Senate Republicans Don't Know What's In Their Health Care Bill—But They Know It Won't Repeal Obamacare

This is why the GOP health care bill is stalled in the Senate.


Senate Republicans aren't saying much about what's in their health care bill, but they have made one thing perfectly clear: They have given up on fully repealing Obamacare. That is not an outsider's view. It is how Republicans themselves are framing the health care legislation that is now working its way through Congress. And it is one of the reasons why Republicans are continuing to struggle with the legislation now that it has been passed on the upper chamber.

Now that the American Health Care Act (AHCA) has passed in the House and moved to the Senate, Republican lawmakers are being blunt about the limited scope of the legislation they are considering.

The Senate, of course, is still working on drafting its own health care plan, which will reportedly differ from the House plan. No legislative language has yet been released, and few specifics have emerged. The policy and political challenges involved in crafting a bill are significant. And some Republicans are already tempering expectations by saying it won't be a full repeal of Obamacare.

"You can't repeal it in its entirety," Iowa Sen. Joni Ernst said this week. "You've got to have 60 votes and we don't have 60 votes at this point," said her Iowa GOP counterpart, Sen. Chuck Grassley. Instead, Ernst said, Republicans have the opportunity to "tinker around the edges."

These are statements about the limits of Senate procedure as much as it is one about the willingness of Republicans to eliminate the law entirely. The legislative filibuster effectively sets a 60 vote requirement to pass bills in the Senate. That's why Republicans hope to overhaul the health care law using a procedure known as reconciliation, which allows for legislation to pass on a simple majority vote. But legislation passed via reconciliation must meet certain conditions, including direct relevance to the budget, meaning that some of Obamacare's regulations are likely to remain in place no matter what.

But these statements also represent admissions that the years of GOP promises to repeal Obamacare will not be fulfilled. The procedural limitations are only one reason why. Party lawmakers have strong disagreements about how or whether to subsidize coverage in the individual market, about the role of Obamacare's Medicaid expansion, and about the necessity of maintaining the health law's preexisting conditions regulations.

At this point, then, the goal for Republicans is to rewrite the health care law rather than repeal it, which invariably means leaving in place many of its essential structural elements.

It is not clear, however, what sort of health policy improvements the GOP would actually accomplish through rewriting. The final Congressional Budget Office analysis of the AHCA found that it would result in 23 million fewer people covered a decade from now. That is the exact same coverage decline the CBO projected as under simple repeal. The initial version of the GOP actually covered even fewer people than a straightforward repeal, according to the CBO. Under all versions, premiums would rise sharply between now and the end of the decade, and would continue to rise afterwards, though less than under Obamacare.

Some of this may be attributed to the quirks of CBO's model, which probably overstates the effect of Obamacare's insurance mandate on coverage, and thereby exaggerates the effects of eliminating it. Even still, it suggests that the health law rewrites Republicans envision would do little to lower premiums or make coverage more accessible. Republicans would not be repealing Obamacare, in other words, and it's not clear that they would be improving on it either.

That helps explain why the bill now appears stalled in the Senate. Just last week, GOP Senate Majority Leader Mitch McConnell, who is usually businesslike in his optimism about the Republican ability to accomplish legislative goals, admitted that he did not know how Senate Republicans would put together the 50 votes necessary to achieve passage.

That doesn't necessarily mean that the bill will stall forever (although it might). The House version of the bill looked dead after a floor vote was called off. And House Republicans had their issues with that bill too. Days before the House voted to pass the American Health Care Act, Rep. Dave Brat, a Freedom Caucus member and Tea Party favorite who ousted Rep. Eric Cantor in a primary challenged, admitted that the AHCA was "not the repeal bill we wanted." Although Brat opposed an initial version of the legislation, he voted for its eventual passage.

But Brat's disappointment remains instructive. Given the limitations of the process, it's not too much of a stretch to say that the AHCA was not a bill that any Republican truly wanted. Nor, as McConnell's comments suggest, is it certain that such a bill could ever exist. Even if the Senate manages to pass something, it will still have to be negotiated with the House, creating more opportunities for disagreement. The only thing Republicans have agreed on about health care over the last eight years is that they want to repeal Obamacare, which they are now admitting they won't do.

