s core features while fixing few if any of the problems that Republicans say they want to fix. It is Obamacare lite—the health law that Republicans claim to oppose, but less of it. It represents a total failure of Republican policy imagination.
The piece is a good run-down of how the Senate bill is what Suderman calls “Obamacare lite.” Regardless of what one thinks about Obamacare as a policy solution, the Senate bill is yet another example of the bankruptcy of the Republican position on this topic. This is noteworthy because the party has been claiming it has a better approach to health care policy since the Affordable Care Act first was signed into law. They have repeatedly claimed the need to “repeal and replace” and yet, given the opportunity to do so has demonstrated a dearth of actual ideas and solutions. Rather, the only principles on display appear to be a desire to cut taxes on upper earners.
And, quite frankly, if that is what the party is, that is what the party is. But, that isn’t what they have been saying. All of which, by the way, is made worse by the fact that a lot of changes are deferred for years. The bill, if passed, would create more, not less, uncertainty and instability in our health care system.
Part of me is not surprised that congressional Republicans have no vision in this area of policy, if anything because they have not demonstrated much in the way of policy imagination, to use Suderman’s term, for some time. Indeed, the degree to which the GOP has been dedicated to actual governance has been questionable for some time, except for their dedication to the notion that tax cuts are the solution to all policy problems. Still, part of me is astounded that there has been so very little in the way of some kind of conservative counter-proposal to the ACA. Of course, part of the problem is that the ACA really isn’t an especially liberal solution (speaking in historic US political usage of the term). Some of its design emerges from conservative-oriented proposals and, further and more importantly, the basic infrastructure of Obamacare was build on a system of employee-based private insurance. It did not radically change the pre-ACA system, rather it just grafted on elements to try and expand coverage.
I would note, too, the amateur nature of the current White House is part of the problem: there is no policy energy emanating from the executive branch on this topic, as was the case when the Clinton administration failed to overhaul health care policy and when the Obama administration successfully passed the ACA.
Another amazing illustration of the fact that the GOP is by no means repealing and replacing the underlying policy structure of the ACA:
The Obama administration initially requested congressional authorization to make the CSR payments, which are called for in Obamacare, but not explicitly appropriated. The House did not provide it. The administration then paid them anyway, believing that the exchanges would collapse without them. In response, House Republicans sued, arguing that only Congress has the power to appropriate funds. A federal judge agreed that the Obama administration was violating the constitutional separation of powers. The Trump administration has continued making the payments while threatening to withhold them, adding to the uncertainty for insurers operating in the exchanges.
Now Senate Republicans are proposing to explicitly authorize those payments for the first time. That means they are proposing to explicitly authorize and continue the very policy their House colleagues took the previous administration to court for pursuing. It amounts to an expansion of Obamacare, and while it may reduce uncertainty in some markets, it is unlikely to halt premium increases or fully stabilize the exchanges, which were degrading even before Trump threatened to withhold the payments. Moreover, it is an admission that Republicans do not believe they can meaningfully improve on the Obama administration’s implementation of the law.
Emphases mine. Such a situation also makes it more difficult to reconcile the Senate version with the House version, one suspects (assuming, of course, the Senate version passes, which may not happen).
h/t: Chris Lawrence for noting the Suderman piece (and the top quote).