The Senate health care bill is dead. Senate Majority Leader Mitch McConnell killed it Monday after it did what President Obama couldn’t do – make Obamacare more popular – and after too many Republican senators said they’d vote against it and none expressed enthusiasm for it.
The unenthusiastic included Arkansas Sens. Tom Cotton and John Boozman, who both remained noncommittal even though Cotton was one of 13 Republican senators who wrote the bill behind closed doors.
McConnell’s new plan is to repeal Obamacare now, but it wouldn’t take effect for two years while Congress creates a replacement. In response, Cotton told conservative radio host Hugh Hewitt Tuesday that he was “pleased” with that direction. He said Congress already voted to repeal Obamacare in 2015, a move supported by all six members of Arkansas’ congressional delegation.
Of course, in 2015 everyone knew President Obama would veto the bill. This vote would actually count because President Trump would sign it.
Cotton seems to think this could happen and seems to support it, even though he told “Meet the Press” in January that any repeal vote should include a path forward and that “kicking the can down the road a year or two years is not going to make it any easier to solve.” He told Hewitt that senators who voted once to repeal Obamacare would have no choice politically but to do so again. Boozman also is on board with the idea.
Let’s hope they don’t get that chance.
Here’s the thing about businesses, including health care-related ones such as insurance companies and hospitals: Like a tree growing on the side of a cliff, they can thrive in difficult environments as long as they know the rules. They can make a profit even when taxes are too high, regulations are too onerous, and government is too big.
But it’s much harder to thrive amidst the shifting sands of uncertainty. In that environment, free market providers can’t make business decisions, so they play it safe and wait to see what happens next. If the Affordable Care Act (Obamacare) were repealed with only a vague promise from politicians of something coming later, the entire system would be thrown into disarray, leading insurers to leave markets and making health care more expensive and less available.
Besides, working off a deadline is not exactly Congress’ strong suit these days. Time and again, it’s funded the government through continuing resolutions – spending what it did last year, plus some, because it didn’t have time to do a real budget. It’s repeatedly extended the debt ceiling at the last minute, and it’s delayed important legislation because it couldn’t get its act together. One example: After the No Child Left Behind education law expired in 2007, Congress didn’t do anything about it until 2015, when it finally replaced it.
We can’t have years of limbo with health care, because people will die. If Republicans don’t have an answer seven years after Obamacare was passed, they won’t have one in two more. It’s not hard to foresee an inconclusive election in 2018, and then the two-year deadline passes with no consensus, so there’s a new deadline, and then another.
Since “repeal and replace” is dead and “repeal, then replace” is a terrible idea, what’s left? There’s “return” – just go back to the old system, where insurance companies denied coverage based on pre-existing conditions, set lifetime limits, and cut people off based on technicalities. In other words, sell you insurance as long as you don’t need it. Want to go back?
Instead of repeal, replace or return, there’s a fourth “R” – reform. Change current law incrementally, and then change it again as needed. This would require a bipartisan approach, along with listening to health care providers and other stakeholders, which did not happen this time. It would anger some supporters and media blowhards, and it would mean accepting that you can’t get everything you want in a democracy. But the health care system would be better.
There is another option, offered by President Trump: Let Obamacare “fail,” and then create a new system.
Presumably, he still could get the health care he needs after the system “fails” and policymakers try to figure out how to pick up the pieces.
The rest of us shouldn’t have to live with such uncertainty. Let’s go with the fourth “R.”
Steve Brawner is an independent journalist in Arkansas. Email him at firstname.lastname@example.org. Follow him on Twitter at @stevebrawner.