Some Republicans, then, have started to figure out that they aren't going to fully repeal President Obama's health care law. But they still haven't figured out what they want to do—or why—instead.

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  1. All of these scumbags need to be scared shitless by a mob.

    Trump should have had them either repeal bama care as they proposed during brak’s tenure or the whole plan should have been simply thrown out and let the citizens experience the lack of government in healthcare for a while

    Trump has blood on his hands as well for this because the answer should have been market driven with plenty of competition and no government subsidy. We all know that is political suicide but it makes trump a pussy too.

    1. As explained in this post, there would not be a repeal of PPACA, unless they somehow got 8 Democrats on board. Or abolish the filibuster, I guess.

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        This is what I do… http://www.webcash10.com

  2. Kirk: “I don’t believe in a no-win scenario.”
    Spock: “What about the time Republicans promised all their cousin-fucking voters that they’d dive once again into healthcare policy just as soon as they get the power to do so, and then much to their horror, they actually acquired that power?”

    1. 2 things:
      1) The speed at which you comment on anything healthcare related is astounding. I’m going to assume you troll the internet all day for random healthcare articles. This now beyond a trend, and going straight into “Tony habits”.

      2) Your comments are just vindictive sir. Obviously you’ve never read Dale Carnegies “How to win friends and influence people”. You my good man, do not act like someone who wants friends :(.

      1. And who the fuck might you be?

        1. Someone who thinks you would benefit greatly from taking a nice long break from political discussions, or reaching out to others with a little less of the “pissy attitude” and a little more “let’s work together for a brighter future!” Remember, an enemy is just a friend you haven’t made yet ;D!

          1. I have a shtick. You don’t have to like it.

            1. At least you’re self aware enough to not take yourself seriously then. That makes me feel better for you :).

              1. Thank you kindly for your concern. However, I can spend all day here without my pulse ever getting above 85.

                1. Or your IQ, apparently.

    2. “cousin-fucking voters”

      See Tony this is why the Democrats lost the election. They (and you) are fighting against a caricature. You (and they) don’t actually understand your enemy.

  3. It’s sad because it’s no great mystery. They’re politicians are just trying to figure out how they can be on both sides at the same time. Forget it, you’re Republicans, the Democrats hate you instinctively. Nothing you do will get you invited to their parties, so stop trying.

    How to repeal ObamaCare: repeal it.

    What to replace it with: Either what we had before ObamaCare, or the million and one plans available from the several dozen conservative and libertarian think tanks around the country.

    1. You can’t repeal it without 60 votes in the senate, and Democrats aren’t going along with it not because they are cool kids to Republicans’ dweebs, but because Republicans don’t actually have any ideas on the table other than “My voters hate the nigger’s law, and we are compelled to pretend to do something about it.”

      1. See comment above

      2. We missed you in the Venezuela thread.

        1. I don’t subscribe to Chomsky’s political beliefs or Stossel’s 1st-grade vocabulary.

          1. You definitely subscribe to Chomsky’s beliefs. You just don’t understand them.

            You only understand what Rachel maddow tells you.

            1. I understand them, but I am a fervent anti-utopian, which is to say, a pragmatist.

              I tried watching The Five the other day for about three minutes. See, the difference between those bloviating bags of grease and silicone and Rachel Maddow is that the latter spends all day doing, like, research before going on the air and the former just fart out whatever inane, completely uninformed opinions come to mind. It’s a major problem in this country that the FOX portion of the electorate don’t understand the difference.

          2. Tony,

            I do recall in a recent thread about Venezuela you denied that there was any significant support for Chavez from mainstream American liberals, and I also recall you favorably mentioning Naomi Klein in that thread to bring up the evils of American “neoliberalism.”

            You can imagine I found it funny when I by chance came across these links recently.



