Senate Republicans face a daunting task next week. With all Democratic senators steadfastly uncooperative and with a margin of only two seats with which to win any vote, GOP senators must be almost completely united in voting for a healthcare reform bill that is far from perfect.
It is discouraging to see that $230 billion in Obamacare tax hikes will remain on the books if this bill passes. It is discouraging also to read that Senate Majority Leader Mitch McConnell, R-Ky., is apparently telling wavering centrists that the bill's cuts to Medicaid, which are not scheduled to take place until 2026, will never happen anyway.
To be sure, the Senate Republicans' bill would be better than the status quo in important ways. By expanding health savings accounts and allowing them to be used to pay monthly premiums, the Senate bill finally extends a tax benefit for health insurance to at least some customers in the individual market. It also, at least on paper, reduces Medicaid spending in the long run.
There is another positive provision worth mentioning, but this one is more controversial. The Senate bill adopts a version of something Sens. Mike Lee, R-Utah, and Ted Cruz, R-Texas, proposed earlier. It would allow insurers to offer less-comprehensive and thus cheaper policies to those who prefer them. In theory, this would make cheaper insurance available and pull many healthy people back into the market who until now have chosen instead to pay the fine (or tax if you prefer) that Obamacare imposes on the uninsured.
This is an excellent idea on its own terms. But there is a good reason Lee is still not sure he'll support it. Unlike what he and Cruz proposed, the new version tries to create this market for catastrophic insurance without abandoning an Obamacare rule that requires all customers in the individual market and in small-groups insurance in a given state to be within the same risk pool. That might blunt or destroy its effectiveness in bringing insurance prices down.
Lee has reasonably said that he's open to voting for this, but will not be convinced until someone knowledgeable can reassure him that this scheme will actually work.
That should be Republicans' chief concern — that whatever they pass actually works. There is a danger, in the current environment, that they will pass something simply because they feel the pressure to act.
It's one thing to pass a bill in the belief that your party will otherwise suffer the perception of being dysfunctional or incapable of governing. It's quite another to live under such a bill, especially if its effectiveness as policy has been subordinated to political considerations. Every voter will have to do the latter. Political considerations won't save a dying individual insurance market, roughly half of whose carriers have dropped out of Obamacare since its inception.
It has become increasingly evident that Republicans are not going to repeal Obamacare "root and branch." Most conservatives have accepted this. Everyone reasonable at this point is hoping they pass something that makes improvements.
But GOP lawmakers need to be careful. If they pass legislation just because they feel pressure to do something, they risk making the same mistake that Democrats did when they backed the flaw-ridden Senate version of Obamacare without amendment in the House in 2010. Yes, Democrats got their bill through. But they also lost the House and Senate in successive midterm elections as a result. If anyone should be aware of this danger, it's the Republicans.