The GOP's Obamacare dilemma

In the run-up to the 2018 midterm elections, the Republicans have an Obamacare dilemma on their hands.  As politico.com reports, the GOP is divided on what comes next following the repeal of the individual mandate.  They "don't want a repeat of last year's Obamacare fumble," but "they also don't want to take repeal off the table":

The reality is [that] the GOP is so divided on Obamacare, [it doesn't] have the votes to achieve either objective – repeal or stabilization.  That means former President Barack Obama's signature legislative accomplishment could keep limping along, crippled by the repeal of the individual mandate in the tax law but lifted by the surprisingly strong enrollment for the coming year.

The Alexander-Murray insurer cost-sharing subsidies bill, aka stabilization bill, has run into opposition among House conservatives, who, as Politico notes, are reluctant "to do anything that props up the health law," including a "bailout" for insurance companies.

In the meantime, "Sen. Lindsey Graham (R-S.C.) is working on resurrecting" the Graham-Cassidy health care bill, which was considered but then shelved last September due to a lack of sufficient votes.  The Graham-Cassidy bill would "turn the federal funding for Medicaid expansion and the subsidies into a block grant program" to the states, among other wide-ranging reforms, as summarized at cnn.money.com when the bill was last considered.

To the suggestion that the Republicans might be "crazy to try repeal again in 2018 with one less vote in the Senate," Senator Graham argues:

I think it would be crazy if you don't[.]  How can you repeal the individual mandate and say we're done?  The thing's going to crumble.  We['d] better find a replacement that works.

When Graham-Cassidy failed last September, there was some discussion of using a fiscal 2019 budget reconciliation bill as a fallback plan for repeal, but as politico.com noted at the time, that would put the "contentious issue of health care back in the spotlight during the 2018 midterm elections."

On the House side, Majority Whip Steve Scalise said Tuesday that he wants to "get back to work" on Obamacare repeal and replace and "fix the things that are broken and jacking up costs," as washingtonexaminer.com reports, but other Republicans are equivocating:

A handful of moderate Republicans told POLITICO that they'd like to move away from Obamacare and on to legislation like infrastructure. But they don't want to be quoted saying that repeal is dead.

The Democrats are doing some equivocating of their own: the individual mandate that was repealed by the GOP tax package "poison pill" has gone from being the "linchpin of the statute" to maybe not that big a deal to Obamacare's defenders.

David Catron at spectator.org notes:

Now the media [have] stopped running articles with gloomy titles like "Killing the Individual Mandate Will Probably Kill Obamacare," and [are] instead publishing pieces under happier headlines: "What if we don't need the individual mandate after all?"

The latter, happier headline appears over a piece by Jeff Spross at theweek.com, which maintains that the "increase in coverage Obama[c]are achieved" was due to the "carrots" of "Obama[c]are's subsidies and its Medicaid expansion" and that there is no "evidence that the 'stick' of the mandate, on its own" increased signups.

Mr. Spross goes on to conclude that perhaps Democrats are secretly breathing a sigh of relief that the individual mandate has been defanged:

This would create an interesting new political reality.  Those carrots are pretty popular.  The individual mandate, by contrast, is widely hated by voters.  Democrats defend the mandate nonetheless, because they feel they must to preserve Obama[c]are's viability.  This has won them no friends.  So maybe, just maybe, killing it will be a blessing in disguise.

As an editorial writer at richmond.com, as posted at realclearpolitics.com, says: "Now they tell us."

Mr. Catron at spectator.org points out the "largish fly squirming in the ointment": under the reconciliation rules used to squeeze the tax bill through the Senate, the mandate was not actually repealed.  The provision involving the individual mandate merely reduced the tax penalty for failing to buy insurance to zero.

This leads Catron to strategic thinking about the 2018 midterms:

If the Democrats ever get control of Congress and the White House again, they will reinstate the fine.  And it will be far larger than the one that was just eliminated.  This is one of the best reasons for conservative voters to show up at the polls in record numbers during the upcoming midterms.  The effective repeal of the individual mandate, as Professor Chemerinsky [who last month termed the mandate "the linchpin of the statute"] and Trump accurately point out, is a poison pill that will eventually kill Obamacare.  But, with the help of beefed up Republican majorities in Congress, President Trump can finish off whatever is left of the risibly titled "Affordable Care Act."  With that done, he will probably be unbeatable in 2020.

Catron's prescription for "beefed up" majorities in 2018 sounds painfully similar to "just give us the House in 2010," "just give us the Senate in 2014," and "just give us the presidency in 2016" when it comes to deconstructing Obamacare.  But at this point, what choice do we have?

