The vote on the latest version of Trumpcare has been delayed as Sen. John McCain (R-AZ) is recovering from surgery. The Congressional Budget Office's (CBO) analysis has reportedly been delayed as well. But if/when a vote is finally held for the bill, will Trumpcare be able to pass?
Here are seven things you need to know about the latest version of Trumpcare.
1. It features a watered down version of Sen. Ted Cruz's (R-TX) amendment. The amendment, the "Consumer Freedom Amendment," would allow insurers to offer plans that don't meet Obamacare's regulations so long as they offer at least one that does. However, the amendment was predicated on the notion that there would be two separate risk pools: one for sicker Americans and one for healthier ones. The version of the amendment in this iteration of Trumpcare keeps all plans confined in one risk pool, a move that would not result in lower health care costs. As Michael Cannon explains, the result of the amendment would be insurers undercharging or overcharging for plans, ultimately making it easier to just offer plans that comply with Obamacare.
Further complicating the matter is the Department of Health and Human Services (HHS), as American Commitment President Phil Kerpen explains:
"People can't make sense of it because it is indeterminate until HHS makes the definition," he said. "It really, I think, leaves the whole viability of the noncompliant plan entirely up to the ability of HHS to conduct this rulemaking in a way that is legally defensible and would create room for them to move independently."
HHS, he said, could continue to have an index rate on the entire pool but allow adjustments in cost based on health status.
"If they want to be more aggressive, they could say single risk pool refers to an accounting actuarial unification across these two different markets," he said, meaning that the rule could allow for market segmentation even if the single risk pool requirement isn't repealed.
The downside for advocates of the proposal, Kerpen said, is that the rule could be redefined under a Democratic administration, putting the noncompliant plans out of business.
2. It trims around the edges of Obamacare. Trumpcare would rescind the employer and individual mandates as well as the taxes on medical devices and insurers, and allow insurers to charge seniors higher premiums. There are problems with these changes when leaving most of Obamacare in place, as The Daily Wire has previously explained here.
The bill also throws a couple of scraps to conservatives by defunding Planned Parenthood for a year and allowing more contributions into Health Savings Accounts (HSAs).
3. It expands the size of the federal government. Here are the important big government aspects of the bill, as outlined by Daniel Horowitz:
- Keeps tax increases to pay for the entitlement: The revised bill maintains the two largest Obamacare tax increases: the increased Medicare payroll tax and the 3.8 percent surcharge on investment income. That was the only aspect of Obamacare that Republicans universally opposed until now.
- Endless bailouts: In addition, it adds another $70 billion to the existing $112 billion bailout fund for insurers to further inflate the price of insurance and self-perpetuates the need for endless bailouts, which will lead to single-payer.
- More Medicaid spending: The revised bill also throws more money at Medicaid than the previous version (not that any of the baseline rate reductions were going to take place anyway). As I explained before, once you fail to heal the private market, we will all be forced onto Medicaid and there will be no way to reduce the program. Mitch McConnell reportedly admitted that our allegation was correct when he allegedly told a group of liberal Republicans not to worry about the Medicaid cuts because they would never go into effect.
In other words, the Senate is mostly keeping Obamacare in place while allowing the federal government to expand through more federal tax dollars for Medicaid and insurance bailouts. The GOP leadership is doing so while trying to shield themselves from the Left's class warfare rhetoric.
4. The bill features numerous backroom deals that are reminiscent of Obamacare. They mostly involve higher Medicaid payments to Alaska and Louisiana, presumably aimed at buying off Sens. Lisa Murkowski (R-AK) and Bill Cassidy (R-LA), who are moderate-to-liberal Republicans.
5. Passing this bill would be political suicide for Republicans. Trumpcare is essentially a Republican version of Obamacare, which means the Republicans will be held responsible for the death spiral set in motion by Obamacare that will continue under Trumpcare. As Ben Shapiro has explained, the Democrats can win in 2018 by simply unifying in reactionary opposition against President Trump and the Republicans, and attaching them to a piece of unpopular legislation. Passing Trumpcare would give them that opportunity.
6. The bill is in a precarious position in the Senate. Two Republican senators — Sen. Susan Collins (R-ME) and Sen. Rand Paul (R-KY) — have indicated that they will vote against the bill. Sen. Mike Lee (R-UT) is undecided on the bill because of the watering down of the amendment he co-authored with Cruz. Should Lee decide to vote against the bill, Trumpcare would fail in the Senate. There are reportedly as many as ten Republican senators who are wary of the bill.
The bill might not even come up for a vote because, according to Guy Benson, "a handful of GOP members are threatening to join with Democrats to reject a 'motion to proceed.'"
"This obstructionist tactic would effectively kill the legislation prior to a floor debate, an unlimited amendment process (as required for budget reconciliation bills), and a final vote," writes Benson.
7. Trumpcare is reflective of the GOP buying into the Democrats' premise of the health care debate. Shapiro took HHS Secretary Tom Price to task for stating that Trumpcare would result in more people having coverage:
And herein lies the problem for the Republicans: they’ve accepted the Democratic metric on health care success. They now believe that the mark of a good piece of legislation is the increase in number of insured, rather than increase in personal freedom in choosing insurance options. That means they are bound to restrict insurance choice, since it is far easier to achieve “full coverage” through regulation and subsidies than it is through allowing people to choose whether to be covered, particularly young and healthy people.
By giving into the Democrats' premise, the Republicans are going to be sacrificing affordability and/or quality for universality, which means that we may never return to a true free market health care system.