Obamacare

Congressional Republicans Take Obamacare Repeal on a Test Run

It's not full repeal. And it won't pass. But it's still worth doing.

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Whitehouse.gov

Sometime this week, the House is expected to vote on a bill that has been widely described as an Obamacare repeal bill. The bill doesn't repeal the entire law, but it would kill major provisions, including the insurance exchanges, coverage subsidies,  and individual mandate to purchase insurance. While some parts of the law would remain on the books, it would be the end of Obamacare as we know it.

The House has passed dozens of bills repealing all or part of Obamacare over the last few years. What's different about this one, though, is that, last month, the Senate also passed a repeal bill—the first time it has done so. Indeed, the reason the bill targets only major provisions rather than the entire health law is that the Senate relied on a procedure known as reconciliation to pass the bill with a simple majority; reconciliation can only be used occasionally, and can only be used to pass provisions with budgetary impact, a vague standard which tends to mean that it needs to reduce the deficit.

The current bill meets that test: According to an estimate released by the Congressional Budget Office this week, passage would result in a net deficit reduction about $516 billion over the next decade. (A previous estimate has found a smaller reduction; the latest figure accounts for $42 billion in additional deficit savings from the recently enacted two-year delay of the health law's Cadillac tax.) 

The bill passed by the Senate originated in the House, but was modified before passage; that's why the House is returning to the bill and passing it again, in its Senate-modified form. Once that happens, the bill will be sent to President Obama's desk, the first time any Obamacare-repeal bill has made it to the Oval Office. That alone makes it something of a milestone.

Practically, however, the bill won't have any direct impact on policy, because Obama is certain to veto it. Like so many previous GOP-led Obamacare bills, it is mostly a symbolic measure.

In one sense, then, the bill does not matter very much. One can even plausibly argue that it represents an abdication of responsibility. Congressional Republicans are touting as the bill as the "best shot at repealing Obamacare." It obviously has no chance at all. Furthermore, the bill, which as a result of the reconciliation process can only focus on certain budgetary provisions, would leave in place much of the law's regulatory apparatus. And it would do all of this without putting an alternative, replacement plan into effect, which is hardly surprising given that there is no clear GOP alternative waiting in the wings. (House Speaker Paul Ryan says it will pave the way for the eventual unveiling of a replacement.) This big Republican victory over Obamacare, then, will end with a presidential veto, and it doesn't address many of the health policy issues that would remain in what would essentially be a post-Obamacare world.

But in another sense, it's a small but important step forward. Yes, the bill will have no direct practical impact, and yes, it leaves far too many questions unanswered about what sort of health policy Republicans would prefer to Obamacare, and what to do about the remains of the law left on the books. But as long as Obama is in the White House, there's no way to avoid a veto. And the lack of Republican alternative is a longstanding problem best understood as general to the party rather than particular to this bill.

This bill, meanwhile, demonstrates what is possible and achievable through the reconciliation process. That alone is important, because the reconciliation process is uncertain and subjective, relying on hard-to-predict judgments by the Senate parliamentarian. The only way to find out exactly what can be done through reconciliation is to try doing it.

In other words, it's a test-run for what might be part of the process of moving past Obamacare. On its own, that's not nearly enough. But it's worth doing.

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  1. And it would do all of this without putting an alternative, replacement plan into effect,

    Well, Mr. Suderman, we can remove most of the cancer, but since we don’t have a replacement disease to give you, we’re just going to leave it where it is.

    1. All I can guess from this remark from Suderman is that it comes from a place of dry political pragmatism. You can’t replace a government program with… nothing.

      1. Look, before there was Obamacare, people were DYING IN TEH STREETS!!11!!!!

        1. Now, they’re buying insurance and THEN dying in the streets!

          1. Don’t oversimplify, X. Its more nuanced than that. They could be paying a penaltax, and THEN dying in the streets, or committing tax fraud, and THEN dying in the streets.

            Its complicated.

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      2. My last pay check was $9500 working 12 hours a week online. My sisters friend has been averaging 15k for months now and she works about 20 hours a week. I can’t believe how easy it was once I tried it out. This is what I do..

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    2. Yeah, but… kill the individual mandate while leaving community rating and pre-existing conditions, and you’re basically asking for a death spiral, and giving Democrats the chance to blame the Republican reform for it, despite the evidence it was already starting thanks to OCare itself.

    3. Reading that line was the first moment I realized this was a Suderman article.

      Reason, I’d like to formally offer to be your Progressive-in-Libertarian clothing for HALF of whatever you’re paying Suderman.

  2. Can’t wait for the Employer and individual mandate to become fully activated. Folks are going to get healthcare insurance GOOD AND HARD whether they want it or not.

  3. It’s worth it to get folks on record as supporting it in spite of how miserably it has failed. It’s about giving congressional Dems enough rope to hang themselves by in an election year.

