Senate Republicans introduced their new health care plan on Thursday, and critics were quick to pounce. That is to be expected.
Tackling health care is a complicated and thankless task; you don’t reform one-sixth of the economy without ruffling some feathers. What is more, conservative alternatives are easy to demagogue. Conservatives can rarely outspend liberals, and thus, their policy alternatives are easy to label as “mean”—to borrow a word from President Donald Trump.
Let’s begin by noting that we’re still in the early stages of this legislative process. We are just learning about this plan, and there will be amendments before a vote is taken (if, in fact, a vote is taken). Then, if the bill passes—still a big if—it will go to conference committee, where the House and Senate will negotiate and compromise. Finally, the bill would have to pass both houses and be signed by the president. My point here is not to deliver a civics lesson but instead to remind everyone that much of the initial outrage will become obsolete.
Think back a couple months. The costliest condemnation of the House bill was that, although it preserved requirements for covering people with pre-existing conditions, it allowed states to apply for community rating waivers. The fear was that this would essentially price sick people out of the market.
It very well might turn out that this concern was moot; the Senate bill would eliminate that problem.
Early broadsides against this Senate bill warn that it would allow states to cut health benefits that were previously defined as “essential.” Only time will tell if this provision will survive to become law. It may well be that outrage and criticism are necessary ingredients required to guarantee that it doesn’t.
Again, we are just now getting to see this plan. Regardless of how you feel about the policy—whether you’re a conservative or a liberal—it’s fair to say that this secretive process, whereby even most Republican senators were kept in the dark, stinks.
The other day, I was talking to conservative columnist and radio host John Ziegler, and he observed that, outside of murder, there is nothing that Republicans could ever criticize Democrats for doing in the future without being hypocritical. He was talking about Trump’s behavior and rhetoric, but what Ziegler said also applies to the lack of transparency that surrounded the writing of this bill. Republicans rightly criticized the way Democrats pushed through the Affordable Care Act on a party-line vote, but they replicated the same strategy, to say the least.
Much of the grousing about this bill, though, is being directed at things that simply reflect a conservative worldview. In other words, it’s not about Trump. These same criticisms would have been lodged if we had a President Rubio or President Cruz.
Medicaid expansion fits into this category. Phasing it out will be portrayed as uncompassionate and extreme, but Medicaid historically covered children from low-income families, women who were pregnant, the disabled, and the elderly. It also covered some of what was considered the "working poor," but there were gaps. The expansion benefits adults over the poverty line, including able-bodied adult males who are of working age..." We can argue over whether it’s better policy to be more generous—or whether such entitlements should truly remain as a safety net for the elderly, disabled Americans, or children. That is a legitimate policy debate that has long divided mainstream conservatives and liberals. Let’s not pretend it is new or that anything egregious is happening here.
A related part of the plan—one I foreshadowed back in March—would shift the growth of Medicaid spending. Liberals will predictably argue that this is designed to hurt the poor, while conservatives can reasonably argue that this will help make Medicaid more sustainable in the future. So it goes.
Additionally, the Senate bill, like its House counterpart, would wholly defund Planned Parenthood (not just the part that handles abortions, which has been barred from receiving taxpayer funds since 1976). This plays right into the always-with-us culture war, but isn’t it fair to ask why my tax dollars help fund an organization that does procedures a lot of Americans find repugnant? Or why conservative tax dollars help fund the health-care spending of an organization whose (legally separate) political arm engages in political activity (including spending $735,000 on John Ossoff’s failed congressional bid in this week’s Georgia special election)? Again, you might disagree with the decision to defund taxpayer dollars, but it’s hard to argue that the idea is absurd—or that it is outside the mainstream of political thought.
We can adequately predict how liberals will attack the plan; it is harder to predict whether the bill will pass. Republicans can afford to lose only two GOP senators, and that means threading a needle.
The party’s Goldilocks dilemma: The plan will have to be conservative enough to win over the Rand Pauls and Ted Cruzes of the world, but moderate enough to win over its Susan Collinses and Rob Portmans. The more moderate senators will likely be concerned about the aforementioned Planned Parenthood and Medicaid concerns, while the four conservatives say they can’t support it as written because it’s too moderate.
Monitor how outside groups like the Club for Growth and Heritage Action view this bill. If there is a conservative consensus that this bill is no better than Obamacare, Republicans are in trouble. Already, conservative opinion leaders are divided. Within hours of the bill dropping, conservative health -care wonk Avik Roy had declared, “If it passes, it’ll be the greatest policy achievement by a GOP Congress in my lifetime.” Center-right journalist Philip Klein saw things differently, tweeting: “This is a bill that does more to rescue Obamacare than it does to repeal it. Lots of up front bailout $, promised cuts come later.” With a razor-thin majority, if three Republicans feel this bill is too liberal—or conservative—it dies.
There will be an amendment process, so Paul, Cruz, Ron Johnson, and Mike Lee are withholding support to gain concessions. The risk here is that they might replicate what happened the first time House Republicans tried (and failed) to pass a bill. In that instance, efforts to appease the Freedom Caucusconservatives alienated moderates (and vice versa). Once you open the door to negotiations, you have to hope you’re not also opening a Pandora’s box.
Aside from the criticism that this plan feels like Obamacare Lite (even as Obama himself disagrees with that assessment), the other problem for Republicans is that no tickertape parade will be waiting for them when they pass this. This is not a historic moment in the same vein as Obamacare.
But it might be a fleeting moment. Republicans have spent seven years talking about repealing Obamacare, and though it has been said many times, this is probably their last chance.
The best arrow in Mitch McConnell’s quiver is to ask wavering Republicans: “Do you want to be the reason the Affordable Care Act is still the law of the land?”
Republicans might not like this bill, but do they dislike it so strongly that they’re willing to take the blame for keeping Obamacare alive? That is probably the most important question.