Senate Republicans’ bid to repeal and replace the Affordable Care Act collapsed on Tuesday, after Sens. Jerry Moran, (R-Kans.), and Mike Lee, (R-Utah), became the third and fourth Republicans to come out against the bill. Their defections deprived Senate Majority Leader Mitch McConnell of the votes he needed to advance the Better Care Reconciliation Act.
McConnell responded by calling for an early vote on a measure that would repeal Obamacare—and delay much of its implementation, for two years. The Republican-controlled Congress approved such a measure in 2015, which President Obama vetoed.
By Tuesday afternoon, that legislative gambit appeared dead, too. Sen. Lisa Murkowski (R-Ala.), announced that she would oppose it, joining Sens. Susan Collins (R-Maine), and Shelley Moore Capito (R-W.Va.).
That may be a blessing in disguise, as “repeal-and-delay” is unwise public policy. Americans voted to repeal and replace Obamacare this past November. Delaying repeal doesn’t just contradict their wishes. It would also lay waste to the individual insurance market—and leave Republicans to take the blame.
The 2015 bill McConnell wanted to revive repealed Obamacare’s taxes and its employer and individual mandates more or less immediately. It delayed the end of funding for the expansion of Medicaid to able-bodied adults making up to 138% of the poverty line and for the exchanges’ insurance subsidies until two years after enactment.
But it did not touch Obamacare’s premium-inflating regulations, including its essential health benefits mandates and guarantee of coverage to all, irrespective of health status or history. The repeal-only bill also left alone Obamacare’s actuarial value rules, which require insurance policies to pick up a certain minimum percentage of beneficiaries’ medical costs, and its age- and community-rating mandates, which forbid insurers from charging the old and sick more than three times what they charge the young and healthy.
Repealing the individual and employer mandates while retaining the essential benefits, coverage guarantee, and price controls on insurance would throw the insurance market into chaos.
Obamacare’s exchanges are already in trouble. Premiums and deductibles are surging. Patients are paying more for policies that cover less, as narrow provider networks proliferate. Consequently, the young and healthy are leaving the exchanges—if they ever enrolled in them in the first place.
As the exchange pool grows older, sicker, and costlier, insurers’ losses are mounting. Some insurers have had enough. Thirty-eight counties are currently at risk of not having any insurers in 2018.
Repeal-and-delay would only accelerate the disintegration of the exchanges. Without an individual mandate, young, healthy people will have even less incentive to purchase policies. Only people who knew they’d need coverage would buy insurance. Insurers would raise premiums and deductibles even higher in response. And the slow death spiral that’s currently plaguing Obamacare’s exchanges would become a quick one.
That’s not an outcome Republicans should welcome. A June Kaiser Family Foundation poll found that 59% of Americans would blame the GOP for any future problems with Obamacare.
That doesn’t seem to bother President Trump, who said Tuesday that he’d now “let Obamacare fail.”
“Then the Democrats are going to come to us,” he continued.
Some congressional Republicans have signaled that they also support reaching across the aisle. Sen. John McCain (R-Ariz.), who is currently sidelined following surgery, called for a bipartisan approach to health reform on Monday.
Sen. Orrin Hatch (R-Utah), said that the Senate should consider short-term fixes to stabilize insurance markets. A group of 11 governors from both parties has called for a similar bipartisan fix, rather than outright repeal. Nevermind that getting Democrats to support market-based health care reform would be nearly impossible.
The Senate GOP leadership, meanwhile, has hinted that it may want to move on from health reform to other legislative priorities.
Republicans have made a mess for themselves. They had seven years and four months to prepare to repeal and replace the Affordable Care Act. And they promised that they’d act to voters last fall. Yet their “effort” may end without a vote in the Senate.