WASHINGTON – This week promises a showdown on the fate of the centerpiece of the Obama legacy.
Republican leaders plan to hold a vote Thursday on their bill to repeal and replace Obamacare, and though the Trump administration has made progress winning over some GOP skeptics, victory is by no means certain, either in the House or the Senate.
If the bill fails, what comes next? What could rescue Republicans from the disaster of failing to keep their promise to repeal and replace Obamacare while holding the presidency, the Senate and the House?
Former Minnesota congresswoman and presidential candidate Michele Bachmann has a market-based plan to fix Obamacare, one that has the virtue of simplicity.
“All the federal government needs to do after repealing Obamacare is to pass a bill that allows any health insurance product to be sold across state lines with no minimum federal mandates. Period.”
And let the market take care of the rest, was the gist of what she told WND, in a plan fully detailed below.
While such simplicity is embraced by many congressional conservatives, GOP leaders have chosen another approach, apparently driven, at least in part, over fear of the fallout that might be caused by the repeal of Obamacare without an immediate replacement.
However, a simple plan B could soon look attractive to more Republicans, judging by the serious obstacles facing their current plan A.
The leader of the Republican Study Committee, Rep. Mark Walker, R-N.C., emerged from a White House meeting with President Trump on Friday to announce, after negotiating modifications, his group would back the House leadership’s bill. The generally conservative-leaning group has about 170 members.
The American Health Care Act, or AHCA, needs 216 votes to pass.
There are 237 Republicans in the House. That means the bill would not pass if just 21 Republicans oppose it.
The House Freedom Caucus has about 30 very conservative members. And its leaders have strenuously opposed the bill.
Even if the bill makes it through the House, it may face worse odds in the Senate.
The bill would need only 51 votes to pass but there are only 52 Republicans in the Senate.
And, in that chamber, Sen. Rand Paul, R-Ky., is adamantly opposed to the bill, Sen. Mike Lee, R-Utah, said he is “not comfortable with it,” and Sen. Ted Cruz, R-Texas, recently coauthored an op-ed with House Freedom Caucus chair Rep. Mark Meadows, R-N.C., vigorously eviscerating the legislation in its current form.
Even though Republicans are united in their promise to repeal and replace Obamacare, they are basically divided into two camps over the best approach: one is complex, the other is simple.
The complex solution is embodied in the healthcare legislation fashioned by House Speaker Paul Ryan, R-Wis., and other GOP leaders, and supported by the Trump administration. The bill seeks to repeal much of Obamacare while trying to simultaneously replace it.
It is part of a three-step process that would also require executive actions and more legislation that would have to cross a 60-vote threshold.
The simple solution is endorsed by conservatives and championed by the likes of Sen. Paul and Rep. Jim Jordan, R-Ohio, who simply want to repeal Obamacare in its entirety, then address any concerns afterward.
Two weeks ago, Paul and Jordan reintroduced a 2015 bill to repeal Obamacare that made it through Congress but was vetoed by then-President Obama.
“Our goal is real simple: Bring down the cost of insurance for working families and middle-class families across this country. In an effort to do that we think you have to get rid of Obamacare completely,” said Jordan.
“[After repeal] we can have a separate vote on replacement legislation that will deliver lower costs, better care, and greater access to the American people,” said Paul.
Trump has chosen the complex route in an effort to save some features of the Obamacare plan, primarily one preserving the guarantee of healthcare coverage for patients with pre-existing conditions, and another allowing children to stay on their parents’ plans until they are 26-years-old.
The president also wants to install a provision to let people purchase health insurance across state lines, which conservatives agree is essential to increasing competition in the market, driving down costs and increasing the choice of plans for consumers.
To do all of this, the administration and GOP congressional leadership have developed a three-phase plan.
1) The House bill is the first part, and, if it passes, would require only 51 votes in the Senate by using the budget reconciliation process to avoid a Democratic filibuster.
2) The second part consists mainly of deregulation actions by Health and Human Services Director Tom Price that Ryan says aim “to stabilize the health insurance market, increase choices, and lower costs.”
3) The third part consists of more legislation addressing non-budget features, such as allowing consumers to purchase coverage across state lines. This legislation would be subject to filibusters and would need 60 votes to pass in the Senate.
Many conservatives believe the complex plan does simply does not repeal Obamacare.
Paul has ridiculed part one, the AHCA, as “Obamacare Lite” because, he said, it keeps “insurance subsidies, mandates, taxes and insurance company bailouts.”
The senator insists the answer “is not replacing the government mandate with an insurance mandate, which is exactly what Obamacare Lite does.”
Favoring the complex approach, Fox News commentator Charles Krauthammer actually agreed with Paul that the GOP leadership’s replacement plan really is “Obamacare Lite”, but, as WND reported, argued that’s the best that can be done.
He asserted Obamacare can’t really be repealed because, “You cannot retract an entitlement once it’s been granted.”
Krauthammer basically advised conservatives to surrender on their promise of repealing the law because, “They’re going to have to concede the fact that Obama created an entitlement. And they’re now gonna transmute it into something different.”
That line of thinking infuriates conservatives.
“Every conservative group out there is opposed to this legislation,” said Jordan, because, “It’s Obamacare in a different form. Because we didn’t tell the voters we were going to repeal Obamacare, but keep some of the Obamacare taxes.”
