Senate Republicans continue to work to repeal and repeal Obamacare, but even if they succeed, it has become clear this week that the law has fundamentally shifted expectations surrounding health care in the country.
Majority Leader Mitch McConnell was forced to delay a vote on the Senate’s health care bill in large part because of widespread concerns among Republicans that the bill was not going to do enough to ensure low-income people had access to health insurance. An independent analysis published Monday from the Congressional Budget Office showed 22 million more Americans would be uninsured under the Republicans’ plan and while premiums would go down, out of pocket costs could rise.
President Donald Trump, expressing frustration with the Senate’s progress, suggested Friday morning that if Republicans can’t pass a bill repealing and replacing Obamacare, they should repeal it now and work on a replacement plan later.
But as Georgia Republican Sen. David Perdue put it, “You can’t just erase Obamacare and go back.”
Senators have worried their states’ subsidies weren’t generous enough, that Medicaid would be cut too dramatically. Republicans even worried about tax cuts — expressing a common Democratic talking point that taxes for the wealthy were being cut while the poor were being left behind.
Sen. Bob Corker, a Republican from Tennessee who is close to leadership, announced he didn’t feel comfortable repealing a 3.8% investment tax on the wealthy at the expense of those who were struggling.
“That’s not an equation that’s appropriate,” Corker said. “If you’re making $12,000 a year, and you get help in buying a plan that has a $6,000 deductible, you don’t have much health insurance. To me that’s a situation that has got to be rectified.”
One conservative senator summed up the problem Republicans are having now as they try and untangle Obama’s Affordable Care Act.
“We have a new entitlement,” said Sen. Ron Johnson, R-Wisconsin. “That’s not going away.”
‘It’s like Obamacare’
If you listen to Republican senators on Capitol Hill this week they sound a bit more nuanced than they did on the campaign trail just a few months ago.
Republicans might have found electoral success vowing to repeal the law “root and branch,” but there are provisions in Obamacare that are overwhelmingly popular.
Trump campaigned on the provision that allows parents to keep their kids on their health insurance until the kids are 26 and the protections for people with pre-existing conditions.
Even beyond those, however, members fought this week to stop cuts to Medicaid and to increase subsidies to buy insurance.
Perdue outlined the difficulties of repealing Obamacare. “Now, you’ve got to try to fix it within two constraints. You got the reconciliation constraints and you got the constraint of what’s already been committed out there for six years.”
It’s a shift from a party that has campaigned on entitlement cuts for years and for a party that wholesale believes that the country cannot continue to grow federal government without offsetting the costs elsewhere.
The irony is not lost on some.
“The more you do this, the more it’s like Obamacare,” said Sen. Lindsey Graham, R-South Carolina. “So eventually you cross a line where saying that you’ve repealed and replaced Obamacare will be hard to say with a straight face if you keep doing this stuff.”
Conservatives back some federal coverage
A handful of conservatives in the Senate continue to push to repeal more of the Affordable Care Act than the current Senate bill does. Sen. Rand Paul, a Kentucky Republican, has said he’s opposed to keeping the subsidies in any form and he’s called them “Obamacare lite.”
Sens. Mike Lee of Utah and Ted Cruz of Texas are pushing for more relaxation of Obamacare regulations.
Even Cruz, however, has admitted that it’s now generally accepted GOP orthodoxy on the Hill that the federal government is going to subsidize coverage for the sick in some ways.
“Those with serious illnesses are going to be subsidized, and there is widespread agreement in Congress that they are going to be subsidized than I think far better for that to happen from direct tax revenue rather than forcing a bunch of other people to pay much higher premiums,” Cruz said as he defended his plan to allow insurers that offer compliant plans to also offer skinnier ones on the Obamacare exchange.
Republicans may still repeal Obamacare. They continue to have conversations and try to find a way forward, but one thing became clear this week: The fundamental heart of Obamacare — the idea that the government has a responsibility to regulate the insurance market in some way and ensure vulnerable populations have access health care — isn’t going to be repealed any time soon.
