Health care reform

Mitch McConnell Wants to Pass the Senate Health Care Bill By Making It More Expensive

After abruptly postponing a vote, dealmaking continues.

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Ron Sachs/SIPA/Newscom

On Tuesday, Senate Majority Leader Mitch McConnell postponed a health care vote just hours after GOP leadership had promised that a vote would be held before the July 4 recess. Moderate and conservative Senators had expressed reservations about the legislation, and the move made clear that Republicans, who hold 52 seats in the upper chamber, didn't have the 50 votes necessary for passage.

The delay wasn't quite as dramatic as when the House pulled a health care vote from the floor back in March, but the effect was similar. The bill that Senate Republicans had hoped to rush to passage would instead have to be inched along, with difficult negotiations along the way and no guarantee of success.

Two days later, the negotiations have advanced somewhat, and several changes to the Better Care Reconciliation Act (BCRA) are reportedly in the works. But so far, McConnell still doesn't have 50 votes. As Sen. Shelley Moore Capito (R-West Virginia), one of the moderate holdouts on the bill, told the Associated Press this afternoon, "We're kind of at a stalemate right now."

As expected, McConnell is starting the negotiation by offering legislative tweaks to both conservatives and moderates. These tweaks eat into the bill's projected deficit reduction. McConnell, in other words, is hoping to secure votes for the bill by making it more expensive.

The first is the addition of $45 billion to treat opioids, intended to bring moderates on board. The second is a change to allow individuals to use money in health savings accounts to pay insurance premiums, a change designed to appeal to more conservative lawmakers. This would reduce the bill's scored deficit reduction by about $60 billion, according to The Washington Examiner. For procedural reasons, McConnell can only cut into the BCRA's deficit reduction score by about $200 billion in total. These changes consume about half of the money he has to play with.

McConnell's strategy runs the risk of wining over some votes while irking other GOP lawmakers. Sen. Rand Paul (R-Kentucky), for example, said that any process that involves offering money to moderates and regulatory changes to lawmakers on right the right "sounds to me like a Washington deal…I'm not going to go for that," according to Axios.

The most intriguing rumored change, however, is one floated by Sen. Ted Cruz (R-Texas). Cruz wants to allow insurers who sell Obamacare compliant plans to also sell plans that don't abide by the health law's rules and regulations. The idea is inject more choices into the market, and, in particular, to create less expensive options for healthy individuals.

The worry with this sort of provision is that it could essentially turn regulated Obamacare plans into pseudo-high risk pools, as healthy people buy cheap plans and sicker individuals buy more regulated products, leading to Obamacare compliant plans covering a small number of very sick people.

If that happened, though, it could cause the public cost of the program to skyrocket, since the BCRA's subsidies, like Obamacare's, are tied to plan prices. However, as Dylan Scott of Vox reports, Cruz agrees that this is a possibility, and even expects it, arguing that it would ultimately make for a more transparent program.

There are other issues with Cruz's proposal as well. The first is that as a regulatory change, it might not be allowed under the Senate's reconciliation process, which only allows for changes with a direct impact on the budget.

The second is that it might be a non-starter with other Republican senators. According to Axios, other Republicans are dismissing Cruz's plan because it would touch up against the law's preexisting conditions regulations — even though it would still preserve regulated plans.

As in the House, which eventually managed to put together votes on a bill, despite reservations from many GOP lawmakers, the Senate bill may yet pass. But it's far from a sure thing, and President Donald Trump, whose threats and cajoling helped push the House bill over the finish line, doesn't have the same sort of influence over the Senate.

That means it's largely up to McConnell to put together the votes. McConnell is by all accounts a master tactician, but even still, the disagreements we're seeing today mostly serve to reveal how difficult the dealmaking process will be.



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  1. alt-text:

    “assphincter says what?”
    “what?”
    “assphincter says what?”
    “what?”
    “excellent”

    1. Alternate alt-text:

      “Quit showing off your dribbling skills with that head of lettuce and pass already. I am starving.”

  2. The HSA provision sounds nice, although if it still requires a HDHP a lot of people won’t be able to benefit from that.

    From a purely tactical, parliamentary POV, I have to give McConnell and Ryan credit if they can somehow manager to get identical bills passed in both chambers.

