With the Republican-led Senate struggling to pass a plan to "repeal and replace" Obamacare as the August recess approaches, Vice President Mike Pence raised once again the alternative of passing a "repeal only" bill and working on a replacement bill later.
"We believe if they can't pass this carefully crafted repeal and replace bill – we do those two things simultaneously – we ought to just repeal only and then have enough time built into that legislation to craft replacement legislation," Pence told talk-radio host Rush Limbaugh Tuesday.
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Last month, President Trump said much the same, tweeting: "If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!"
The Republican leadership Tuesday announced the August recess will be delayed two weeks to give more time to pass a repeal-and-replace bill. Senate Majority Leader Mitch McConnell is expected to unveil a revised bill Thursday after the Congressional Budget Office assessed the initial version would leave 22 million more Americans uninsured by 2026.
But, as WND reported, the CBO — the bipartisan federal agency that provides budget and economic information and assessment to Congress — has a history of inaccurate forecasts that typically fail to account for the impact of market forces. Critics argue the CBO does not score legislation dynamically, ignoring growth that results from tax cuts and the reduced growth that results from tax increases. And the scoring of the Senate health-care bill does not take into account the millions of healthy Americans who, with the Obamacare mandate removed, would choose not to have health insurance.
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Republican Sens. Rand Paul of Kentucky, Ted Cruz of Texas and Ben Sasse of Nebraska are among the senators who favor a “clean” repeal bill as an alternative.
Paul has called the Senate bill "Obamacare-lite," and Sen. Mike Lee, R-Utah, called it “far short of repeal," contending it "keeps the Democrats' broken system intact."
They remind Republicans they ran in 2016 on repealing Obamacare "root and branch."
However, moderate Republican Sen. Cassidy of Louisiana has insisted a "repeal-only" bill would be a "non-starter," and, like McConnell and Sen. John McCain, R-Ariz., has said it may be necessary to work with Democrats on legislation instead to stabilize the insurance markets.
The New York Times reflected the skepticism of opponents of "repeal only" or "repeal and delay."
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In the Times' analysis column "The Upshot," writer Margot Sanger-Katz disputed the contention of "repeal only" proponents that "the status quo" could "float along until a new political compromise arrived"
The theory, she said, "is that the repeal bill would come with a one- or two-year fuse, and that the looming explosion would compel lawmakers to compromise and pass something else in a hurry."
She argued the CBO has scored what "partial repeal" would look like: 18 million people would lose insurance coverage in the first year and 32 million in a decade. Over the course of that decade, CBO concluded, the average insurance premium would double.
She also doesn't believe increased pressure would bring lawmakers closer to compromise.
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"The very Republicans most enthusiastic about a repeal-only strategy seem less interested in pursuing a separate, costly replacement provision," she wrote.
But Sasse proposes in his "repeal only" proposal "a year-long implementation delay to give comfort to Americans currently on Obamacare that a replacement plan will be enacted before expiration."
In a letter to President Trump espousing his alternative, Sasse pointed out that with "one exception, every member of this Senate majority – moderate and conservative – has explicitly endorsed and/or already voted to repeal ObamaCare, most recently on December 3, 2015."
If there is no agreement on the Senate bill, he said, the senators should immediately vote again on H.R. 3762, the December 2015 Obamacare repeal legislation that the Congress passed but President Obama vetoed.
Rachel Bovard, the Heritage Foundation's director of policy services, pointed out Republicans have chosen to try to pass a health-care bill through the reconciliation process, which requires only 51 votes to end debate and vote on the bill, rather than 50. Republicans have a 52-member majority.
What makes reconciliation so tricky, she said, is that reconciliation bills must contain only subject matter that has a direct budgetary impact.
She favors repealing first and replacing later, noting the December 2015 bill contains a two-year phaseout of significant parts of Obamacare, which would allow Republicans to discuss, debate and deliberate on what a replace plan should look like.
Work with Democrats?
Privately, senators and aides said McConnell remains well short of the 50 votes needed to start debate on the bill, Politico reported Tuesday.
McConnell has urged senators to use the bill’s open amendment process to alter it to suit their concerns, according to senators and aides.
Cruz and Mike Lee, R-Utah, have proposed an amendment that would allow the sale of inexpensive, deregulated insurance plans for healthy subscribers. But Politico said the amendment is fracturing Senate Republicans, with disagreements over its drafting threatening to delay or even sink the bill.
Sen. John McCain, R-Ariz., doesn't think Republicans can come up with an agreement and may need the support of Democrats.
