Why Is Everyone So Certain 'Skinny Repeal' Will Go To Conference?

As the Senate’s “vote-a-rama” continues, it’s looking more and more likely that the only bill that has any chance of passing is what’s now known as “skinny repeal.” Who comes up with these labels, anyway? Nomenclature aside, though, there is a rather large assumption being made right now that may prove to be faulty ― that the skinny repeal bill will immediately move from passing the Senate into a House/Senate conference committee. This would serve to slow the process down and give Congress (at the very least) all of August to contemplate their next step. But this conference may not happen at all, which pretty much everyone in Washington is currently ignoring.

Let’s unpack all of that a bit, for those who haven’t followed every twist and turn in the health care bill saga over the past 24 hours. The Senate’s “vote-a-rama” is a freewheeling procedure where any senator can offer up amendments to the bill under discussion, for a minimum of 20 hours of debate. As of this writing, the score stands at three major amendments considered, all of which failed to pass.

To start the whole debate process, John McCain gave a wonderful speech yesterday on the Senate floor, in which he tried to shame his fellow Republicans into supporting “regular order” for bills ― sending them through committee, holding hearings, getting input from the minority party, etc. This was sheer hypocrisy from the get-go, however, which I explained in detail yesterday. In a nutshell: McCain could have forced the Senate to do exactly what he said he wanted them to do if he had either voted “no” on the motion to proceed or even if he had just stayed home and not voted. But he didn’t ― he voted to give the finger to regular order and just steamroll ahead towards a partisan tribal win. Thus the stinking hypocrisy of his wonderful speech.

Mitch McConnell has brought up two major amendments which would replace (pun intended, I guess) the House bill with the third version of his own McConnellcare plan. This “repeal and full replace” bill went down in flames, with nine Republicans voting against it. McCain wasn’t one of them, by the way. Then McConnell put forward a “repeal only” bill which also quickly went down in flames, with seven Republicans voting against it. Democrats, meanwhile, took McCain’s lofty sentiments to heart and proposed a bill which would have sent the bill back to committee and restored the precious regular order McCain so dearly lionized in his speech. This amendment went down on party lines. It only needed a majority to pass, so if three Republicans had supported it, McCain would have gotten his wish. McCain, however, voted against this amendment (once again proving the rank hypocrisy of his speech). So far, the Democratic amendment has gotten the highest vote total (48-52) of any of these proposals.

What will now follow will be a scramble to offer more and more amendments on the fly, completely winging the complete redesign of one-sixth of the American economy. How responsible! Nothing like batting a few ideas around over beers and pizza in a brainstorming session for solving all the world’s problems, eh?

In the background, a consensus seems to be emerging, or at least trying to. This is to pass a “skinny repeal” bill, which would just repeal three or four of Obamacare’s regulations (the individual mandate, the mandate on businesses to provide health insurance to their workers, and a tax on medical devices). The thinking is that a minimalist approach would serve to nicely solve a whole handful of Republican political problems, so the Senate could then go home for vacation, having “done something.” Such a skinny bill wouldn’t completely undercut Medicaid, it wouldn’t slash spending on the poor in order to give a breathtaking tax cut to billionaires, and it wouldn’t defund the Medicaid expansion or undercut funds currently fighting the opioid epidemic. This would address many Republican senators’ concerns, this thinking goes, so maybe they could all see their way to voting for it.

This is nothing short of an attempt to kick the can down the road, in a big way. Which is kind of ironic, since the Republicans seem to be caught in an eternal game of: “Somebody, please save us from ourselves!” The House version, you’ll recall, was sold to reluctant GOP representatives with the promise: “Don’t worry, the Senate will fix it!” Now the Senate is considering doing exactly the same thing: “Don’t worry, the House/Senate conference committee will fix it!” In other words, skinny repeal is being sold as a risk-free vote which will allow senators to brag to their constituents that they “passed a bill to repeal Obamacare,” which (politically) is seen as a lot better than admitting “we tried, but we failed to pass anything.”

The skinny repeal bill hasn’t even been written yet. So of course the Congressional Budget Office hasn’t been able to score it. However, a very similar bill was considered a while back, and the C.B.O. said it would mean 15 million fewer Americans with health insurance and a 20 percent hike in premiums. It’s probably safe to say the numbers will be similar for whatever Mitch McConnell jots down on the back of an envelope in the next few days.

So, to recap, “repeal only” failed, which would have kicked 32 million off insurance. “Repeal and replace” failed, which would have meant 22 million losing insurance. McConnell’s hope now is to exhaust everyone with the vote-a-rama and then at the end offer up a “skinny repeal” which would only kick 15 million off insurance.

But there’s a fly in this ointment, to use a medical metaphor. Because if skinny repeal passes the Senate, there is absolutely nothing stopping the House from just quickly passing the exact same bill, right before they scarper off for a month’s vacation. Everyone in Washington (including the media, who should really know better) is making the assumption: “Of course there will be a conference committee, since the Senate bill will be so different than the House version.” This assumption is based on absolutely nothing, as far as I can see. What it essentially takes for granted is that after a process of jamming a bill through in both houses by the seat of their pants, suddenly both Paul Ryan and Mitch McConnell will see the wisdom of returning to regular order at the last moment. Really? Everyone believes that? Why?

Why is nobody even considering that Paul Ryan would, instead, make the following political calculus: “It was so hard getting a bill through the House the first time that I initially gave up. The only way we could get a bill through the second time was by promising everyone that the Senate would fix it. If we go to conference committee, then we’ll spend months fighting within the Republican caucus, bickering over what should be in the final bill. The committee might not even be able to reach consensus on any bill, in the end. But all that could be avoided by just hustling through the Senate’s skinny repeal bill in the House, right before vacation time. Trump could sign it by the end of this week. All Trump has ever cared about is signing some bill with the title ‘repeal Obamacare’ that would give him a political victory to brag about. He’s never cared what is actually in any bill, he just wants to have his signing ceremony. Skinny repeal can be sold to the Republican base voters as ‘a good first step’ toward total repeal of Obamacare. We will have proved we can get legislation to Trump’s desk, which will blunt the complaints that we haven’t fully repealed it yet. So let’s just move on the Senate’s bill, and get this thing over with before the weekend.”

It’s really not that hard to imagine such a scenario. But currently nobody seems to even be considering it, at least from what I’ve read and heard. Everyone (politicians and pundits alike) is completely buying into the assumption that a conference committee is downright inevitable. But it isn’t. All it would take would be Paul Ryan deciding that some version of the above paragraph is the way to go, and skinny repeal could be the law of the land before the end of this week. People need to start facing this reality.

I’ve long said the smartest thing Republicans could have done would have been to pass a one-page bill that merely mandated that every government official and department never use the term “Obamacare” again, and instead be forced to call it “Trumpcare.” Nothing else would change, and the change itself would be meaningless (the law has always officially been the “Patient Protection and Affordable Care Act,” not “Obamacare”). Trump could triumphantly sign it, and nobody’s lives would be negatively affected. It would be the ultimate proof that Trump does not care what is in a “repeal Obamacare” bill, in other words.

Republicans seem to be moving in this general direction with skinny repeal. But skinny repeal will still do a lot of damage to the health care system. It’s not as benign as just swapping “Trumpcare” for “Obamacare.” Even so, how can people not see the appeal to Ryan right now of passing something ― anything ― through Congress as fast as humanly possible, just so Trump can have his precious signing ceremony? If skinny repeal does take this route and Ryan decides to put skinny repeal on the House floor unchanged and unamended, there are going to be a lot of astonished people caught completely unawares by the move.

Personally, though, I won’t be one of them.


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