The Senate GOP health care bill isn’t so much “Obamacare Lite” as “Obamacare Essential Everyday,” a less expensive and less known knockoff of the brand-name product. That much was confirmed on Saturday when Vox.com reported that Republicans were mulling a new provision that would ban customers from buying health insurance on the individual market for six months if they don’t maintain continuous coverage. That addition was confirmed by Politico this morning, which says it’s “expected” to be in the final bill.
The six-month lockout is intended to fill the role formerly occupied by the individual mandate, which Republicans are striking from the books with great fanfare. So no more punitive fine if you don’t buy insurance! Instead it will merely be against the law for you to change your mind during the next half-year, and if an emergency befalls you during that time, godspeed. This is economic liberty as interpreted by Cass Sunstein, a nudge towards what government wants that feels more like another RNC-sanctioned body slam.
“The Obamacare mandate is coercion.” Republicans rightly made that point for eight years. Except now they’ve realized that you can’t pluck out the mandate without disrupting the malfunctioning but nonetheless carefully calibrated Obamacare contraption. The health insurance exchanges need young people to be whipsawed into signing up for pricey coverage by the threat of a pricier penalty in order to support the costs of the old and sick. So in its place Republicans have devised an equally coercive measure, one overtly biased against the young. (The House bill did something similar, slapping an odious surcharge on those who went without insurance for more than two months.)
You can argue that this is the right thing to do—Americans want stability in their health care rather than selection, you might say, and the waiting period is a small price to pay for preventing the present insurance system from collapsing outright—but in that case you have to ask: what is the point of all this? Note my choice of language: “present insurance system,” meaning the exchanges, the subsidies, all of it. The Republican bill preserves the existing bone structure of Obamacare, while merely transplanting a few of its organs like the mandate. Liberals spent last weekend dousing themselves in gasoline over the Medicaid cuts, but even those, the legislation’s most radical changes, aren’t scheduled to begin for another four years. When Congress kicks a can that far down the road, you can be certain it isn’t going to happen.
So why are Republicans doing this? Why are they about to pass a measure that will accomplish little except shifting onto themselves the blame for America’s health care dysfunction?
Two theories come to mind; both of them involve politics. The first is that Mitch McConnell understands he can’t navigate through a genuine health care overhaul so he’s settled on something less. This hypothesis sees McConnell as a victim of circumstance, hemmed in by his party’s unshakeable mandate to repeal Obamacare on one side and the realities of a fractured GOP caucus on the other. The Senate majority leader, never lacking in analytical ability, knows his legislation is largely cosmetic, but he’s determined to pass it anyway out of deference to eight years of won elections.
The second theory paints McConnell as a cynic, one who dropped a defective bill, set an intentionally impossible Fourth of July deadline, stepped back to watch as conservatives and moderates thrashed it to smithereens, and has no intention of ever whispering “health care” again after next weekend. Under this reading, the bill is pure Potemkin, allowing Republicans to go home and sigh, “We tried but those damned Democrats/RINOs/conservatives got in the way.” Obamacare will become a forever campaign, one that continues to ignite voters but never elicits serious action from Congress.
Depending on how much McConnell reveals in the coming days, we may be able to tease out which one it is. In the meantime, another CBO score is about to land with a thud—bearing all the certitude of a horoscope, it will nonetheless fuel further Democratic freakouts. I can’t imagine why they protest so much. They should submit their amendments, let the bill pass, kill the Medicaid cuts before 2021—and then rejoice that years of public fury resulted in only this much change.