"I think my view is it's probably going to be dead," McCain said of the GOP bill. If Democrats are included, he said, it doesn't mean "they control it. It means they can have amendments considered. And even when they lose, then they're part of the process. That's what democracy is supposed to be all about."
GOP accepting 'Obamacare logic'
Rep. Dave Brat, R-Va., a member of the House Freedom Caucus who taught economics for 20 years, supports repeal first and replace later.
He told WND earlier this month he can't support the initial Senate bill because it concedes the faulty economic logic that put Obamacare "in the ditch."
"That Obamacare logic was just about 100 percent attention paid to coverage and no attention paid to the price of health care. As a result, people were covered with gold-plated health insurance policies, but no one could afford health coverage," said Brat.
He says that's exactly what Republican voters expected after the 2016 elections, but they aren't getting it.
"When you vote 50 times to repeal and then you tell the American people you're going to repeal and then you end up very close to Obamacare logic. That is not good for the Republican brand," said Brat.
Brat is confident that if repeal came first, there would be plenty of interest across the spectrum in getting on board with the replacement bill.
"Then you have the leverage to work with the Democrats. There's no shortage of people who want to add programs in D.C. in the swamp, right? So you first repeal, and then the floodgates are open to add. You can get as many votes as you want from any politician to say yes. Politicians love to say yes. That would have been a brilliant move back in January," he said.
He is imploring his fellow Republicans to proceed on the principles they constantly espouse about the success of the free market.
"If you believe in free markets and the standard American package of free enterprise, etc., that will deliver the goods. Everybody knows these eye surgeries that started out at $6,000 per eye are down to $450 per eye to get your Tiger Woods eye surgery," said Brat.
"That's what the market can do if you let it alone. If you let the government intervene, you end up with Medicare, which is insolvent in 2034. You end up with Social Security, which is insolvent for the kids in 2034. Twenty trillion dollars in debt, $100 trillion in unfunded liabilities to those major programs, and we're going to add more government," said Brat.
Daniel Horowitz, editor in chief of Conservative Review, contends
the GOP bill does not repeal Obamacare.
The key problem, he said, is government interference in the health-care system.
"Through government interference in health care, politicians have joined with industry lobbyists to destroy the health care market and the direct relationship between consumers and providers," wrote Horowitz.
"After destroying health care with third-party and fourth-party insurance payments supplanting direct payments, they then destroyed health insurance, whereby most insurance is provided by the government or paid for by employers, thereby placing individuals at a tremendous disadvantage. Not only do we no longer pay for our own health care, the overwhelming majority of those third-party payments are paid for by a fourth party: employers, government, or both."
Horowitz, author of "Stolen Sovereignty: How to Stop Unelected Judges From Transforming America," pointed out that in 2015 the public and private sectors combined to spend a total of $3.2 trillion on health care, accounting for about 18 percent of the economy. The reason health care is so expensive, he said, is because of the way Americans pay for it.
"In a functioning market, prices reach an equilibrium between the desire of profit for providers and the desire of consumers for the service," Horowitz explained. "When consumers are paying for a service with their own money, there is a limit to what they can and will pay. This forces providers to innovate and cut costs to conform to the organic market demand.
"No such organic market demand exists when consumers don't pay for their own product and all the money comes from a third party, which is primarily subsidized by a fourth party. Not only does this fail to lower costs, it encourages providers to charge even more, because they know there is an open-ended spigot from government-sponsored debt fueled by political pressure to keep the gravy train flowing."
Last month, when McConnell postponed a vote on the bill until after the Fourth of July holiday, Washington Post columnist Charles Krauthammer said the delay was for no other reason than that people don't want to lose entitlements from Obamacare.
The problem is that Obamacare inflated Medicare to include able-bodied workers up to 400 percent of the poverty line, he explained.
“The fight now, and the reason a lot of moderate Republicans are scared is because under this bill it goes from 400 percent down to 350 percent,” Krauthammer said. “This is a marginal retrenchment of what makes you eligible for Medicaid. And people are used to what was. They don’t want to give it back. That’s the reason that Obamacare repeal is in trouble."
He said the country is not where it was seven years ago.
"It’s the reason that the left usually wins, because when you hand out goodies since the New Deal, it is extremely hard to bring them back. That’s the core issue here.”
In May, Krauthammer said the United States is on its way to a single-payer health-care system completely funded by the government.
“I think historically speaking we are at the midpoint," Krauthammer told guest host Chris Wallace on the Fox News Channel's "Special Report."
"We had seven years of Obamacare, a change in expectations, and I would predict that in less than seven years, we will be in a single-payer system.”