  3. Christ, what an asshole.

  4. Also, I’d like to see an analysis of the cost impact of Cruz’s proposal. It does make sense that premiums would increase within the Obamacare market, increasing the required subsidies per person. How much of that is offset by fewer people getting subsidies in the first place (by buying non-Obamacare plans)?

  5. Any analysis beyond “fuck off, slaver” is superfluous.

    1. How is that messaging strategy working out for the libertarians?

      1. fuck off, slaver.

        1. So about as well as Rand Paul is doing for hairstyle trends.

          1. You’ve been saving that one up for a while, haven’t you.

            1. Just came to me. Not bad huh.

              1. No, it was pretty bad.

                1. As you quickly google “how to un-perm hair.”

                  1. That’s a slightly better burn. D+

                  2. Look, Rand styles himself after the loop part of a hook-and-loop fastener, and that’s just the way he likes it.

                    1. One of the core tenets of any liberty minded belief system is the right to style your hair like Little Orphan Annie.

  6. The problem isn’t just moderate Republicans who don’t want cuts plus extremist Republicans who want more cuts, it’s the fact that the redder your state, the larger the proportion of your population is actually on Medicaid. It’s like 30% in West Virginia. So it’s quite a knot.

    I’m as surprised as anyone that McConnell seems to have misjudged this whole thing. Maybe it didn’t actually take the unmatched political genius people thought he had to come up with “Whatever Obama wants, we’re agin’ it.”

    1. Dumbass, you out to love this. Even more government involvement in healthcare. The beauty of obam care and republican care is that they are both doomed to failure because socialism does not work, cannot work, and has never worked.

      You seem to think there is some happy marriage of capitalism and socialism. That is why you are such a dumbass. Subsidized and single payer healthcare is a failure in England for the same reason ours will fail. When you remove the profit motive from something, it becomes inefficient, corrupt, and impossible to manipulate because it takes away choices, preferences, and opportunities for people to profit by innovation, cost savings, and service.

      1. That makes no fucking sense. Not one sentence. Every single country and society in the world contains elements of individual trade and elements of collective resource pooling. It’s not the boogie monster, it’s what human beings do and have always done. You people are psychopaths who bitch that the world doesn’t give you your way every single time you demand it. That’s the crux of all your bullshit–I don’t want to ever compromise with anything because I’m a fucking 3 year old or special or something!

  7. Last I read reported here at Reason, the CBO had the AHCA saving $880 billion over ten years, and the Senate version saved even more. If giving back a small portion of that is what it takes to get rid of the individual mandate and transfer 11 million people from Medicaid to private insurance plans, then that’s a good deal.

    It shouldn’t be surprising to see some horsetrading going on anyway. That’s how sausage gets made, that’s how things get done.

    You know how else things get done?

    Ted Cruz want to run for president again, and there’s no way he’s gonna be the guy that stands in they way of eliminating ObamaCare–not if he wants to turn around and contend for the nomination in the Republican primaries. Same thing can be said for Rand Paul. They’ll be there when the time comes.

    The people to worry about are the moderates.

    Of the 20 Republican representatives who voted against the AHCA in the House, 16 of them were from moderate states like New Jersey or swing states like Ohio and Pennsylvania. We’ll see the same kind of reluctance in the Senate. We tend to focus on the “radicals” because we’re libertarians, but the controversy here is the moderates.

    Trump should call up Heller and tell him they’ll put off Yucca mountain or do something expensive at Nellis if that’s what it takes.

    1. Where are you getting your numbers from? The CBO estimated $321 billion in savings over 10 years for the Senate bil and about $200 billion less than that for the House.

      http://www.foxnews.com/politic…..-mean.html

      1. “Under the House plan, the federal savings would amount to $880 billion over a decade. The Senate bill is supposed to wring out even more.”

        https://tinyurl.com/y9mox7zf

        If you read your Fox link, the $321 billion is how much it would cut from the deficit. We’re scheduled to spend a lot more money on other things, too.

        I think the $880 billion in savings is legit. We’re talking about spending less on Medicaid mostly.

  8. the addition of $45 billion to treat opioids, intended to bring moderates on board.

    *** resists urge to make snarky grammar-nazi comment ***

    I have no idea what “to treat opioids” means.

    1. Lots of laxatives to treat OIC.

      1. Excuse me, Mitch would have written “to treat OIC” if that were his intent.

    2. poor opioids…so sick…need treatment

  9. Welcome to the sausage factory. (Except that sausages, however disagreeable the process of making them, sometimes taste good.)

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