How Insane Could This Get?

How Insane Could This Get?

At long last, the Senate is poised to begin voting today on a measure to repeal and/or alter portions of the Affordable Care Act.

Much remains in flux regarding process and the substance of what will be voted on.   According to multiple media sources today, Senate leaders latest strategy is to hold a vote on a narrower piece of legislation than those circulated in recent weeks.

The substance of such a measure—if indeed, it exists and is submitted for a vote—is unclear as of this posting.  But it reportedly could contain just a repeal of the ACA’s individual and employer mandates and a few of the law’s taxes, such as the one on medical device companies.

This narrow, or “skinny,” bill would not have any provisions pertaining to Medicaid.

The idea, apparently, is to pass this initial piece of the puzzle—to get things going—and then to take up the larger and more controversial issues that have so deeply divided the Republican caucus.

According to the Huffington Post, House and Senate leaders would then try to negotiate a version of the more comprehensive legislation in both chambers that Republicans could rally around.

That would seem still to be a tall order, especially if they are still trying to get it all done before the August recess, which begins August 11.  Of course, that’s subject to change as well.

And there’s not yet any certainty that initial votes would allow this “skinny” bill process to proceed.  Some Republican lawmakers might balk out of concern that no replacement for the mandates and larger bill, for example, would ever be forthcoming.  That would then compel a vote to repeal the initial repeal bill since that bill would likely lead to a rush to the exits by insurers now serving the exchange markets.

CBO has estimated that repealing the individual mandate while leaving the rest of the ACA’s regulations in place would result in 14 to 15 million more uninsured and premium hikes of 20 percent within a few years.

There’s broad consensus that John McCain’s return to the Senate today adds significant impetus to Republican efforts—in terms of sentiment and possibly some outright political opportunism leveraging his dire diagnosis to spur action.

As Axios’ David Nather opined this morning: “How insane could all this get? Completely, wildly, utterly, spectacularly insane.”

Further spinning our heads in the last few days, Democratic leadership has begun to talk openly about submitting and pushing a “Medicare for All” bill this year and in 2018 if the Senate effort fails.

THCB’s editor asked me to write this quick synopsis of where things apparently stand today (July 25), and to get the ball rolling on comments and updates over the coming days.   All thoughts welcome as this historic process begins.