In the run-up to the 2018 midterm elections, the Republicans have an Obamacare dilemma on their hands.  As politico.com reports, the GOP is divided on what comes next following the repeal of the individual mandate.  They "don't want a repeat of last year's Obamacare fumble," but "they also don't want to take repeal off the table":

The reality is [that] the GOP is so divided on Obamacare, [it doesn't] have the votes to achieve either objective – repeal or stabilization.  That means former President Barack Obama's signature legislative accomplishment could keep limping along, crippled by the repeal of the individual mandate in the tax law but lifted by the surprisingly strong enrollment for the coming year.

The Alexander-Murray insurer cost-sharing subsidies bill, aka stabilization bill, has run into opposition among House conservatives, who, as Politico notes, are reluctant "to do anything that props up the health law," including a "bailout" for insurance companies.

In the meantime, "Sen. Lindsey Graham (R-S.C.) is working on resurrecting" the Graham-Cassidy health care bill, which was considered but then shelved last September due to a lack of sufficient votes.  The Graham-Cassidy bill would "turn the federal funding for Medicaid expansion and the subsidies into a block grant program" to the states, among other wide-ranging reforms, as summarized at cnn.money.com when the bill was last considered.

To the suggestion that the Republicans might be "crazy to try repeal again in 2018 with one less vote in the Senate," Senator Graham argues:

I think it would be crazy if you don't[.]  How can you repeal the individual mandate and say we're done?  The thing's going to crumble.  We['d] better find a replacement that works.

When Graham-Cassidy failed last September, there was some discussion of using a fiscal 2019 budget reconciliation bill as a fallback plan for repeal, but as politico.com noted at the time, that would put the "contentious issue of health care back in the spotlight during the 2018 midterm elections."

On the House side, Majority Whip Steve Scalise said Tuesday that he wants to "get back to work" on Obamacare repeal and replace and "fix the things that are broken and jacking up costs," as washingtonexaminer.com reports, but other Republicans are equivocating:

A handful of moderate Republicans told POLITICO that they'd like to move away from Obamacare and on to legislation like infrastructure. But they don't want to be quoted saying that repeal is dead.

The Democrats are doing some equivocating of their own: the individual mandate that was repealed by the GOP tax package "poison pill" has gone from being the "linchpin of the statute" to maybe not that big a deal to Obamacare's defenders.

David Catron at spectator.org notes:

Now the media [have] stopped running articles with gloomy titles like "Killing the Individual Mandate Will Probably Kill Obamacare," and [are] instead publishing pieces under happier headlines: "What if we don't need the individual mandate after all?"

The latter, happier headline appears over a piece by Jeff Spross at theweek.com, which maintains that the "increase in coverage Obama[c]are achieved" was due to the "carrots" of "Obama[c]are's subsidies and its Medicaid expansion" and that there is no "evidence that the 'stick' of the mandate, on its own" increased signups.

Mr. Spross goes on to conclude that perhaps Democrats are secretly breathing a sigh of relief that the individual mandate has been defanged:

This would create an interesting new political reality.  Those carrots are pretty popular.  The individual mandate, by contrast, is widely hated by voters.  Democrats defend the mandate nonetheless, because they feel they must to preserve Obama[c]are's viability.  This has won them no friends.  So maybe, just maybe, killing it will be a blessing in disguise.

As an editorial writer at richmond.com, as posted at realclearpolitics.com, says: "Now they tell us."

Mr. Catron at spectator.org points out the "largish fly squirming in the ointment": under the reconciliation rules used to squeeze the tax bill through the Senate, the mandate was not actually repealed.  The provision involving the individual mandate merely reduced the tax penalty for failing to buy insurance to zero.

This leads Catron to strategic thinking about the 2018 midterms:

If the Democrats ever get control of Congress and the White House again, they will reinstate the fine.  And it will be far larger than the one that was just eliminated.  This is one of the best reasons for conservative voters to show up at the polls in record numbers during the upcoming midterms.  The effective repeal of the individual mandate, as Professor Chemerinsky [who last month termed the mandate "the linchpin of the statute"] and Trump accurately point out, is a poison pill that will eventually kill Obamacare.  But, with the help of beefed up Republican majorities in Congress, President Trump can finish off whatever is left of the risibly titled "Affordable Care Act."  With that done, he will probably be unbeatable in 2020.

Catron's prescription for "beefed up" majorities in 2018 sounds painfully similar to "just give us the House in 2010," "just give us the Senate in 2014," and "just give us the presidency in 2016" when it comes to deconstructing Obamacare.  But at this point, what choice do we have?

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