I've been reading back through my post-November posts on Obamacare repeal strategies, and most of them look a lot like this March critique of the House mess, in which I pointed out that the easiest thing to do was always small-bore stuff. Repeal the medical device tax. Repeal the employer mandate. Call it a series of victories.
The Senate just barely managed to open debate yesterday, and "repeal-and-replace"already went down. In my opinion, Republicans missed an opportunity there. Anyone who wanted to cast a "repeal Obamacare" vote without consequence could have used the parliamentarian's declaration that they needed 60 votes to invoke cloture on McConnell's bill to say they voted yes on something, giving them a pass for any other no votes, but what's done is done. Their loss...
Regardless, where we are now is that Mitch McConnell is playing with fire. Nuclear fire. The new proposal is "skinny repeal," which means repealing the medical device tax, the employer mandate (so far, so good) and... the individual mandate. "Skinny repeal" can pass, and it is extremely dangerous.
In my original strategic proposition, I excluded the individual mandate because the idea of repealing the individual mandate while leaving in place the regulations requiring insurance companies not to discriminate on the basis of pre-existing conditions is absolutely fucking batshit crazy. Insurance is a low-margin business. That's a death spiral waiting to happen. If the healthy people pull out, the insurance companies can't make a profit, and they go under. Or, they just pull out of the exchanges altogether before it happens, en masse.
Obamacare itself is an ideological bill motivated by the notion that the government has a redistributive role to play in the healthcare system. You can oppose it on ideological grounds if you oppose Robin Hood-ism. Obamacare puts the government's gun to people's heads and says, "pay up," as a mechanism to fund healthcare for the sick and the poor. That's a moral tradeoff that not everyone wants to make. That's about ideology. Repealing the individual mandate without repealing the insurance regulations isn't about ideology. It is insane and stupid and indefensible. Some ideas are the realm of legitimate debate. Others deserve nothing but scorn. This is the latter. And of course, this is hypocritical since we all know that the individual mandate was part of Romneycare, which came from the Heritage Foundation, and the GOP supported it until the Democrats did too.
I didn't originally think the GOP would push a repeal of the individual mandate without changes to the insurance regulations because it would be so insanely dangerous. Yet, here we are. McConnell is doing exactly that. Holy shit.
And it can pass. Why? Because it will be really hard for anyone in the GOP Senate delegation to vote against it. The problem is that the GOP has railed against the individual mandate-- itself intrinsically unpopular-- for so long and with such intensity that once you put it on the agenda, voting no will look really fishy. I wouldn't be surprised if even Collins or Murkowski voted for "Skinny Repeal." I just have no prediction here. The pressure to vote yes will be intense.
Make no mistake: on policy grounds, this is probably the most dangerous bill the GOP has proposed. This isn't ideology. This is stupidity. I did a series a little while back on the death of "classical conservatism," and unwillingness to consider unintended consequences, but the thing about this is that we know the consequences of "skinny repeal." This is knowingly crashing the system.
Now, one could imagine a sequence in which "skinny repeal" causes the entire healthcare system to collapse, and the GOP uses that as an excuse to repeal the rest of Obamacare, but this doesn't look like an elaborate plan to me. This looks like McConnell flailing around blindly for anything that can pass. So, he has latched onto something that has been knowingly kept off the agenda precisely because putting it on the agenda alone is so dangerous. Besides, intentionally crashing the healthcare system and expecting to remain in power is hardly a foolproof plan.
There is also the question of what happens when the House Freedom Caucus gets a look at "skinny repeal." After all, McConnell is currently telling everyone in the Senate that it doesn't matter what they pass, because the whole point is to get to conference, but if that's the case, he is basically admitting that he is a shyster, and that nobody should trust him. If the Freedom Caucus wants something bigger, the Senate is back in the same mess, and "repeal-and-replace" is probably dead again.
If the Freedom Caucus accepts reality, though? I've said all along that small-bore stuff can pass. I just never thought McConnell would be this crazy. Small-bore doesn't mean harmless. A tiny blood clot, in the wrong place, can kill you. Holy shit.
I didn't think McConnell was this crazy. He is. He's doing this. "Skinny repeal" really might pass, and it is probably the most dangerously stupid piece of legislation I have ever seen. What next? Are we going back on the gold standard? I know, I know... Don't joke, with this crowd of fuckwits.
Regardless, what are the chances of passage for "skinny repeal?" I have no clue. I wouldn't even hazard a guess. McConnell's strategy all along has been secret negotiation, reveal the bill at the last minute and give nobody any time to think or respond. It hasn't worked so far, but this one is really dangerous. Once it gets to the floor, though, the best chance to defeat it will be the amendment process. Keeping it "skinny" is what keeps it acceptable to the GOP, so once it gets loaded down with amendments, if it gets loaded down, the support collapses. If people really want to defeat it, then, they'll vote for amendments so that support drips away. Beyond that... I just don't know. This is beyond insane. At the last minute, proposing a bill with no formal study that everyone with a brain knows will crash the system, all based on the premise that everyone should ignore its contents because everything will change in conference? This is insane.