Tuesday, March 28, 2017

Listen: might they try again on healthcare -- is Obamacare safe?

Even though a lot of people are happy about the death of Trumpcare/Ryancare/Affordable Health Care Act, many of them are still afraid that the Republicans will soon try again.  This is a reasonable fear, since (a) they have promised to repeal Obamacare for seven years, and (b) they just suffered a humiliating and very public defeat on that very issue.

So what are the chances of that, and what are the chances of success if they do try again?

It's true that they could try again.  The GOP tried to enact healthcare reform first, after all, because it was going to make tax reform a lot easier; they could use a trillion dollars of healthcare funding to pay for some big, permanent tax cuts.  Why is that?  Well, thanks to the rules of the Senate, Congress essentially has these options on tax reform:
  • Option A: Repeal Obamacare and use the savings to pay for permanent tax cuts with Republican votes.
  • Option B: Don't repeal Obamacare and pass some temporary (ten-year) tax cuts with Republican votes.
  • Option C: Enact bipartisan tax reform with Democrats.
The Republicans really wanted to avoid Option C, because it means they would have to compromise.  They also don't really like Option B, since they don't want the tax cuts for the wealthy to expire.  If you remember, Obama only kept the parts of the Bush tax cuts that applied to the lower and middle classes.  The GOP wants to avoid that, so Option A was very much their preferred choice.

Given this set of facts, then, Republicans may indeed want to return to Option A, despite their first failure.  The president says he wants to move on, of course, and GOP leaders are uncertain about a second attempt, but that doesn't mean they can't all change their mind.  And given their other options, they might do so.

But a few things stand in their way.

First and most importantly, the facts of healthcare are no different now than they were a month ago, when I wrote that Obamacare will be fine.  Obamacare's most important benefits are still really popular, and the unpopular mandate is still the best way to pay for them.  Republican voters benefit enormously from Obamacare and many of them know it, and any replacement that doesn't at least approximate Obamacare's level of coverage is going to be unpopular.  There is no magical bill out there that will do all the good things without any of the bad things (if there is such a bill, we should pass it immediately!).

Further, there is no prospective bill that will make Republican legislators happy.  Rand Paul's bill can't pass (moderates hate it).  The Cassidy-Collins bill can't pass (extremists hate it).  A simple repeal can't pass (the sane hate it).  Right now, Republicans don't have any viable path forward.  Someone might propose one soon, but it doesn't yet exist.

The clock is ticking, too.  Congress doesn't really work that much, and they've wasted weeks on the AHCA -- and got brutally criticized for their haste, to boot.  They won't be able to rush and railroad through a second attempt, which means the process would have the potential to consume months of Congressional effort.  It took nine months to pass the ACA... does anyone believe that Republicans have the stomach for that, after this AHCA debacle?

And finally, the loud pronouncements that "Obamacare is the law of the land" were heard by everyone.  The Kansas legislature is now in the process of approving Medicaid expansion under the ACA and five other states (North Carolina, Georgia, Iowa, Nebraska, and South Dakota) are likely to join them.  Even more importantly for Obamacare, if unfortunate for some citizens, numerous states are not expanding Medicaid, including states like Virginia and Texas.  That makes it very complicated to change the system -- if all states had expanded Medicaid, a uniform solution could perhaps be found.  But when some big conservative states have declined to do so, it's harder.

Republican legislators have every incentive to put on a show of reform, but very little incentive to actually repeal Obamacare. And right now, even the show doesn't seem very convincing.

The bottom line is this: Republicans can try again, but right now there is little chance that they will succeed.

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