The fate of America’s healthcare system is hanging in the balance at the moment, as various proposals for reforming healthcare pass through the Senate.
I’ve spoken to a lot of people since Monday who’ve asked me “So what was it that John McCain voted for? Did that pass? Does that mean that Obamacare is being repealed now?”
If you’re trying to work out the difference between repeal-and-replace, repeal-only, or skinny-repeal, you’re definitely not alone.
Here’s a guide if you’re struggling to keep up.
So, where are we now?
On Tuesday, the Republicans tried to get an amended version of the Better Care Reconciliation Act passed (linked if you’d really like to read it). The Better Care Reconciliation Act (for once, a Senate bill without a catchy acronym) was a proposal by Mitch McConnell to repeal and replace the Affordable Care Act. Despite John McCain voting for the Act, the act was defeated. Fifty-seven senators voting against it, including nine Republicans.
Not to be deterred, McConnell put another plan to repeal Obamacare and put off a replacement for two years to the Senate on Wednesday. This was also defeated, this time with fifty-five senators against it. Still following?
Good, because here’s where things get slightly complicated.
There’s going to be another vote, which could take place on Thursday, on another bill from McConnell. This is McConnell’s “skinny repeal bill.”
Right now, McConnell is in an interesting position. On the one hand, he managed to get Senators to agree to start two debates on repealing, and repealing and replacing Obamacare without knowing which proposals were going be considered. In knocking back both of those plans, Democrats have managed to ensure that at least some of Obamacare is going to remain in place.
Right now, the big debate is about how “skinny” the skinny repeal bill will be.
CNN claim to have a source that’s seen an outline of the bill.
Here’s what’s laid out in that outline: Repealing the individual mandate, repealing the employer mandate for a minimum of six years, providing greater flexibility to the states through the 1332 waiver, and defunding Planned Parenthood, directing those funds to Community Health Centers.
While this is clearly not “nothing,” it will leave much of Obamacare intact. The Medicaid expansion, that has seen 14m Americans get healthcare, will stay. The Obamacare exchanges will stay too. Federal subsidies that refuse the cost of health insurance to low-to-middle income households also stay. Insurers will not be able to bar people with pre-existing conditions.
That said, repealing the individual mandates will be damaging in its own right. A 2015 analysis by the Congressional Budget Office found that eliminating the individual mandate would increase the number of uninsured by about fifteen million over a decade and raise premiums for everybody else by about twenty per cent.
The big worry at the moment is that if McConnell manages to get the skinny repeal bill through, that it will magically sprout new provisions during the summer recess. The working assumption is that McConnell wants this bill to then go through a congressional conference committee. This would then roll back the remaining bits of the ACA that the Republicans don’t like.
While no one would doubt that McConnell is enough of a little bastard to try something like this, there are problems with this approach. There’s no reason to suppose that a conference committee is going to plump for an extreme repeal of Obamacare.
That said, even if skinny repeal goes through relatively unscathed, Republicans could then claim that they’d managed to repeal at least some of Obamacare. But right now it’s looking far from certain that even skinny repeal will go through.
Hope you’re ready with the popcorn!