            A choice quote from that last article (after Chavez’s death):

            “Ch?vez was a strongman. He packed the courts, hounded the corporate media, legislated by decree and pretty much did away with any effective system of institutional checks or balances. But I’ll be perverse and argue that the biggest problem Venezuela faced during his rule was not that Ch?vez was authoritarian but that he wasn’t authoritarian enough. It wasn’t too much control that was the problem but too little.”

            1. Never heard of the first website and that letter is ludicrous (as are many of the alleged signatories). Klein’s support of Chavez is regrettable, but let’s not pretend that Chavez is the worst political leader in the history of earth because you think it helps you score rhetorical points. If Klein thinks he was democratically elected, then it follows that she would praise his socialism, as she is a notable anti-capitalist who would naturally favor spreading oil wealth around rather than letting the 1% take it all for themselves. Which is perhaps the most important actual economic policy libertarianism exists to defend, for some ungodly reason. (The billionaires put the oil in the ground so they can damn well dig it up and sell it and keep all the money for themselves?)

              Never heard of the guy writing the obit either. I don’t know what you’re trying to argue. I’m not in favor of authoritarians. I’m not in favor of the ones installed by the US in order to loot the countries of their resources for rich Americans (capitalism) either.

              1. By ludicrous, are you saying it’s fake or stupid? I can’t tell.

                Regarding the Nation article, my apologies, I forgot to include Klein’s tweet linking to that article.


                Combined with her repeated support for Chavez over the years, it’s very difficult to not read that as an endorsement of him and the article.

                I’m not surprised at all she supported him, I just found it funny that you repeatedly denied there was ever significant mainstream support for Chavez while approvingly referencing Klein in the same thread. And your weak deflection here to the evil billionaires and the 1% is pathetic. I’m not even trying to argue Chavez invalidates everything left of center, I know he wasn’t universally beloved by everyone in that category, I just wish you’d be able to admit that a lot of people on your side got fooled by him and have egg on their face as a result. Hell, your line about supporting Chavez vs. the 1% (as if it’s a dichotomy that simple) implicitly suggests that anyone who wasn’t a tool of the billionaires logically would have sided with Chavez. Or are you saying that you were on the side of the 1% back then?

                1. I spent all of 2016 bashing Bernie bros and Steiniacs, so you’re just not going to pin me down as part of the loony left of this country, and ideologically you’re not going to pin me down as a socialist in the mold of Chomsky either, much as you may prefer an easy target.

                  There are two separate issues here: authoritarianism and economic models. Obviously no one here, least of all me, should support authoritarian leaders. They are all the same in some ways. But the difference between Chavez and, say, Pinochet, is that the former came to power by selling socialism while the latter came to power via a US-backed coup and then implemented free-market fundamentalism.

                  You tell me which regime was “better.”

                  1. Bashing Bernie bros doesn’t automatically make you not loony, and I didn’t accuse you of being Chomsky either. I think you just have a compulsion to defend your “side” and bash the other. That doesn’t necessarily make you a hardcore ideological socialist, but I think it does lead to you on occasion making inane defenses of socialists and/or their apologists, as well as poor critiques of capitalism that sound much more like they’re coming from one of the “Bernie bros” you decry rather than the “reasonable, pragmatic, evidence-based” liberal you try to present yourself as.

                    Here, for instance, I find the notion that you think authoritarianism and economic models are totally separate to be baffling. Obviously authoritarianism can exist in a range of economic models, but that doesn’t mean all economic models are inherently equally authoritarian. It’s also a bit rich that Chavez and his regime were lauded as being super democratic and for the people right up until the moment the economy collapsed and the slide toward dictatorship accelerated, at which point authoritarianism become the sole root of the problem, and it had nothing to do with the economic policies adopted by the regime. There are a lot of authoritarian regimes, they don’t always fail as spectacularly as Venezeula has in such a predicable fashion.

                    And seriously, who the hell mentioned Pinochet? He is totally irrelevant to this discussion. You’re flinging around straw men and whataboutism desperately.

                  2. “Obviously no one here, least of all me, should support authoritarian leaders.”

