Things are moving quickly on the health care front, which means they are moving slowly if at all. In fact they are moving so quickly that they may have come to an absolute full dead stop by the time these words reach print.
Having pledged for seven years to “repeal and replace” the Affordable Care Act (aka Obamacare) or, in the case of some senators and congressmen, simply repeal it, the party dominant in both houses of Congress, which pledged to do one or the other if only it had its president in the Oval Office, has hit a roadblock. The stall is not the product of Democratic intransigence, but conflict within its own ranks.
The stalemate was utterly, absolutely predictable. So is the delight of more than one Republican, Gov. Asa Hutchinson included.
To recap: the first plan came from the House of Representatives, judged so radical, so devastating to Medicaid beneficiaries and the clinicians who care for them — and to the more moderate members of the Senate — that it was pronounced Dead on Arrival. President Trump initially praised the legislation, hosting a big celebration in the Rose Garden upon its House passage, only to reverse himself days later, terming it “mean.” Send me a bill with “heart,” he said. Mr. Trump’s turnabout followed an assessment by the Congressional Budget Office, the CBO, which calculated that about 22 million Americans would soon enough lose their health insurance should the House plan prevail.
So, the Senate’s turn. Majority Leader Mitch McConnell assembled a team from his caucus, including Arkansas’s Tom Cotton. They met in such super-secrecy that even fellow Republicans were openly critical of the lack of transparency. Denied participation, Senate Democrats voiced outrage but, knowing McConnell and suspecting what his ad hoc panel was cooking, they were licking their lips.
Sure enough, McConnell delivered. And the first to recoil from his recipe were his Republican colleagues, some because of what the bill cut and others because it didn’t cut enough. Democrats feigned astonishment and angst but could scarcely contain their giggles. And that was [begin ital] before [end ital] the CBO scored the Senate bill. The agency’s evaluation elated fiscal hawks; the McConnell scheme would reduce the federal deficit by $321 billion, substantially more than the $119 billion in the House version.
But, said the CBO, the Senate’s approach was near-identical to the House’s in its human impact: about 22 million Americans would almost certainly lose their medical insurance, and the low-income, especially the elderly, would pay higher premiums with reduced benefits. With that, McConnell’s bill, already on life support, began hemorrhaging Republican votes.
The CBO report was unveiled at mid-afternoon Monday. I scurried to the Governor’s Mansion for an event I had not planned to cover, a meeting of his Cabinet to which Mr. Hutchinson had granted limited press access. The Governor was in good humor. Perhaps he had got word of the CBO report.
Mr. Hutchinson was not available for questions, his aides said, thus no new statement on the Washington currents. His previous remarks, however, are testament sufficient, not for what they applauded — the “flexibility” offered states in their Medicaid programs — but for what gave him pause, what moved him to withhold comment pending “further study.” As most other governors, especially Republican governors who enlarged or continued their Medicaid expansion programs under Obamacare, was quietly horrified at the prospect of reduced federal financial assistance. Those D.C. dollars have helped bankroll the income tax cuts that are Mr. Hutchinson’s pride and joy, a campaign promise delivered on.
Even when pushed into the future, the scaled back assistance would wreak havoc with the state budget, which even now the Governor is resolved to prune. Already he is proposing to reduce the Medicaid rolls by the tens of thousands.
Mr. Hutchinson has, naturally, communicated his alarm to his fellow Republicans, meaning the six who sit in the House and Senate for Arkansas, all of whom campaigned against an Obamacare that is suddenly more popular than they might once have imagined. McConnell is busy trying to cut deals, trying to romance fellow Senate Republicans. Maybe it will work, maybe.
A few days ago, just after the Senate plan was unveiled but before it had been evaluated by the CBO, a friend with long years in Washington politics observed that “Whatever happens to Obamacare, or whatever they would call their plan, the Republicans will own it.” One could hardly disagree: with the GOP in control (to mean, majority membership) in the Senate and the House, and, since January 20, the White House, the immediate future of health care in America is in their hands.
My pal was wrong. Whatever happens, the Republicans already own it.