McConnell’s AHCA Kabuki

he McConnell Obamacare repeal and replace “discussion draft” is worse than I imagined possible even taking into account that it would be worse than I imagined possible. I fear he made sure it was horrible so moderate Senators could win staged battles and claim they had saved people (needless to say I am not the first to write of this possibility).

I guess a vox explainer is always useful and Sarah Kliff is very smart thorough and reliable.

The bill is surprisingly aweful in two ways. First it doesn’t slow the phasing out of the ACA Medicaid expansion over 7 years but rather does it in 3 (from 2021 through 2024). Several relatively non reactionary Republican senators stressed how important of 7 year phaseout was to them. Also the bill contains no additional funding to deal with the opioid addiction crisis. Many of those senators specifically proposed this increased funding.

I fear that this is all theater. That the so called moderates will get their 7 years and their opioid treatment funding and then vote yes. Not including them in the “discussion draf” will make this more dramatic, allow the self described moderates to claim credit, and give them cover.

The Senators in question are almost saying this is their price.
I will include phone numbers in case any reader is interested in calling to say he or she is not falling for it. All are from the very useful
https://www.trumpcaretoolkit.org/

The Senators include
Robert Portman of Ohio (202-224-3353) who wrote
portman

This almost explicitly says his price is an extended Medicaid phaseout and, especially, money for treatment of opioid addiction.

Shelley Moore Capito of West Virginia (202-224-6472 called senator Capito with the accent on the a not on the i as in the Italian word for understood)
She has a very strong position on increased opioid treatment funding. West Virginia (like Ohio) is hard hit by the epidemic.

Her web page includes

Earlier today, I posted a link to the health care discussion draft on my website for all West Virginians to read. Over the course of the next several days, I will review the draft legislation released this morning, using several factors to evaluate whether it provides access to affordable health care for West Virginians, including those on the Medicaid expansion and those struggling with drug addiction.

Which, again, is very clear. I want to mention that I guessed there was a press release similar to Portman’s before checking, and why, lo and behold, there is (it’s almost as if they coordinated).

Dean Heller of Nevada (202-224-6244 is another self described moderate (and up for election in 2018 and very vulnerable)

His web page has

“Throughout the health care debate, I have made clear that I want to make sure the rug is not pulled out from under Nevada or the more than 200,000 Nevadans who received insurance for the first time under Medicaid expansion. At first glance, I have serious concerns about the bill’s impact on the Nevadans who depend on Medicaid. I will read it, share it with Governor Sandoval, and continue to listen to Nevadans to determine the bill’s impact on our state. I will also post it to my website so that any Nevadans who wish to review it can do so. As I have consistently stated, if the bill is good for Nevada, I’ll vote for it and if it’s not – I won’t.”

Again quite clear. The phrase “the rug is not pulled” is almost explicit that slowly sliding it out from under them would be OK. The reference to Sandoval is important, as Sandoval is very popular in Nevada and signed a letter opposing the House AHCA and generally arguing for bipartisan compromise (so did Gov. Kasich of Ohio whom Portman didn’t mention).

update 3: This is interesting. John Ralston is a very highly respected expert on Nevadan politics. He tweeted

“I don’t think so. And will say he [Heller] votes No after consulting with @GovSandoval.”
replying to another top reporter, Ronald Brownstein, who tweeted “#AHCA reduces # covered by Medicaid in NV by 45%. #SenateHealthCareBill proposes > l/t cuts. Can @SenDeanHeller vote Y? @RalstonReports”
end update:

OK how about Lisa Murkowski (202-224-6665 only interested in voice mail from Alaskans) ?
Nothing yet. I actually find this promising. She might not have decided on the price of her vote.

