Wednesday, January 4, 2017

Obamacare and budget reconciliation?

I'll take another break from "Assessing democracy..." because we have more actual stuff happening.  This time, on Obamacare.  And, actually, the aborted Ethics changes, which tell us something about Obamacare too.

Senate Republicans seem to be going the route of "budget reconciliation" for an Obamacare repeal process.  I've actually talked about this a bunch of times, and it gives us plenty of new information about what Republicans are thinking.  As a reminder, a "budget reconciliation" bill cannot be filibustered in the Senate because there is a built-in time limit for debate.  However, it can only be used for budgetary matters, and budget reconciliation bills can only increase the deficit for ten years.  Since Obamacare had non-budgetary provisions, like requirements that health insurance companies provide insurance to those with pre-existing conditions, and it was scored as reducing the deficit, the Republicans couldn't repeal it with budget reconciliation.  So, what do we learn?

1)  The Republicans aren't using the nuclear option to get rid of the filibuster in the Senate to do a full repeal of Obamacare.  They could have!

2)  That means they are terrified of repealing Obamacare.  But, we knew that!

3)  They have no plan (fuckin' Cylons strike again!).  The poorly formed nature of the proposal shows that their repeal plan is about as well-structured as the replacement plan that will never exist.

4)  This is where the Ethics thing comes in.  The caucus over-ruled the leadership and backtracked because... no planning.

5)  The future of Obamacare is still indeterminate.  Even with budget reconciliation, a couple of Republican Senators could peal off and decide that they don't want to vote for a proposal that causes a healthcare death spiral before there is a replacement (which we all know will never happen anyway).  Will they vote down a whole reconciliation bill?  Maybe not.  Maybe they just strip it down with amendments to some minor stuff, or something like that.  Maybe they put in a trigger that doesn't go into effect until a replacement is passed, and since there will never be a replacement, the whole thing is just a joke.  I dunno.  There are a lot of ways to cheat this thing for Susan Collins, Lisa Murkowski, and maybe one or two more who get a bit twitchy.

6)  Watch the lobbyists!  Weakly-formed though the plans are right now, they freak the ever-living-fuck out of the healthcare industry.  Health insurers and doctors are going to read about the proposals, as they are worked out, and organize to talk to GOP Senators.  I wonder what will happen!

What will happen with Obamacare?  I still have no idea.  I wouldn't put money on anything right now.  GOP leadership is scared shitless that they are going to get what they have been saying they want, but the problem is that it is a hell of a lot easier to complain about people whose premiums have gone up than it is to take away people's health insurance entirely, and that latter thing happens too when you actually go through with a repeal.

Ted Cruz understood this when he pushed for that 2013 shutdown.  He was lying to everyone when he said the shutdown could work, but he was right that once the subsidies went into effect, the politics changed...

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