Pictured above: Three skinny health reform amendments that could stand a chance of passing.
Sadly, we’re out of diet puns to describe health insurance reform on Capitol Hill. It seemed likely if not inevitable Wednesday that a “skinny” repeal of Obamacare later this week was Senate Republicans’ best shot of keeping the legislative process alive. Amid a sprinkle of amendments the last couple of days—a few messaging items with no chance of passage—and the downpour of them to come Thursday, the process was headed for legislation that repealed the Affordable Care Act’s most unpopular mandates, left in place the ones on insurers, undid a business tax, and ignored Medicaid.
The idea made political sense: Even though the law’s (publicly reviled) individual mandate and (publicly acclaimed) regulations that suppress premiums are not easily severed, undoing the former has always been among the GOP’s non-negotiable priorities. Taxing medical device companies wasn’t in favor even with some Democrats once upon a time. And fussing with Medicaid has troubled moderate Republicans since reform originated in the House several months ago. Free-market conservatives who want to dilute the insurance regulations are the only GOP faction in this arrangement who can’t claim a victory. But according to the Senate parliamentarian, as relayed by budget committee ranking member Sen. Bernie Sanders, undoing those regulations violates the technical rules constraining the current legislation. (This is a budget bill and needs only 50 yea votes for approval—Republicans can attack the regulations in a non-budget measure, but it would require 60 yea votes to pull off.)
But not even this narrow combination of goals is a sure thing. There’s been no indication this week that 50 Republicans were prepared to sign off on skinny repeal. And now, Politico reported Thursday, the anticipated legislation could become “skinnier”: the employer mandate just would be partially repealed, and the ability to undo Obamacare taxes under Senate requirements was uncertain. In short, it appears the GOP has little to work with, both for political and practical reasons. Little, however, could still be enough. And it might reflect the appetite the country truly has for attacking this law: a fat-free repeal.
The amazing gap between Obamacare’s approval in the polls and that of the House and Senate GOP bills doesn’t tell us everything about the ACA’s entrenchment. The ideas before the two chambers do not comprise the spectrum of Obamacare replacements, especially if you ask conservatives. But the public has only those proposals to evaluate at the moment—and, at their most ambitious, the way they went about amending the law’s pre-existing conditions regulations and Medicaid was poorly received. Much of that could be attributable to an onslaught of bad press, the interpretations of Congressional Budget Office estimates, and the GOP’s indifferent defense of their ideas. (Writ large, the party has always—always—preferred slamming Obamacare to proclaiming what would be better in its place.) It’s also attributable, by some measure, to what happens when people derive a benefit from government for a sufficient period.
I pinged some Republicans in GOP districts for their thoughts on how their constituents perceive the law. There was a mixed bag of responses; some folks still can’t stand Obamacare. But there’s also a growing realization that acting on such disapproval on their behalf comes at a cost. On Medicaid, one veteran House aide in a Republican district put it bluntly: “They are becoming less comfortable repealing Medicaid expansion by the day because many are finding out they are on Medicaid expansion.” Another spoke to the pre-existing conditions narrative. “The grassroots in our district, which is not insignificant, still wants Obamacare repeal. They never liked the House bill or the Senate bill, and really only went along with those bills because Trump did,” the aide said. “However, what has happened in the first half of 2017 is that outside of the grassroots, most people have realized they want to keep some aspects of Obamacare [like pre-existing conditions coverage and insurance subsidies], and the ‘repair’ message became a lot more attractive to regular citizens, especially those less involved with politics.
The House and the Senate haven’t provided an Obamacare alternative that makes a majority of people comfortable with the idea of ditching the law. This has been the backdrop to what the GOP has tried to pull off all year.
This post originally appeared on Weekly Standard