    1. Yes, indeedy!

  4. And the lack of Republican alternative is a longstanding problem best understood as general to the party

    As a purely political statement, I can get this.

    As a statement of actual policy, namely, that the federal government should be heavily involved in financing and regulating health care, I find it abhorrent.

    I’m not clear which meaning Peter is trying to promote here.

    1. There only needs to be a few federal components of a replacement plan, aimed at creating a freer, true market

      not limited to…
      1) limits on malpractice
      2) taxing individual plans same as employer provided
      3) allowing providers to operate across state lines

  5. Can we, just once, get an article that actually espouses free market health policy? Repealing the ACA is the first step, IMHO, in ripping the tentacles of the Federal government out of the health care market, and it doesn’t need anything to “replace” it. What needs to happen after that is for more meddling to be undone, both at the Federal and state levels.

    1. Comrade, I need to see your certificate of need to post comments. Now.

  6. Ten years ago, sedated by Jesus juice, I had a probe stuck my ass in search of early formations of colon cancer. The docs at Kaiser tell me that’s not needed anymore. Blood samples can now be analyzed with about the same veracity.

    That’s cool. I hope they are right, and not just cutting corners.

    1. If It’s true, they are not using that method at Banner-UMC in Tucson. In the past 16 months, I’ve been through 4 probings and one endoscopic partial colon.removal. The 4th probing was 4 weeks ago to confirm they snatched all the cancers out.

      1. Well, BUMC can charge a hell of a lot more for multiple endoscopies than they can for a blood test or two. So, there’s that.

        I don’t know how good the blood test really is, BTW. I do know what the financial incentives are.

        1. The blood test is Carcinoembryonic Antigen (CEA). I had several of them throughout the 16 months. I was told it can give an indication of a problem, but not anything definite. And you can’t snip polyps with a CEA blood test. I would not trust my life with it. I preferred to stay awake and watch the movie. (2 times out of the 4)

  7. ” . . . it is mostly a symbolic measure.”

    And therein lies the problem. At this point “brownie points” for trying are worthless. These guys are spineless bureaucrats and cowards who only care about their elite lives. They live in a bubble and are like the middle-aged douche who is frightened to piss off his feminist wife with chin whiskers because his balls have long been removed.

    They control the budget process and are afraid of the media. Pathetic.

  8. I look forward to the unironic cries of treason for using reconciliation to pass this. I bet we get those faster than alt-text.

    But as long as Obama is in the White House, there’s no way to avoid a veto.

    I also look forward to the cries of “obstructionist!” I bet we have a better shot at Root alt-text.

    1. There is no way to avoid a veto and also no way for the Democrats to avoid continuing to own this steaming pile of crap unless they are willing to vote to override the veto. I wish them luck with that.

      At this point, I am skeptical the Republicans will ever repeal it not because they think it is a good plan but because repealing it would me giving up the greatest political gift anyone has ever given them.

      1. What the Repubs are too stupid to understand is that they will be blamed for everything that happens under OCare. They are already catching some blame, and if they win in November, it will forevermore be a Republican program.

        1. No. The Democrats are catching all of the blame. People know who is responsible. If they didn’t, Democrats wouldn’t be getting voted out of nearly every office in the country. Now if and when the Republicans ever get the power to repeal Obamacare and refuse to do so, then they will start sharing the blame. But they have not and will not until then.

          1. Oh no, it will most assuredly be spun as “Republicans are preventing this from working right!”. It might not work now because too many people impacted by it were watching when it was passed, but 5, 10, 15 years from now? The people turning 26 this year, and losing their parents’ insurance, were still in college when Obamacare went into effect. It will only get worse. The GOP will eventually take the hit for Obamacare’s failings because they’re the stupid party and eveil will always triumph.

            1. If that lie worked, it would have worked now. The narrative isn’t going to change once it has been set like that.

      2. I’m confused what your comment had to do with mine. Did you misplace it?

  9. Remember how Obmacare was going to “bend the cost curve” and was the only alternative to national bankruptcy? Funny how repealing it will cut the deficit. That is awfully strange how repealing a program that was supposed to save us from bankruptcy will reduce the deficit. it is almost like the people in the media who pushed Obamacare were lying partisan sacks of shit or something.

    1. My health care ‘insurance’ premium with Kaiser went up 30% in September. i pay about $470/month. I don’t know if that’s too high or too low. One thing I do know is that I do not want expensive end-of-life care.

      1. The way to cut cost of medical care was not to do anything to increase the supply of medical care. No, the way to cut the cost of medical care was to force people to buy insurance and force millions of people currently not on insurance rolls and generally avoiding the doctor to buy over priced insurance creating an incentive to consume more medical care, while also doing nothing to increase the supply of medical care.