                    You were singing a different tune in the climate scam thread.

      3. They have plenty of ideas; even the McCain-Ryan plan from 08 would be an improvement over the ACA. But they’re stuck with dealing whatever hodgepodge they think they can pass because, as you note above, economic parasites get to vote, so you can’t win an election by passing legislation that actually allows costs to fall ont hose with who don’t save money, plan ahead, or who overconsume (or inefficiently provide) healthcare. A freeloader’s vote unfortunately is worth as much as anyone else’s.

        You, our beloved ‘pragmatist’ should be sympathetic. You wanted a single payer, but got stuck with Obama’s idiotic, self-contradictory mess of a law; the one that kneecaps insurance companies just for the hell of it, then subsidizes them to keep them from going out of business from the kneecapping; the law that actually made it illegal for an entire industry to charge a higher price for providing more service. (e.g., “I have a congenital glandular problem! so I want two cheeseburgers but should only have to pay for one!”) The law that tried to cut medicare costs by declaring, by fiat, that healthcare doesn’t cost as much as it really does.

        In short, pot, kettle, etc.

    2. I know this is a favored meme around here, but the ‘RINOs’ aren’t trying to appease Democrats. They’re trying to appease voters and donors.

      1. Politician’s handbook:

        1. Get elected (by any means)
        2. Get re-elected (by any means)

        The End

        1. You forgot 3. Profit.

    3. What to replace it with: Either what we had before ObamaCare

      Obamacare happened because the status quo ante sucked. The individual market has been broken for decades. Employer-based coverage means that healthcare access is cyclical – which creates incentives to overutilize just-in-case-I-get-laid-off. Further, employers have been deliberately offloading both their sick and lower-paid to taxpayers or to fend for themselves for decades as well. Data here is from 2009 but hasn’t changed much:

      Lowest 10% of income – 26% have access to employer plan. If they do, they pay $97/mo employer pays $248/mo. For family, they pay $380/mo employer pays $560/mo.

      Lowest 25% of income – 42% have access to employer plan. If they do, they pay $98/mo while employer pays $272/mo. For family, they pay $384/mo employer pays $625/mo

      Highest 25% of income – 92% have access to employer plan. They pay $85/mo while employer pays $336/mo. For family, they pay $320/mo employer pays $843/mo

      This ain’t a solution to anything.

    4. Obamacare (ACA) including the individual mandate, is very similar to a Heritage Foundation plan. It’s similar to Romneycare in Massachusetts. The conservative think tanks, at least prior to OCare, did not have anything better. I haven’t seen the latest think-tank output at present..


      The problem with these plans is that there is no incentive for controlling costs. Competition between hospitals and pharma companies isn’t going to control costs because these entities are so large they are effective monopolies in local areas. Hospital groups keep absorbing other groups.

  4. I agree that most of the people (Trump included) are fucking pussies, particularly when it comes to getting rid of Obamacare.

    But, I am getting real sick and tired of blaming “The Republicans” for all of this mess. Not a single Republican in Congress at the time voted for Obamacare.

    The Republicans are hardly a homogeneous group on this issue. The Freedom Caucus folks have been fighting to get rid of most (if not all) of Obamacare, but the Dems and “squishy moderate Republicans” simply won’t vote for anything even remotely close to that. It is a political reality that most of us who vehemently opposed this monstrosity predicted would happen.

    Once it got passed, there was no way it was ever going to get successfully, completely repealed (without replacing moderates with fiscal conservatives in blue states, but that isn’t going to happen).

    And don’t blame the Freedom Caucus folks for voting for a “bad bill” because it didn’t go far enough. They wanted a hell of a lot more. This was the best they were going to get. Should they have voted no on the AHCA? That would get us literally NO where.

    1. Should they have voted no on the AHCA?


      That would get us literally NO where.

      Which is where we currently stand. They could have voted no and still had their principles, now they just seem even more like regular ol’ sleazy politicians.

