By most reported accounts, the Republican Party's attempt to convince 50 of its 52 senators to agree on what to do about Barack Obama's signature Affordable Care and Patient Protection Act is hanging by the thinnest of threads. With Sen. Rand Paul (R-Kentucky) continuing to sound like a "no" vote—today he told reporters, "At this point, I cannot support the bill….I don't see anything in here really remotely resembling repeal"—that leaves the leverage in the hands of two of the other three senators who joined Paul in opposition after the first Better Care Reconciliation Act (BCRA) was introduced last month: Sens. Ted Cruz (R-Texas) and Mike Lee (R-Utah). Yes, the guys most responsible for shutting down the government over Obamacare funding in 2013 are the ones now widely considered to be the swing vote in President Donald Trump's first major legislative effort.
Over at Slate, Jim Newell assesses the latest political status of the Cruz/Lee "Consumer Freedom" amendment (which Peter Suderman preliminarily addressed on policy grounds here last month), noting that "as currently proposed, [it] would cause too many moderates to flee, since it would undermine pricing protections for those with pre-existing conditions." And yet, as Lee told me in an interview Monday, if the bill doesn't include the amendment, he will definitely vote against it:
Look, the fact is that we as Republicans, basically every Republican, with very, very few exceptions that I can think of, who have campaigned for any federal office over the last seven years, have done so with the promise that we would repeal Obamacare. And I can't look my constituents in the eye and tell them that we've done that or even made substantial progress toward doing that, unless at a minimum we allow people to choose a health care plan that works for them, and we allow them to pay for it with pre-tax dollars using a health savings account. And that's what we're trying to do with our amendments. If they will include those amendments in a variation of this bill, then I can get to a yes. If they can't then I won't; it's that simple.
"Since this amendment is what Cruz and Lee have named as their price," Newell writes, "Senate leaders have to find a way to let them have it—but with some adjustments to ensure that it doesn't scare off moderates." So what does that look like?
One option that's gaining steam, because it sounds like it could work in the abstract, is being pushed by South Dakota Sen. Mike Rounds. Though nothing's been put to paper yet, the idea would be to link the prices of the compliant and noncompliant plans by a ratio to prevent the ACA plans from spiraling in cost while the "Cruz plans" remain nice and cheap.
"I talked to Sen. Cruz a couple of weeks ago about it and told him I would support it as long as there are provisions built into it so long as there is a ratio, a specific ratio, between the least expensive plan and the most expensive plan that any insurance company offers," Rounds told reporters Monday afternoon. "And if [insurers cut the price on a cheaper] pool, they have to cut the price on the most expensive pool as well." In other words, Rounds wants to keep the sicker pools tethered to the healthier pools, so insurance companies couldn't keep premiums low for the plans healthy people want to buy while allowing premiums to skyrocket for the Obamacare plans sick people need.
The idea quickly gained traction among desperate Senate leaders trying to count votes.
Meanwhile, a new USA Today poll puts public support for the Senate bill at a mind-bogglingly low 12 percent.
More Mike Lee quotes about the Senate's Obamacare exertions after the jump:
MW: On a process basis alone, how would you describe the Senate's work here? I would imagine that, as someone who likes transparency in the operations of government and open hearings and these kind of things, it would be disappointing, to put it mildly, to the point of being maybe even inadmissible. How would you describe the process, and whether we should, as American consumers of politics…be able to accept an end result of a process that looks this kind of lousy, to be honest?
ML: Well, I've found it incredibly frustrating. Look, transparency is important, especially when you're talking about tinkering with one-sixth of our nation's economy, and involving the federal government as heavily as it has been. It's one of the problems I had with Obamacare from the beginning, as it was passed in secret, behind closed doors, members of Congress were told when it was passed by then-speaker of the House Nancy Pelosi they had to vote for it in order to find out what's in it.
There is no greater transparency than that which occurs with the American people in an open, honest dialogue with them, one in which we say, "We're going to repeal this law. You give us a chance to control the political branches of the federal government, we will repeal this law." There's nothing more transparent than that, there's nothing more simple than that. That's what we should have been doing all along. The further we deviate from that, the more difficult it is to maintain that same kind of transparency. We've compounded it by having the bill drafted largely in secret, having a fair amount of complexity in it. I still think there is way to get it to the point that it's good enough that it can garner my vote, but there are conditions attached to that, which I have outlined.
MW: And…if that all falls apart, are you of the kind of Rand Paul school of "Let's just repeal it, and then have a promissory note to replace later"? Is that something you would get behind?
ML: It is not only something that I would get behind, it's what I've been advocating all along. It's what I've been talking about all year and ever since the election—is that what we need to do is go ahead and repeal it, put a delayed implementation measure in there, so that it's delayed a few months or a year perhaps down the road, and then that ups the ante for us to get something else passed, to figure out what comes next, what fills in in the interstitial spaces that have to be filled by the federal government. That's what I've advocated all along, and I'm pleased that President Trump and Rand Paul and others are now on board with that.
A month ago I asked the immortal question, "Which Republican Will Play Gandalf to Trump's Balrog of a Health Care Bill?"