Okay, here is a little secret that the Republican candidates will never admit in public. They really aren’t going to repeal Obamacare because most voters like at least some part of the law. While, every GOP Presidential candidate is saying repeal and replace, repealing the law is not as easy as it sounds and there is no plan complete enough on the books offered by the GOP to replace the existing Affordable Care Act.
Both Republicans and Democrats lawmakers in the House and the Senate alike, know that it’s awfully hard to take away government benefits once they’ve been offered. In the case of the Affordable Care Act, repeal would mean taking health coverage from more than 16 million people who didn’t have it before, between those who now get subsidies for private health insurance and those who gained access to Medicaid coverage via the law’s expansion of that program to more low-income adults.
The Medicaid expansion that now appears to be complicating the “Repeal Obamacare!” movement. The House has voted dozens of times to get rid of Obamacare (or at least cripple it) since 2011, but the Senate has been in GOP hands for almost a year and a repeal bill is still on a winding path through the sluggish upper chamber. It may eventually wind up on President Barack Obama’s desk, finally giving congressional Republicans the veto they’ve so long craved.
New obstacles have appeared, in the form of Republican senators who aren’t so sure they want their names associated with an effort to magically transform millions of their constituents from insured people to uninsured people.
Meanwhile, as the clock is ticking to the holiday recess Senate Republicans are divided over how far to go with an ObamaCare repeal bill they plan to send to the president’s desk by year’s end.
It’s not a real “repeal” what Republican lawmakers are trying to pass is a filibuster evading measure using budget reconciliation that they fully expect to be vetoed by President Obama. Let’s be clear here this bit of political theatre is being done to prove if a Republican is elected president then Obamacare will be gone.
But even in trying to pass this symbolic measure, they’re running into some snags, because some Republicans don’t want to take away their constituents’ Obamacare, even if it’s only for pretend.
One of the key features of the Affordable Care Act is its expansion of Medicaid, which the Supreme Court allowed states to opt out of in 2012. As we know Florida was one of a number the Republican run states that flatly refused to expand Medicaid.
The Department of Health and Human Services has been discussion with a number of states to “experiment” with different ways to implement the program. As it stands right now, 30 states and the District of Columbia have expanded Medicaid in some way, and GOP run Utah is in talks to become the 31st. Lots and lots of low-income people have obtained access to healthcare as a result of this steady expansion.
And that explains why Republican senators who represent states that expanded Medicaid are suddenly having reservations about passing legislation that would take that coverage away. So, as this symbolic vote to repeal Obamacare is in flux many senators are un willing to even participate in is supposed to by just a show of unity for the GOP.
A number of those senators spoke on the record to The Hill for their Friday edition.
“I am very concerned about the 160,000 people who had Medicaid expansion in my state. I have difficulty with that being included,” said Sen. Shelley Moore Capito, a Republican from West Virginia.
Sen. John Hoeven (R), who represents North Dakota, where an estimated 19,000 people gained access to Medicaid after Republican Gov. Jack Dalrymple decided to broaden the program, said he was unsure about repealing the expansion.
“We’ve started to talk about it but we haven’t gotten into it in depth,” he said. “I’m going to reserve judgment until I see exactly what we’re going to do.”
“I respect the decision of our Legislature and our governor on Medicaid expansion,” said Sen. Steve Daines (R) of Montana, which has a Democratic governor. “I’m one who respects their rights and voices.”
More than 5,000 people signed up for Medicaid in Montana after federal officials approved expanded eligibility in the state earlier this month.
It should be noted that the two sitting governors running for the 2016 GOP Presidential election did accept Medicaid expansion money. New Jersey Gov. Chris Christie supported the expansion and Gov. John Kasich of Ohio, went a step further by going to other states to help Republican governors get Medicaid expansion through their conservative legislatures.
Kasich, defended Ohio’s acceptance of the Medicaid expansion by arguing that “when you die and get to the meeting with St. Peter” at the gates of heaven, “he is going to ask you what you did for the poor.”
Repealing the Medicaid expansion is a not a winning strategy for endangered Senate incumbents running for reelection in Illinois, Ohio, New Hampshire and Pennsylvania, all of which broadened Medicaid.
Many senators are concern that states who chose to expanded Medicaid would be penalized by billions of dollars if Congress repealed the federal assistance. They are concerned that if they actually did repeal Obamacare that states would have to foot the bill to cover the poor.
Under ObamaCare, the federal government covers 100 percent of the costs of expanding Medicaid for the first three years and at least 90 percent of the costs thereafter, according to the Congressional Budget Office.
In a brilliant move by some Senate Democrats they might be willing to join some Republicans to amend the law. A couple of place’s that some both sides could find common ground might be with the so called “Cadillac tax” on expensive health plans and the medical device tax.
By making changes in the law that President Obama might sign, it would indicate that fixing the law in a thoughtful bi-partisan way is more appealing to the Senate than repealing the Affordable Care Act.
Meanwhile, Sen. Ted Cruz (R-Texas) and Sen. Mike Lee (R-Utah) want to repeal as much of ObamaCare as possible, including the Medicaid expansion. Many will also recall that both men were quick to respond to a House-passed repeal bill last month that they felt did not going far enough.
Democrats argue that McConnell may not be able to include language in the bill repealing the mandates on individuals and employers to buy and offer healthcare insurance, citing a ruling Tuesday afternoon by the Senate parliamentarian, Elizabeth MacDonough.
According to The Hill, the ObamaCare repeal package is moving along a special procedural track, known as reconciliation, that will allow Republicans to pass it with a simple majority vote instead of having to clear the 60-vote threshold normally required of controversial legislation.
But to qualify for protection against the filibuster, the legislation must pass a multi-step test known as the Byrd Rule. The key point of that test is to ensure the primary motivation of the legislation is to reduce the deficit by affecting spending and revenues.
Conservatives, who want to expand the repeal package beyond what the House has passed, agree with Democrats that repealing the mandates alone doesn’t comport with the rules for reconciliation because they don’t have much of a budgetary impact.
This should be a very interesting test for political wonks and