Health care reform

Mike Lee, Jerry Moran Torpedo Senate Health Care Bill

It took two libertarian-leaners, one moderate, and a Kansan irked at the process to deny Donald Trump his unpopular, critically panned legislation.

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Stuck at a 50 no-vote impasse since last Thursday, and delayed by Friday's blood clot surgery of 80-year-old Sen. John McCain (R-Ariz.), the Senate's optimistically monikered Better Health Care Act (BHCA) died a sudden death Monday night, as two Republicans joined forces to be the decisive 51st and 52nd votes to prevent the 115th Congress's most important piece of legislation from even being considered on the Senate floor.

Sen. Mike Lee (R-Utah), the libertarian-leaning fiscal conservative with no love lost for President Donald Trump (even while insisting that the unorthodox president is arguably an avatar for "constitutional conservatism"), was always a leading choice to join ideological fellow traveler Rand Paul (R-Kentucky) in rejecting a bill that, contra seven years of electorally successful promises to repeal Obamacare, left its basic framework in place. When he had been one of four GOP senators to oppose a previous version of BHCA last month, Lee had erected a high bar for changing his vote: "it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their health care costs." And in an interview with me one week ago, Lee stressed that it the Senate's rewrite included the Consumer Freedom Amendment he had co-authored with Ted Cruz (R-Texas), "then I can get to a yes. If they can't then I won't; it's that simple."

That is indeed what happened, as Lee explained in a piece for The Resurgent tonight. The updated bill included some of the Consumer Freedom Amendment, but not all, and the difference was both a policy and political dealbreaker. "The new version still forces insurance companies to follow Obamacare's 'single pool' regulation," Lee complained. "A new analysis by a government agency claims it would raise insurance premiums for people on freedom plans by $600 a year. I do not want to gamble $600 in relief for middle-class families in exchange for an amendment that might be undermined because of Obamacare regulations."

Had Lee been the lonely 51st vote (joining the previously opposed moderate Susan Collins of Maine), you could have expected to see the Tea Party/libertarian minority of the Senate come under similar blame and scrutiny as the House Freedom Caucus did from President Trump after Obamacare reform's first failure in the people's chamber. But the Utahn was lashed at the hip with Sen. Jerry Moran (R-Kansas), whose objections were more procedural. "This closed-door process has yielded the BCRA, which fails to repeal the Affordable Care Act or address healthcare's rising costs," Moran said in a statement. "We must now start fresh with an open legislative process to develop innovative solutions that provide greater personal choice, protections for pre-existing conditions, increased access and lower overall costs."

Senate Majority Leader Mitch McConnell (R-Kentucky) reacted to the news by formally abandoning repeal-and-replace. "Regretfully, it is now apparent that the effort to repeal and immediately replace the failure of Obamacare will not be successful," McConnell said in a statement. "So, in the coming days, the Senate will vote to take up the House bill with the first amendment in order being what a majority of the Senate has already supported in 2015 and that was vetoed by then-President Obama: a repeal of Obamacare with a two-year delay to provide for a stable transition period to a patient-centered health care system that gives Americans access to quality, affordable care." That, The New York Times concluded this evening, "has almost no chance to pass, either."

There will be a likely mini-cascade in the coming hours and days of Republican senators expressing their belated disgust with the now-dead legislation. Wisconsin's Ron Johnson, for example, who had been one of prior bill's opponents, expressed outrage earlier today that McConnell had reportedly promised moderates that purported future Medicaid cuts wouldn't actually take place. "I was strongly in favor of the motion to proceed before I read the comments by Senator McConnell," Johnson told reporters. "It really does put in jeopardy the motion to proceed." Vulnerable western Sens. Jeff Flake (R-Ariz.) and Dean Healler (R-Nev.), both of whom face dicey re-election bids in 2018 and rumored primary challenges from Trump-backed candidates, never had to say definitively how they'd vote, though their lack of enthusiasm has been palpable. And according to Washington Post political reporter Robert Costa, "Privately, several House [members] and [senators] told me for weeks they didn't really want to pass it." The bill has always been profoundly unpopular among the public, and unloved by conservative and libertarian health-policy analysts.

