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probably would have a lot of problems next year when premiums increased as a result of the individual mandate being repealed.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.