’Skinny’ Repeal Could Make This Bill Much More Passable But Also Much Less Conservative
No one knows for sure right now what will be in the so-called skinny repeal. But if it largely leaves alone Medicaid, as most indications are so far, this is a huge shift, politically but also in terms of policy. The cuts to Medicaid — both to the Obamacare expansion and, in particular, to the traditional program — in both the House and Senate versions of this legislation have always seemed like an overreach in terms of the politics. By making cuts to traditional Medicaid, this legislation was not just a repeal of Obamacare but an effort to use the Obamacare repeal as a vehicle to accomplish a long-held but not very popular conservative goal: reducing Medicaid spending. Those cuts helped galvanize the left, which could point to the effects that the cuts would have on seniors, the elderly and disabled people. Traditional Medicaid has heavy benefits for these groups, while the Obamacare expansion of Medicaid targets uninsured adults who are generally working-age and not disabled.
These Medicaid cuts would also take away money from states, which led to vocal opposition from Nevada’s Brian Sandoval and Ohio’s John Kasich, two Republican governors who have been blasting the Obamacare repeal effort for weeks.
If the Medicaid cuts are out, Alaska’s Lisa Murkowski and Nevada’s Dean Heller become much more likely to vote for this bill. But it’s possible that conservative groups such as Heritage Action will oppose that move and make this into a conservatism test, potentially turning Rand Paul, Ted Cruz and Mike Lee against this more limited repeal. And can the conservative House Freedom Caucus support this direction?
There’s talk that this provision is just a way to get the bill through the Senate and then Republicans will move back toward a more conservative version of this legislation in conference. I’m not so sure. It would seem to me that the most passable version of Obamacare repeal in both chambers would be whatever Heller can support.
If this skinny repeal (or something else that doesn’t include Medicaid cuts) passes, the middle point between the House and Senate bills will be much less conservative than it appeared that it would be a week ago. That affects the conference process. If skinny repeal becomes the legislation the Senate passes, this is a big, important shift.