Welcome back and hope you had a good 4th of July. I will not repeat my usual obnoxious habit of explaining every July that the date the Continental Congress voted to declare independence from Britain was actually July 2. But, if you missed the other umpteen times I wrote that piece, here’s one of the old versions. Of slightly less historical import but making news while MinnPost was down for the holiday …
…With all humility and a willing acknowledgement that I can’t see the future: For the moment, I decline to take the suddenly-slightly-fashionable scarey/stupid “repeal-now-replace-later” approach to the Republican health care dilemma seriously.
Idea floated on Fox
Sen. Ben Sasse, R-Nebraska, seems to have brought this idea back for the current round of discussion, but he controls roughly 1 percent of the votes in roughly one of the houses of roughly one of the three branches of the federal government. He floated the idea on “Fox & Friends” on Friday morning and, 18 minutes after he ran it up the Foxy flagpole, President Trump (I’m guessing he was watching the show) tweeted:
“if Republican senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date.”
It is truly frightening to think a remark by one senator on a morning news show is the basis for a change in presidential position on a subject of this magnitude. Because I am hung up on such things, I must point out that Trump very explicitly rejected the repeal-now-replace-later idea on Nov. 11 on “60 Minutes,” dismissing it as stupid and not-gonna-happen. As far as I can tell, he has not explained when or how it got smarter, but one gathers there’s only so much brilliance you can fit in a tweet.
Sasse suggested a one-year-later effective date for the repeal so the House and the Senate and the president can spend that year coming up with the replacement plan (neither the specifics nor the broad outlines of which are known at this time, but rest assured, it’s gonna be great).
But neither Sasse nor Trump has given an answer that I can find to this question:
If you pass the repeal bill, and aren’t able to agree on a replace bill (and how can anyone possibly feel confident that they will agree on one), what happens then?
Replaced by nothing?
In such a not-so-very-unlikely case, presumably the Affordable Care Act – which, for all its assets and liabilities, has cut roughly in half the portion of the non-elderly population that was uninsured before the ACA passed in 2010 – just goes away and is replaced by nothing.
The Congressional Budget Office estimated recently that number of Americans without insurance in 2026 would rise by 23 million under the House version of Trump/Ryan care, and by 22 million under the Senate bill now under consideration. Those estimates were bad enough, but more recently and with a bit less notice, the CBO estimated that spending on Medicaid – the chief federal health care program for the poor and near-poor – would be 35 percent lower in 2036 under the supposedly more moderate Senate version of the bill than under current law.
Sasse and Trump seem to want to assure us that that would not happen. Why? Because, of course, if the Republican-controlled Congress passed a law putting Obamacare on a one-year sentence to oblivion, the same members who cannot agree on a replacement plan now would be able to agree on one then.
Or, to put it another way, what if they don’t?
You could convince me that they would feel under even more pressure to come up with a new plan. And you could make a sort-of non-reassuring argument that it might work. But I haven’t heard Sasse nor Trump nor anyone else identified with this new plan-to-have-a-new-plan-then-that-we-can’t-come-up-with-now explain why the plan is guaranteed to work and the bill to pass or discuss what happens if it doesn’t.