However, while conservatives may have been shunned by House leaders, they apparently do have allies inside the White House.
Top presidential advisers realize that the reason the bill ended up as “Obamacare Lite” is because House leaders excluded conservative from the legislative process, according to a report in Politico.
The paper reported, “The Freedom Caucus, however, has clearly found a sympathetic ear in Trump’s right-hand man (Steve) Bannon, who wants conservatives to be included in the legislative process instead of twisting their arms to vote yes.”
A West Wing source said they had “opened up a direct channel” with Meadows, Jordan and Cruz.
Politico said “Trump has essentially become the middleman between warring House GOP factions.”
The paper reported that the alliance had given conservatives hope of winning the White House over to their side. But perhaps equally, if not more, important it also gave them hope “that Trump won’t blame them if Obamacare repeal implodes.”
Because, even as the major media reports that the bill is crucial for the viability of the new administration, even some Trump supporters don’t see the bill’s failure as the worst thing that could happen.
As WND reported, talk-radio host Rush Limbaugh speculated last week that Trump may be looking many moves ahead and planning for the possibility the bill could fail.
In fact, the conservative icon wondered if Trump isn’t actually counting on it failing.
“What if Trump has a long-term plan, and what if it is to let these nimrods in the House and Senate have their turn at it and then announce they can’t do anything?” Limbaugh posited.
He continued, “Trump refuses to accept failure and comes in with his own salvation or his own plan, after Congress has thrown up its hands in frustration and defeat and said we can’t do it.”
Limbaugh mused the strategy might be to make sure the bill passes in the House, but to “load it up with so much the Democrats object to it and send it to the Senate, where they kill it. And that way, the Democrats get blamed for it, not the Republicans.”
And that’s when a simpler approach could look particularly attractive.
Bachmann outlined just such a plan to WND.
When asked what she would propose, the former congresswoman replied, “An Obamacare fix? Easy.”
Then she provided these five steps.
1. “Pass the full Obamacare repeal bill. That gets us to 2008 when health care was far cheaper than it is today under the burdensome, heavily bureaucratic Obamacare mandates.
2. “Each state needs to decide what it wants to spend on health care and what it wants to offer its citizens, if anything. The federal government has repeatedly proved itself a failure on this issue for decades. They need to get out of creating monopolies in health care and punishing free market competition.
3. “All the federal government needs to do after repealing Obamacare is to pass a bill that allows any health insurance product to be sold across state lines with no minimum federal mandates. Period.
4. “Medicare eligible Senior citizens and poor people on Medicaid should have the option of choosing a voucher to spend toward the purchase of any type of healthcare plan they want, then put the surplus, if any in a Health savings account.
5. “I’d also encourage the states to pass liability shields for charity clinics. If doctors, nurses and facilities want to offer free healthcare, then the clinic and practitioners should be free from the threat of lawsuits.”
Her bottom line?
Let the market fix the problems caused by Obamacare.
Once the impediments were removed, “People would be shocked at the low-cost options that would arise in the marketplace.”
Political commentators have noted there is a reason so many politicians, including Republicans, have shied from market-based solutions such as the one she proposed: fear.
Fear of a public-relations nightmare that would not end until the market-based fixes took effect.
A fear that, once they take away Obamacare’s benefits, Republicans would end up watching an endless stream of suffering people on the evening news telling tales of woe about lost coverage.
As WND reported, Krauthammer has explained the deep fears held by GOP leaders as to what would happen if Obamacare were to be repealed without being immediately replaced.
He ominously warned Republicans they must find a way to cover everyone who might lose their health care coverage “one way or the other, or you will have a PR and political catastrophe.”
Krauthammer said the only choice was to spend whatever it takes to cover everyone who loses coverage, because “you can’t be counting your pennies now when there can be so many stories out there of people who are hurt and really hurting as a result of the reform.”
WND said to Bachmann that conservatives would likely see that as a panicked plea to throw ever-more money at the problems caused by taking a half-measure.
So, WND asked, how she would deal with the potential PR dilemma of a parade of people on the news who had lost their health-care coverage after a full repeal of Obamacare?
Bachmann recommended fixing the problem for good rather than pursuing damage control.
“The bolder the GOP’s move to embrace free market health care, the quicker more Americans will have healthcare they can both afford and access,” she began.
Her solution was to unleash Yankee ingenuity and to recommend the president lead the charge.
“President Trump could announce he’ll showcase as many innovative new health-care solutions as companies can create. Imagine free press from the White House – it is a spotlight on job creation and pumping up the U.S. economy.”
Bachmann asserted that with an open health-insurance marketplace, “which we haven’t seen since circa 1965, President Trump would have more innovations and job creation in healthcare to brag about than he could possibly get to.”
“It would be thrilling.”
She focused on the opportunities provided by change as far exceeding the perils.
“Think of all the minute clinics located in grocery stores today, the concierge health services people buy for $80/month (in Colorado), the nurses and doctors offering ‘in home’ appointments via Skype?”
Bachmann noted, “These innovations are available today in spite of massive government intervention in the healthcare business.”
“Innovation in health care is a given, its the price of government bureaucratic intervention that we can’t afford,” she concluded.