So how did President Donald Trump react? Like this:

Reason's Peter Suderman, who has forgotten more about health policy than I'll ever learn, and who counseled Republicans 10 days ago to just start over from scratch, will be in this space tomorrow with more policy analysis.

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  1. a repeal of Obamacare with a two-year delay…

    So once again, Republicans run by promising the voters something they can’t possibly deliver, which leaves them unable to actually accomplish anything without committing career suicide. So they decide to create a manufactured crisis for the next congress in hopes of forcing themselves to jump on the grenade between now and then. Since no one actually wants to do that, nothing will be down over the next two years, but they will still be surprised when it blows up in their face like sequestration, the debt ceiling, etc.

    Republican legislative strategy (nsfw): https://www.youtube.com/watch?v=4XrPEBKZLP0

    1. I was wondering about this. Here’s a fuller quote:

      … a repeal of Obamacare with a two-year delay to provide for a stable transition period to a patient-centered health care system that gives Americans access to quality, affordable care.” That, The New York Times concluded this evening, “has almost no chance to pass, either.”

      What exactly makes that impassable? I would think that’s pretty darned close to full repeal; what’s a two year delay? In fact, if they really believe that is what will get them re-elected, then it’s even better because it covers two elections.

      Either they are afraid they won’t be able to come up with a replacement within two years, or it’s fear of a Dem filibuster to not even get the chance to pass it 52-48.

    2. Frankly, its been the Democratic legislative strategy also.

      Look at the PPACA – can’t deliver, hurts a lot of people, didn’t even have the benefit of getting them through the next election cycle.

      1. Sometimes, when you toss grenades out for other people to jump on, they don’t – and you end up with a face full of shrapnel.

    3. So, you’re upset that Republicans failed to repeal a law you like?

      And how did the sequester blow up in their face? Is that what you read at Paul Krugman’s blog? The sequester’s failure to lead to immanent economic collapse as Democrats predicted, and the fact that Republicans have kept congress since then, don’t suggest ‘blowing up in their face.’

      1. And how did the sequester blow up in their face?

        It was immediately ignored and then eventually repealed without ever having cut any spending?

        1. Why would you assume most Republicans wanted to cut spending?

  2. Its kind of amazing what Congress can do when you have a President they *all* hate in office.

  3. Reason‘s Peter Suderman, who has forgotten more about health policy than I’ll ever learn, and who counseled Republicans 10 days ago to just start over from scratch…

    Look at all the cut-and-runners. Have we learned nothing? We don’t need a retreat on this, we need a surge.

  4. But peoples will die!!!

  5. Its not like there aren’t plenty of ideas out there on how to reduce health care cost (mainly by getting government out of way), the GOP just doesn’t have the balls to do it. Someone might get less free stuff and the media will blame them and call them meanies which is too high a price to pay.

    1. There are great things they could accomplish (but more at the state level than federal) w/o anyone’s losing free stuff if they’d do as Mike Hihn has said by focusing on the costs rather than how the tab’s going to be paid. But those measures don’t have the cachet of a “national inusrance fix”, “repealing Obamacare”, “replacing the ACA”, etc. Of cours they still should repeal the ACA or any parts thereof they can. Stupid to hold out against partial in the hopes of getting full or more parts.

    2. Hey, it’s an election year! (It’s ALWAYS an election year)

  6. Republicans want to vote against Obamacare while making sure that nothing actually happens to it. When you’re in the majority, those efforts tend to look a lot sillier.

  7. Do they really think they’ll wind up w something better by this rule-or-ruin tactic?

  8. Not gonna lie… Moran really surprised me here. I might consider voting for him next go-around instead of pulling the ‘L’ lever.

  9. Dems will join in!

    Why would they join in?

    1. Because he’s tremendous at making deals, an Democrats want to win, therefore

  10. The Dems will join in only if it is “single payer”.

    On related news, as an American living in Canada, I saw my doctor the other day about a finger injury (pulling crimps in the gym). She got me right in to see a specialist — on Sept 26. I guess I should be glad it is this year, not next.

