WASHINGTON ― Senate Republicans are still figuring out just how skinny their Obamacare “skinny repeal” needs to be to secure 50 votes, but what remains unclear is what happens after that.
Republicans are trying to build the most comprehensive health care bill possible that can still garner 50 votes, playing legislative hot potato with their long-promised repeal. Sen. Bob Corker (R-Tenn.) told reporters Wednesday there are two schools of thought on how to do that: by stripping away portions from the original GOP replacement or by building it from the ground up.
Whichever way they go about it, there seems to be very little that 50 Senate Republicans agree on, much less 50 Senate Republicans and 218 House Republicans.
Senate GOP leadership has suggested numerous times that its scaled-down repeal bill would just be a vehicle so the chamber can move along to a conference committee with the House. Majority Whip John Cornyn (R-Texas) said as much Wednesday afternoon, telling a small group of reporters that the skinny repeal probably wouldn’t touch Medicaid and that lawmakers would address Medicaid “when we conference with the House.”
But about an hour later, Cornyn was raising the possibility that House lawmakers could just take whatever limited bill the Senate passes and send it to President Donald Trump’s desk for his signature.
“There doesn’t need to be a conference,” Cornyn said. “There could be an informal conference. The House could take up the Senate bill and pass that, or they could amend it and send it back.”
Forgiving for a moment that Cornyn is essentially just laying out the constitutional options that lawmakers have, if a conference committee ― or an informal conference committee ― got bogged down in negotiations, it’s not hard to imagine some Republicans just advocating that the House simply pass the skinny repeal and call it a day, or make only very small adjustments and have the scaled-down measure be the basis of the health care plan.
House Republicans have previously voted on repealing the individual and employer mandates, as well as the medical devices tax ― the three main components of a skinny repeal at this point ― and even though House conservatives have staked out an early position against just taking that bill and calling it their Obamacare repeal, that position could change quickly.
Senate GOP leaders are selling their small bill as a vehicle to come up with a larger plan, which is still the most likely scenario, but lawmakers are also ignoring obvious policy shortcomings because leadership has told them this won’t be the final bill. Conservatives are holding off on insisting that Medicaid changes be in the skinny repeal because leadership is telling them this measure is just advancing the process, while moderates from expansion states are hard-pressed to vote “no” because they’ve said all along that they just want to make sure Medicaid is preserved for their states. In this narrow bill, the expansion isn’t touched.
Asked how Republicans are going to ever deal with those trickier issues on a repeal-and-replacement plan if they can’t deal with them now, Cornyn gave HuffPost one of his famous non-answers. “That’s what talking is for,” he said. “And working together and trying to figure out what’s possible.”
But, if more talking isn’t a viable solution, could the skinny repeal be the endgame?
Politically, Republicans just passing the scaled-down bill and giving Trump his Rose Garden signing ceremony could be disastrous. The Congressional Budget Office has previously said similar legislation would lead to 15 million fewer people with health insurance and premiums that are 20 percent higher. And that’s just in the first year.
Removing the mandates from the current health care law could actually produce something resembling a death spiral ― a result of only the sickest people signing up for health insurance ― which Republicans (wrongly) say Obamacare is in now.
After enacting such policy, Republicans would own the most troublesome part of Obamacare ― the insurance market ― while preserving a number of other components in the law that they wanted gone, namely, the Medicaid expansion, Obamacare taxes, and regulations they say are driving up costs.
Those items are difficult to find consensus on, however, in part because many lawmakers think they’re working.
Senate Republicans are being sold on the idea that they don’t need to evaluate the policy effects of their legislation because it’s only advancing the process. Already, 50 Republicans voted to do that when they agreed to the motion to proceed to debate on this bill.
But a fair question to ask when you’re making policy is whether the bill you’re voting on is an improvement on current law. It’s hard to argue that just removing the mandates makes anything better.
When HuffPost asked Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R-Tenn.) whether the skinny repeal would be an improvement on Obamacare, he was waiting for the Senate subway doors to close. He stared at us, filibustered with a joke that we were holding up the doors, and then said, “It’s not a solution.”
So why are Republicans treating the skinny repeal like it is one?
Jonathan Cohn contributed to this report.