What Went Down On Health Care This Week

My colleagues have already shared their thoughts on whether “skinny repeal” would be popular. So let me pass my impressions along also, with the goal of stepping back and casting a slightly wider lens. At various times since Republicans first proposed a health care bill in March, I’ve wondered about the political wisdom of taking such a sweeping approach. The House’s American Health Care Act and the Senate’s Better Care Reconciliation Act would both have made massive cuts to Medicaid and used those cuts, it part, to finance tax cuts that would mostly have helped well-off Americans. And tens of millions of people would have lost insurance coverage. It’s hard to write a popular health care bill; Americans are inherently nervous about changes to the health care system. But AHCA and BCRA almost seemed designed to be as unpopular as possible. As compared to AHCA or BCRA, “skinny repeal” would be narrower and much more targeted — and its primary goal would be repealing the individual mandate, which is pretty unpopular. Republicans probably would have a lot of problems next year when premiums increased as a result of the individual mandate being repealed. But in comparison to AHCA or BCRA — which would also have disrupted the insurance marketplaces — they’d be somewhat more palatable, politically. Here’s the thing, though. Republicans wouldn’t be passing “skinny repeal” in a vacuum. Instead, they’d be passing it after a months-long debate in which many of their members had already voted for the super-unpopular AHCA or BCRA at some point along the way. Meanwhile, the Republican base’s expectations have been raised by the AHCA and BCRA and by years of promises to repeal Obamacare. While some conservatives will give them credit for “repealing Obamacare” by removing the individual mandate, others will feel disappointed — or even betrayed that they left so much of Obamacare intact. So Republicans would wind up with:

1. A lot of Republicans on record as having voted for AHCA or BCRA.
2. A substantial likelihood of premium increases that will kick in before the 2018 midterms, and a resulting increase in the uninsured population.
3. A bill that the GOP base isn’t all that thrilled about.
4. A public which is broadly confused by the months-long process — with the result of the confusion being that the public tends to read all of the above in an unfavorable light for Republicans.

In exchange, they get:

1. Trump and congressional leaders claiming some kind of “win” for having “repealed Obamacare.”
2. Removal of a provision, the individual mandate, that was rather unpopular.

That isn’t a good trade for Republicans. It’s a pretty bad one, in fact, and one which will contribute to the likelihood of Republicans losing seats in Congress next year. It’s still probably better than enacting AHCA or BCRA into law, however, just because those bills are so unpopular and would be even more disruptive to insurance coverage.

Over at Kaiser Health News, Julie Appleby has written a very interesting history of previous state attempts at regulations that mirror the “skinny bill.” TL;DR: It didn’t go well.

If the health care bill ends up in a conference committee between the House and the Senate, it could be a while before a final bill is agreed to by both chambers. Since 1980, reconciliation bills that have passed both chambers and then gone to a conference committee have taken anywhere from three days to 126 days between original passage (the date that the second chamber passed the bill) and final passage.

Reconciliation bills that went to conference committee

FISCAL YEAR	ORIGINAL PASSAGE BY BOTH CHAMBERS	FINAL PASSAGE BY BOTH CHAMBERS	DAYS ELAPSED	DAYS ELAPSED
1981	September 17, 1980	December 3, 1980	77	–
1982	July 13, 1981	July 31, 1981	18	–
1983	July 23, 1982	August 19, 1982	27	–
1983	August 11, 1982	August 18, 1982	7	–
1986	November 14, 1985	March 20, 1986	126	–
1987	September 25, 1986	October 17, 1986	22	–
1988	December 11, 1987	December 22, 1987	11	–
1990	October 13, 1989	November 22, 1989	40	–
1991	October 19, 1990	October 27, 1990	8	–
1994	June 25, 1993	August 6, 1993	42	–
1996	October 28, 1995	November 20, 1995	23	–
1997	July 23, 1996	August 1, 1996	9	–
1998	June 25, 1997	July 31, 1997	36	–
1998	June 27, 1997	July 31, 1997	34	–
2000	July 30, 1999	August 5, 1999	6	–
2001	July 18, 2000	July 21, 2000	3	–
2002	May 23, 2001	May 26, 2001	3	–
2004	May 15, 2003	May 23, 2003	8	–
2006	November 18, 2005	February 1, 2006	75	–
2006	February 2, 2006	May 11, 2006	98	–
2008	July 20, 2007	September 7, 2007	49	–
Average			34	–