What Went Down On Health Care This Week

Rep. Mark Meadows of North Carolina, the head of the House Freedom Caucus, is already criticizing “skinny repeal,” according to Capitol Hill reporters. But first things first: Conservatives in the Senate may be okay with the “skinny” approach. Here’s what Rand Paul said, per Politico, “I’ve always said I will vote for any permutation of repeal.” A spokesman for Mike Lee was non-committal. I had not quite realized this initially, but skinny repeal or something like it has the potential to unify moderates and conservatives in the Senate. It is a kind of “pure repeal,” like Paul favors, in that it doesn’t require him to vote for any kind of new health policy that benefits insurers or creates new regulations. But it doesn’t gut Medicaid, which Dean Heller and the moderates oppose. (Heller has already suggested that he supports this idea.) The only problem is that we aren’t sure that skinny repeal, particularly getting rid of the individual mandate, would actually work in terms of policy, or if it would cause even higher premiums. (Health care experts are actually pretty sure it won’t work. Look at the Twitter feed of the Kaiser Family Foundation’s Larry Levitt, who is very skeptical.) I would not be surprised to see Republicans look for a repeal of the medical device tax and the employer mandate but try to find a way to pass something that creates incentives for people to buy insurance before they get sick (which is the point of the individual mandate).

Trump and other Republicans have repeatedly implied that problems in the Obamacare marketplaces, such as those that might occur under a “skinny repeal bill” that repealed the individual mandate, could create political problems for Democrats. The evidence suggests that Republicans would take most of the blame instead. Start with a poll that asked directly about this question. In April, the Kaiser Family Foundation’s monthly survey asked voters whether they thought former President Barack Obama and Democrats or President Trump and Republicans were more responsible for “problems with [Obamacare] moving forward.” Some 61 percent of respondents said Trump and Republicans would be more responsible, as compared to just 31 percent who said they’d assign more responsibility to Obama and Democrats. There’s also the problem that the public trusts Republicans less on health care overall. An average of recent polls from Gallup, NBC News and George Washington University find that Democrats hold a 50-35 lead over Republicans on trust on health care. The Democratic advantage had narrowed in this category in the years immediately following the passage of Obamacare — but it’s since opened back up again as Republicans have spent the past several months trying to pass various unpopular iterations of their health care bill. Finally, there’s the general principle that the party in power is blamed for the country’s problems. Economic conditions have a significant effect on an incumbent president’s chance of being re-elected, for example, even though presidents themselves don’t usually affect the economy all that much. Skinny repeal may nevertheless be less politically costly than some of the alternatives. But Republicans are naive if they expect to escape blame for whatever problems it creates.