  5. Democrats didn’t have 60 votes when they passed Obamacare under reconciliation. This is obviously a cop out.

    However, I think it’s better to let it collapse under its own weight. Submit a full repeal to the Senate. Let the Democrats block it, and then let the exchanges continue to death spiral.

    In the meantime they can build support for an alternative by allowing insurance companies to sell noncompliant policies that are labeled as such.

    In the end that could be the best way to transition to a cash economy for healthcare that actually drives prices down.

    1. Bone up on the history. A separate bill was passed under reconciliation, to get the House to agree to the Senate version that passed with 60 votes.

    2. The Democrats did pass Obamacare with 60 votes. What happened is that they had 60 votes and the Senate passed a bill, and then before the House could vote on it and the two branches could then reconcile, Scott Brown got elected, so they no longer had 60 votes. The House then had to pass the Senate bill as it was passed in the Senate, and then a separate bill was passed via reconciliation to address other concerns (and this was subject to the rules and limits regarding reconciliation).


  6. The GOP can’t possibly succeed because they don’t have a clue what they actually want to do.

    If they want to reduce healthcare costs, then they have to restructure ERISA and Medicare. They ain’t gonna do that because that would take balls and they are both nutless and witless.

    If they want to restructure ‘insurance’ and/or decentralize things so that markets can work locally (and healthcare is ALWAYS local for 99% of people), then they need to reform Medicaid so it creates the right incentives/disincentives. But that takes an actual belief in federalism (in the modern sense) and the GOP is as top-down and nationalizing as the Dems.

    So all that’s left is to play politics. To kick the other sides stupids around to show your own stupids that you are the best party to march into what can only end in civil war. And since the stupids love that shit, so do the pols.

    1. The Paul Ryans of the world would like nothing more than to dismantle Medicare, but since they can’t get elected without the votes of the people they’d be putting into immediate destitution for the sake of a demented political-ideological experiment, it’s a bit of a problem.

      All they’ve succeeded in doing is to make the ACA popular when it never was before. It remains true for now that it is politically impossible to take away a benefit once it’s been passed. Republicans could attempt it for the first time ever, but they know as well as anyone that they would only suffer more losses in 2018 as a result than they already will because of Trump.

      It’s a legitimately interesting question for liberals and libertarians alike: what to do about the “problem” that so-called entitlement programs can never go away once they exist?

      1. I’d like to get rid of Medicare too or merge it with Medicaid and transition it over to the states. That could be done too but yeah it does take enough honesty to have a discussion about what we want the thang to look like. And neither Dems nor GOP are honest.

      2. I assume you’re joking. One thing leftists never worry about is giving too much free stuff paid for by others to their voters. When our economy is 80% ‘public’ sector and our socialized healthcare system gives free massages and waterbeds to anyone who asks while people spend a year waiting for heart surgery, you and the Liz Warrens of the world will still be asking ‘now what else can we socialize? Free pets for everyone? Free vacations? Free dildos?’ You and I both no there’s no point where a leftist says, ‘no, that’s enough government, thanks.’

  7. It takes only a simple majority to change the rules, i.e. abolish filibuster. Could keeping the cloture rule possibly be more important than repealing the ACA??

  8. In a rare moment I agree with Lindsay Graham. Collapse and replace. The insurers are bailing on the exchanges, most of the coops have gone out of business, the remainder in trouble.
    The big insurers played the democrats well. Agreed to play in their exchanges as long as unlimited bailouts existed.
    Now they just get to sell full blown policies that meet the “essential” benefits requirement ensuring that most people will be forced to buy more insurance than they need and their stock prices are reflecting that huge win.

    1. How do sick people afford health care if the healthy people don’t pay more than they need to? These suggested “high-risk pools” would need absolutely enormous taxpayer-supported subsidies unless costs for sick people are controlled. How to control costs? That’s difficult given that pharma, hospital-groups, medical device manufacturers etc. all want to increase their stock prices.

      Just capping medical lawsuit rewards (tort reform) won’t balance the books. Maybe we have to import more doctors, limit the lengths of patents more, look at other regulatory issues. How to get rid of monopoly hospital groups in local areas?

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