The GOP’s bumpy road towards an attempt to repeal and replace the Affordable Care Act has hit yet another pothole. On the day that a new, revised version of the American Health Care Act, widely derided by Democrats, debuted, two GOP senators have unveiled a rival policy that would scrap the AHCA entirely in favor of a different model. So what’s going on? And what does it mean for you?
First, an outline of Senate Majority Leader Mitch McConnell’s revision to the AHCA leaked this morning. The revisions soften the bill slightly, but only slightly, by retaining some of the taxes from the original ACA. It also adds $70 billion to help pay for high-risk plans, $45 billion to fight the opioid epidemic, and allows people to use health savings accounts, or HSAs, to pay for premiums. Still, these are relative pittances compared to projected need, and it seems unlikely this will solve the plan’s problems either politically or in terms of people thrown off health insurance. Most notably, it includes Ted Cruz’s “skimpy” option, which would allow any insurer to move those plans, provided it sold at least one robust plan in a market as well. It’s telling that the insurance industry is ardently opposed to Cruz’s idea.
The idea was to bring on board Republicans opposed to the bill, but it doesn’t seem to have worked. Senator Dean Heller of Nevada, the Republican most visibly opposed to the bill, remains a “no.”
Meanwhile and in a break from their own party, Senators Lindsay Graham of South Carolina and Bill Cassidy of Louisiana have announced they’ve been drafting an entirely different plan, based on the Welfare Reform Act of 1996. Their legislation would keep most of the taxes intact, although it would do away with the taxes on medical devices and the individual mandate, and it would simply give all the money collected to the states to create their own version of the ACA. If they work out ways to save federal money, the states get to keep it.
The problem with that approach is that the Welfare Reform Act is, at best, controversial. Analysis has found that it might have actually made some social problems worse and leaving the program up to the states has meant those most vulnerable are at the mercy of state legislators. It’s unlikely that Democrats will support a plan that puts health care for Americans at risk, which leaves Graham and Cassidy to try and convince their fellow Republicans.
The main question here is whether Graham and Cassidy are looking to torpedo McConnell’s legislation completely and replace it with their own, or if they’re simply using this bill as leverage to force McConnell to change the bill yet again. Neither Graham nor Cassidy are up for re-election soon, so they can make life miserable for McConnell, and there’s little the Senate Majority Leader can truly do about it. If their plan draws more support than McConnell’s, it would potentially mean that the GOP has to go back to the drawing board, yet again, to try and come up with a plan it can pass.
Given that McConnell has already cut the Senate’s August recess in half, one can easily bet that it will take that long for the Senate GOP to get their health care act together, or it might never happen at all.