Actually, he still seems to think he can pass repeal-only. Or was that still repeal and replace? So hard to keep straight, his crafty game of one-dimensional chess. “I have pen in hand, believe me, I am sitting in that office, I have pen in hand. You never had that before,” the president said at his lunch Wednesday with Republican senators, mixing those promises with threats (“Look, he wants to remain a senator, doesn’t he?”) into a word salad. “We can repeal it but the best is repeal and replace and let’s get going.”
That was hours after Georgii Malenkov went on Pravda TV—I mean, after Corey Lewandowski went on Fox & Friends Wednesday morning—and swore that repeal-only is still alive, even though it died Tuesday when GOP senators Shelley Moore Capito and Lisa Murkowski said they’d join Susan Collins in opposing it. That makes three against, and that’s the magic number.
Does the White House have some trick up its sleeve? Does Mitch McConnell have something on one of the three? Or is it just because Lewandowski is a hackish sycophant, and Trump is like the world’s greatest dealmaker and anybody who thinks otherwise is brainwashed by the sad fake news media?
I don’t know. But I think it’s hard to see any of those three flipping. Collins is apparently off to run for governor. She’s not going to support a repeal without a replacement while she’s seeking the office from which she’d have to administer the resultant nightmare. Capito isn’t up for re-election until 2020, and in 2014, she won all of West Virginia’s 55 counties, so even though Trump is still popular in the state, she can do what she wants. Murkowski doesn’t face Alaska voters until 2022, assuming she decides to. McConnell says he’s forcing the vote, but that’s probably just to get it out of his life.
Oh, and the CBO said Wednesday night that repeal-only would cost 32 million people their coverage, as opposed to 22 million under repeal-and-replace. That probably means the GOP base prefers it, but it doesn’t mean those three flip.
So assuming that fails, we’re on to letting Obamacare die. You may have been wondering since Trump said that: Can he actually do that? In theory, yes, he totally can.
It’s like this. The federal government makes what they call “subsidy payments” or CSR’s (“cost-sharing reduction” payments) to insurance companies to help them cover the cost of insuring poor people under Obamacare. It’s explained well here, in this PBS NewsHour segment (video and transcript). The long and short of it is that it involves up to $12 billion a year in payments, and if insurers don’t get that money from Washington, they’ll have to raise it by jacking up premiums for some 20 million people by as much as $1,000 a year. And we’re talking about poor and working-class people for whom $1,000 is nothing to sneeze at.
So, the Trump administration ends the subsidies (this would be starting next year, an election year), and pretty soon you’ve got 20 million people whose Obamacare costs are going to shoot through the roof. And it will set off the infamous death spiral, and Republicans will say, “See? Obamacare! We told you!”
Kinda sounds like it could work, doesn’t it?
Maybe. Except for two big things. One: Insurance companies themselves are blaming, and have been blaming, the Trump administration, not Obama. You’ve not noticed this in all likelihood, because it’s not been on the front pages, but for months now, insurance executives have been telling reporters that it’s the instability and uncertainty caused by the Trump administration’s refusal to commit to continuing the CSR’s that’s going to force them to jack up premiums.
Here for example is Brad Wilson, the head of Blue Cross/Blue Shield North Carolina, speaking around Memorial Day to The Washington Post’s Greg Sargent: “The failure of the administration and the House to bring certainty and clarity by funding CSRs has caused our company to file a 22.9 percent premium increase, rather than one that is materially lower. That will impact hundreds of thousands of North Carolinians.”
Technically, the Trump administration can do this tomorrow by dropping an appeal on a lawsuit that would allow the government to stop the payments. So if the Trump administration does that and has actually refused to send the CSR’s, the question is how will these companies react. Will they go all timid and both-sidesy on us? Democrats have to make sure that people know that if these subsidies end and people’s premiums get jacked up, it’s Trump and the Republicans’ fault, not Obama’s.
Number two: The Democrats have one point of leverage here that they’d be foolish not to threaten to use. The debt limit is going to be reached in late summer. Because of the number of extremist Republicans who won’t vote to increase the debt ceiling unless it comes with sending half of America to poor houses (I exaggerate—“dramatic domestic spending reductions”), it’s likely that McConnell and Paul Ryan are going to need Democratic votes to increase the debt ceiling.
To which the Democrats should say: You want our votes on the debt ceiling? Fine. You got ’em—if you continue the CSR’s.
That’s hardball all right. But the Republicans opened that door in 2011, when they became the first party ever to attach conditions to a debt-limit increase vote. There’s no reason at this point for the Democrats to act like this is a game of tiddlywinks.
It’s not a game at all. Reasonably affordable health coverage for 20 million people is on the line.
What we have right now is one party that passed a complicated and flawed law that has nevertheless helped millions of people and moved the country dramatically in the direction of the normal global standard for advanced democratic countries. That party is actually trying to fix what’s wrong with the law. Which, incidentally, isn’t actually very complicated, as explained here.
Then we have a party that wants to give huge tax cuts to the wealthy, cripple Medicaid (these were the two major elements of the Senate’s so-called health bill), end the individual mandate cuz evil gummint, and take 20-plus million people back to where they were before Obamacare came along.
That’s the truth of the matter. The Democrats have to make sure people know it.