        That is what people in journalism like to call playing “four dimensional chess”. simple minded people like you and me just can’t see the genius of such a plan or understand the amazing cost saving qualities of the “preventative care unicorn.”

  10. …amazing cost saving qualities of the “preventative care unicorn.”

    It’s a tad before my time, but from what I can gather, Americans were content, for a while, with smoking cigarettes, drinking booze, and launching space ships to the moon. They didn’t live to a be 100.

  11. Get government out of the health insurance business as much as possible. Limit them to limited regulations and financial support for health insurance to those who need it.

    Obamacare, Medicaid, Medicare and VA hospitals should be phased out. People under these programs and those who are financially below the poverty level should be given a yearly amount that they could use to purchase health insurance.

    Keep the federal regulation stating that insurance companies have to cover pre-existing conditions as long as the person had previous insurance.
    Allow people to purchase insurance from any state. Deregulate state health insurance markets. Unhinge medical insurance from employers in the tax code.

    Getting government out and increasing competition in this way will lower health insurance costs. It cuts the bureaucracy costs, cuts the fraud costs and improves competition and quality of care.

    Why not do financial assistance for health insurance the same way we do financial assistance for food?

  12. I’m confused, I see in other places that this measure would save over $50B a year in government expenditures. That doesn’t seem “largely symbolic” to me. That seems like a good start.

    1. It’s symbolic because it has no chance of making it past the presidential veto.

  13. Unhinge medical insurance from employers in the tax code.

    Medical insurance is grey accounting.

  14. It seems to me that this is a bit of a Hail Mary in the long run. It’s going to be vetoed, that’s not even a question. The Republicans have stated time and again that repeal is a primary objective, but this will signal supporters of Obamacare that, under a Republican president, that objective might be within reach. Hopefully, we won’t wind up with a Dem in office and the various Congresscritters who voted against repeal but weren’t especially married to Ocare will hedge their bets and quietly support repeal. But another alternative could be that the Dems get so scared of a successful repeal that they launch an all-out PR blitz to try to win back control of Congress under the auspices of preventing those evil Republicans from taking healthcare away from poor people (or some other such idiocy).

  15. Repealing Obamacare under any Democratic president is not possible – there hasn’t been a veto-proof single-party majority since the 60s and I don’t think there will be again for a generation or two (or at least until the Great Libertarian Takeover of 2022).

    That said, good on the Rs for making some Ds put their name on it.

    Also, it would be far superior to replace this garbage with nothing than with some slightly less odious moderate Republican plan.

  16. I would much prefer a Singapore-style health care system, as opposed to ObamaCare.

    Has Reason written any articles about it?

  17. No, voting on doomed bills is not worth doing.

  18. Do away with health insurance for routine exams and procedures. Wouldn’t paying the doctor/lab directly bring costs down?

    Small premiums for insurance for major or life threatening illness is what the original intent was.

    I could pay out of pocket with money to spare with what I pay in premiums, co pays and deductibles.

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  20. It is not the first time a bill, with changes to 0blamocare, has made it to his desk.
    In fact there have been seven successful bills that not only made it to the desk but were signed.
    One of them being the financially disastrous effort to implement government funded long-term care insurance.

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  22. If I was running the GOP, I would be smart as a fox and let Obama run its course (except for repealing the individual mandate, perhaps).

    The repeal efforts will go nowhere, and even the country generally dislike ACA, certain parts are popular enough that total repeal won’t enjoy a national mandate. Right now it sort of trudges on as a terribly inefficient welfare system that made some respectable gains in reducing “uninsurance” rate.

    But the worst parts of the law are yet to come. The ACA will fire up the white GOP base and depress the minority turnout (who are less of a factor in midterm elections) just enough to matter every election. Whether the GOP can propose a real “alternative” is a moot point. Because America will reject it. Doctors and hospital administrators won’t accept pay cuts, patients won’t agree to pay for more things out of pocket, and “market based medicine” isn’t universally popular even among conservatives.

    People don’t embrace change or reform unless something bad happens to them. It’s human nature. The Republicans can come up with all sorts of great ideas but an reluctant senate and majority of the hardcore left is all takes to stop them. Lots of people will have second thoughts about this law in the foreseeable future. Now is the time to pick our battles and bide our time for bigger changes.

  23. There’s bigger fish to fry. The only thing that needs repealing is the mandatory fee (cough tax cough) associated with not having healthcare.

  24. The GOP is useless as an opposition party – no balls, no spine.
    Obama should have been impeached by now
    So you all can go fuck yourselves.

    1. Republicans may be the Stupid Party, but they aren’t stupid enough to impeach the “first African-American president.

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  26. My last pay check was $9500 working 12 hours a week online. My sisters friend has been averaging 15k for months now and she works about 20 hours a week. I can’t believe how easy it was once I tried it out. This is what I do..

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