"If we fail," Sen. Majority Leader Mitch McConnell warned Republicans who resisted the GOP healthcare bill, "we're going to be negotiating with Chuck Schumer."
It was almost Trumpian in both its take-it-or-leave-it tone and as a stark declaration from a party leader of independence from the party. But it also raised a question: negotiating what, exactly?
If you listened to Republican leadership for the past eight years, you believed their agenda was repealing Obamacare. That was the central campaign promise. That was why voters had to put Republicans in charge of the House in 2010, the Senate in 2014, and the White House in 2016.
If repealing Obamacare is the aim of the Republican healthcare effort, what possible common ground could McConnell have with Schumer? Schumer calls Obamacare one of "the three pillars that support the American healthcare system." Obamacare is the signature achievement of congressional Democrats this generation.
So if McConnell thinks he can work with Schumer on reforming healthcare, then Obamacare repeal isn't his ultimate goal. He clearly has some other aim.
The best guess is that the GOP leadership's main aim is propping up insurance companies.
This isn't necessarily craven. It may not be cronyism. But saving Aetna, Cigna, and Blue Cross in order to prevent an insurance market collapse wasn't exactly the platform on which Republicans took over Congress.
The Better Care Reconciliation Act does not repeal Obamacare. It leaves in place many of the regulations of the private insurance market—regulations the private insurers agreed to in 2008 in exchange for a bigger pool of customers—thus making permanent the Obamacare foundation of intensively regulated and heavily subsidized private insurance.
One of BCRA's innovations is Section 106, the "State Stability and Innovation Program." This section appropriates $50 billion over the next four years for the federal government "to fund arrangements with health insurance issuers to address coverage and access disruption and respond to urgent health care needs within states."
Insurers these days are nervously warning Republican senators that they foresee Obamacare's individual market collapsing, and this story hardly seems farfetched. In Iowa, earlier this year, the sole remaining insurer almost pulled out of the individual market. One insurer decided to stay in for 2018 while saying it would raise premiums by more than 40 percent. The worry—the threat—is that the dam will break in 2019, and insurers will flee the individual market altogether in many states.
This has Republican leaders very concerned, for at least three reasons.
For one thing, a collapse in the individual market is bad, because it makes it harder for people who want insurance outside of their employer to buy insurance.
Second, Republicans tend to be very sensitive — at times too sensitive — to the concerns of major businesses lobbies.
Third, a collapse of the individual insurance market would hurt a lot of people, and the consequences would manifest themselves with brutality in October 2018, when people are trying to renew or buy into a new plan for 2019. October 2018 happens to be one month before the midterm elections. Republican leaders fear that such turmoil will fall on them politically because Republicans control the White House, the House, and the Senate.
Operating under this fear, Republicans created the stabilization fund. But they've done plenty more to help the insurers. The bill restores a contested Obamacare subsidy known as the Cost-Sharing Reduction Payments (or CSRs). Republicans have to date refused to appropriate money to fund these payments, which go to insurers required to reduce copays for low-income customers. The GOP had actually sued — successfully — to block the Obama administration from paying out this money. BCRA authorizes these payments.
There's more good news for insurers in this bill. Deviating from earlier models of GOP reform, BCRA does nothing to diminish the tax subsidy for employer-sponsored insurance. The rejiggering of subsidies for individuals' health insurance combines with a rollback of Medicaid's growth, meaning that means some people will end up with subsidized private insurance instead of Medicaid.
And the insurers' biggest objection to the bill that came out last week was its repeal of the individual mandate. On Monday, Republican leaders fixed that problem by creating a waiting period for anyone who goes uninsured for more than two months. This may not be as good for insurers as Obamacare's mandate, but it's certainly an incentive for low-risk people to buy insurance.
So the GOP leadership is ready to do what it takes to prop up the health insurers who warn of an impending collapse—even if that requires cutting a deal with Chuck Schumer.
Timothy P. Carney, the Washington Examiner's commentary editor, can be contacted at firstname.lastname@example.org. His column appears Tuesday nights on washingtonexaminer.com.