Finally (for moderates for now) Susan Collins of Maine (202-224-2523) Nothing on the McConnell discussion draft yet. A lot on the Opioid crisis (very bad in Maine too). Also “bipartisan” is her favorite word. Actually the web page section on health looks OK. Her voting record doesn’t. Collins and Murkowski strongly support funding for Planned Parenthood. Neither have said they will vote no if the elimination of that funding stays in the bill (most likely they propose an amendment and it goes down 50-51 including Pence). I do not want to count on Senator Collins growing a spine.

update: Collins spoke with the press instead of having a staffer write a press release. Her comments as reported by Tierney Sneed are mildly interesting

Sen. Susan Collins (R-ME) gave the Senate health care bill released Thursday a mixed review, but zeroed in on its major cuts to Medicaid as a potential problem for her.

She took issue with how the Senate bill, starting in 2025, used a rate of growth for federal funding for Medicaid that is significantly slower than the typical increases of costs for the program.

“I’m very concerned about the inflator that would be used in the out years for the Medicaid program,” she told reporters in the Capitol a few hours after the bill was released. “It’s lower than the cost of medical inflation and would translate into literally billions of dollars of cuts.”

She added that she was concerned about how the cuts would negatively affect rural hospitals or prompt states to restrict Medicaid eligibility.

This might amount to something. Unlike “pulling the rug out” Heller, Collins is talking about the long term and a huge amount of money. The ceiling on Medicaid spending amounts to a huge cut over 10 years. It is they key measure used to finance the bill’s tax cuts for the rich. Unlike the 3 year Medicaid extension phase out it can’t be fudged. The case for Heller, Capito, Portman Kabuki is strongly supported by the fact that they don’t specifically address the ceiling.

It is vital that people who had no problem before the ACA understand that they will have huge problems if the AHCA passes, because of the huge cuts of legacy (pre-ACA-expansion) Medicaid spending. The fact that Collins discusses this would be a hint that she might actually vote no (if she weren’t actually Senator Susan Collins (R-Maine) who always always caves).

end update:

update 2: Collins is stealing the stage. I think she is torturing us. She said she can’t vote for a bill which deprives tens of millions of health insurance (I’ll believe she can’t if she votes no and not before)


ehd update 2:

Separately 4 right wing Senators said the McConnell draft is too close to the ACA: Ted Cruz, Mike Lee, Ron Johnson (Wisconsin) and Rand Paul (Kentucky).

I think Paul might really mean it. He is extreme and resistent to party discipline. Also the ACA has benefited Kentucky enormously. Blocking the repeal bill would be good for Rand Paul (and Mitch McConnell). Blocking it for not being extreme enough could be crazy like a fox 11- dimensional Aqua Buddha chess.

Ron Johnson has been hinting a no for a long time. He was just re-elected. Here I think that senators with 6 safe years might be more likely to vote no. Failure to pass a bill with hurt Republicans in the short run. Passing a horrible bill will hurt them in the long run.

I’m pretty sure Cruz and Lee are play acting. My guess is that they said no to establish a bargaining position — if McConnell is the right most position, the bill will move further left than if they pretend they might vote no. I read somewhere thatCruz had an individual statement in which he made it almost clear he was going to get to yes.

Summing up, I have no prediction for how this will end. But I do very strongly suspect that Heller, Capito and Portman will win two (staged) battles and get 7 year phaseout and some opioid money, declare victory and vote yes.

update 4: My prediction was wrong (as usual). Heller denounced the bill. He described many of its horrible aspects, definitely including the long term cuts to legacy Medicaid. This is not an issue which can be fudged, because the amount of money involved is huge. He still might cave, but it would be an authentic cave not a staged victory. This is very good news. Also there is even better news reported by The Washington Post

Sen. Dean Heller (R-Nev.) announced that he could not vote for the legislation without revisions, singling out the measure’s long-term spending cuts to Medicaid as the reason for his opposition. The announcement caught some Republicans in Senate Majority Leader Mitch McConnell’s orbit by surprise.

If McConnell had been counting on Heller, his count could be off. In particular, he might have counted to 49 and assumed he could get one more from a senator unwilling to decide the victory for the Democrats. Heller’s announcement takes pressure off of her (she is named Lisa or Susan).

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