What Went Down On Health Care This Week

One side note on the implications of this “skinny repeal” plan: McConnell’s current strategy appears to be to have the Senate pass a narrow replacement bill in order to take it to conference with the House and ultimately end up with something both chambers can agree on. That, of course, means it will be even longer before we know what the final bill will look like. The delay is significant because insurers are right now deciding whether to participate in the insurance markets next year, and states are negotiating what they can charge for plans. Kicking the can down the road legislatively only makes that process more difficult.

We’ve spoken a lot about how unpopular the Republican health care bill is. But the party may have found a popular alternative in the so-called skinny repeal. This would seek to eliminate the insurance mandate and the medical device tax. Both of these help to pay for the ACA. The mandate — the part of the ACA that requires nearly all Americans to have health insurance or pay a fine — has polled poorly. In November 2016, the Kaiser Family Foundation, a nonpartisan health care think tank, found that the mandate had a 63 percent unfavorable rating, compared with a 45 percent unfavorable rating for the ACA overall. A majority of Americans, 57 percent, favored repealing the medical device tax — the part of the ACA that taxes the manufacturers of medical devices such as artificial joints — in a September 2015 Kaiser survey. The popularity of these two pieces of the skinny bill stands in stark contrast to the Republican health care plan, which hasn’t had a favorable rating from a plurality of Americans in any poll since at least May 2017. Keep in mind, though, that surveys asking about the mandate and medical device tax were taken before the current debate on the Republican health care bill. It’s possible that both proposals would poll differently now.

At the moment, the most promising path to some sort of repeal and replace is through what’s being called a “skinny bill.” The idea is to pass a pared-down version of previous replacement bills, cutting some of the least popular aspects of the ACA, such as the individual mandate that requires most people to have insurance or pay a fine, while keeping the more popular aspects of the law, like its Medicaid expansion. The bill would also effectively repeal the requirement that most employers offer health insurance coverage to employers, as well as a tax on medical devices. (Impressive work from the medical lobbyists — Republicans have tried to cut all of the Obamacare taxes and faced opposition. The medical device tax is the lone survivor.) The “skinny” name might suggest narrow effects, but that’s not quite right, according to estimates from the Congressional Budget Office. The CBO estimates that it would leave 15 million additional people without insurance and would raise premiums 20 percent on the private market. Many speculate that it would also lead insurers to flee the markets. It’s also not likely that passage of this version would be the end of the road for the bill. Republican senators have said they want to pass this measure in order to get to the next phase in the legislative process, negotiating with the House to find a broader replacement plan that can garner enough support from the moderate and conservative wings of the Republican Party and both chambers of Congress to make its way to Trump’s desk.