    1. How much did you pay for the doctor visit?

      How many uninsured people do you think ought to have gone without medical care completely so you could get your wittle finger looked at sooner?

      Assuming you’re telling an ounce of truth, that is.

      1. I don’t know about his finger, but I can tell you that my wife does physical therapy and the number of Canadians coming to the US for hip or knee replacements is ever expanding. All tell the same story – they could wait for 2 years, or pay for it here and get it done in short order. Given how important it is to be ambulatory, I’d say it’s more systemic than his “wittle finger.”

        1. Why would they come to the US for treatment? Is there no private alternative in Canada?

          1. They can come here for better and immediate health care and still get the bill paid by Canada.

          2. Who wants to rely on Canadian doctors? All of the best Canadian doctors fled to the US decades ago.

      2. How many uninsured people do you think ought to have gone without medical care completely so you could get your wittle finger looked at sooner?

        Deflecting Johnny’s completely valid observation that socialized medicine leads to long wait times to see a specialist (assuming the waitee doesn’t die in the interim, which seems to happen with regularity) by peddling that “if ObamaCare is repealed poor people will not be able to see a Doctor so they’ll die” bullshit? Your lack of self-awareness is stunning.

        Assuming you’re telling an ounce of truth, that is.

        Demanding proof of an assertion? That’s really rich coming from you Tony.

      3. Yeah, how dare he object to waiting ridiculous amounts of time to see the doctor. Selfish bastard! SUCK IT UP AND LOVE IT, PEASANT!!!

        But here’s the good news, Tony! Single payer IS coming [thanks GOP!], and when it does, YOU TOO can wait aeons to get your problems looked at! YAY!!! Doesn’t that sound great? Hell, maybe it’ll even be life-threatening, and you’ll just simply DIE before you get in! I certainly hope so, anyway…

  11. The republican establishment same as the democrat establishment. Nice to collect campaign donation and win votes opposing the other guy but do they really oppose? Clearly not. In 2012 they ran Romney the father of Obamacare and now that the vote counts they can’t pass the same repeal they sent to Obama.

    Very reminiscent of democrats and the Bush era Patriot Act. Democrat slammed the attack on privacy and constitutional freedoms only to renew it as is when they controlled all 3 branches of government.

    When will the masses realize there is really just one party of entrenched politicians committed to taking your freedom and money and consolidate their greed for power.

  12. I’m not seeing the downside here.

    Repeal with a window to work in. What’s not to like?

    2 years to OPENLY put together something that actually works.

    Sounds a lot better than anything else I’ve heard.

    1. I agree except that states are no better than the federal and they will bounce it back to the federal for a few more years of extensions. both the state and the federal will play this game for a long time. its going to cost a bundle no matter which way they go.

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  14. I am waiting for the complete “libertarian” solution for healthcare…or for that matter, any other issue/problem.
    But, I am also waiting to hear from any prominent “libertarian”, especially one in elected office, to elaborate on your Jesus’s (Ron Paul) remarks in response to the question what you do with the guy who chose “freedom” and NOT to have health insurance and has a terrible accident and is seriously injured.
    1) who comes and gets him and who pays for that
    2) who treats him in the emergency room and who pays for that
    3) who pays for his hospitalization, surgery, anaesthetic, drugs, rehabilitation

    I would like to hear: “yes”, he chose freedom which is not his right to dump those costs on anyone else, so therefore he has to be left by the side of the rode and any assets he has be used to clean up the wreck and dispose of the body in the cheapest fashion.
    Right?

    1. Hopefully some private organization would choose to be humane and help him out. That’s what used to happen before we decided to hold guns to everyones’ heads and force them to pay for ever-decreasing quality health care.

      1. “Hopefully”

  15. The funniest thing is, I consider this the best thing for the Republicans. Lee, Paul, & crew are actually saving the Republicans from themselves. They really don’t want ownership of the ACA.

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