One of the most effective rallying cries against the Affordable Care Act in 2009 and 2010 was a simple question: “Have you read the bill?” The question was an indictment of a 2,700-page measure that was poorly understood by those voting for it, sold to the public under false pretenses (“if you like your plan, you can keep your plan”), and rushed to a vote in the Senate on Christmas Eve.
If Senate Republicans are asked that question today about their own bill partially to repeal and replace Obamacare, their answer will be “No.” They haven’t read it because they haven’t seen it.
Fifty GOP senators (with the help of Vice President Mike Pence) voted on Tuesday to open up debate on health-care legislation. They knew they didn’t have the votes to pass either the current repeal-and-replace bill or the bill they passed in 2015 to repeal Obamacare’s taxes and spending (but not its regulations) after a two-year delay. So the leadership’s plan, after the failure of repeal-and-replace and repeal-and-delay, is to bring a slimmed down or “skinny” repeal bill to the floor.
We offer no opinion on the “skinny” bill because—like everyone else, including most Republican senators—we have no idea what’s in it.
Even conscientious lawmakers (and there are some) can find it impossible to comprehend every word of every bill they vote for or against. And repealing or reforming a 2,700-page law doesn’t require a wonkish grasp of every detail. Even so, it’s worth remembering that it was the passage of an unread bill in 2009 that created this byzantine mess in the first place.
Current circumstances—a slim Senate majority, a president apt to undermine any reform effort with wildly inconsistent messages—suggest a more targeted approach. The reconciliation process could be used to effect some rational changes: allowing people to use Health Savings Accounts to pay for their premiums, for instance; or eliminating the the employer mandate; or defunding Planned Parenthood. These measures aren’t complex, and using reconciliation to pass them would preclude any possibility of a filibuster. (Repealing the hated individual mandate is probably not a wise option without also loosening requirements on insurers covering preexisting conditions, and the latter is extremely unlikely to happen in the “skinny” repeal bill.)
With several centrist Republicans evidently determined to stop any significant reform to Medicaid—Dean Heller (NV), Shelley Moore Capito (WV), Rob Portman (OH), and Lisa Murkowski (AK)—scaling back Obamacare’s grossly irresponsible expansion is almost certainly beyond hope. So, it appears, is any large-scale reform. But Senate Republicans still have an opportunity to execute some sane reforms—and time enough to read those reforms before they pass them.
