On Tuesday, the Senate voted to proceed with debating and amending the healthcare bill passed by the House on May 4. This amendment process will allow modifications to any part of the bill within the budget reconciliatory rules, turning the Senate into a “wild west” scenario, according to Senator Bob Corker (R-Tennessee). Vice President Mike Pence provided the tie-breaking vote.
Even with this minor victory, Senate Majority Leader Mitch McConnell is stuck between a rock and a hard place. The conservative and moderate sides of his party have stymied his efforts to repeal and replace the Affordable Care Act, also known as Obamacare. Each time he tries to appease one faction of Republican senators, he loses the support of the other.
Despite having voted over 50 times to repeal and replace the ACA under the Obama administration, Republicans are finding it much more difficult to pass new legislation now that this healthcare entitlement has been established for seven years.
Faced with rising premiums and just one insurer on their exchanges in many parts of the country, including South Carolina, the votes to repeal and replace the ACA are simply not there.
As of now, there are two competing options for McConnell and the Republicans. The first would be to pass the Republican version of healthcare reform. The second option would be to repeal the ACA now and allow for a two-year adjustment period to find an alternative plan. The Congressional Budget Office, a nonpartisan government agency tasked with forecasting the effects of major legislation, has predicted that a repeal without a replacement plan would lead to 32 million people uninsured over the next decade.
President Trump has proposed a third option: to let Obamacare fail under its own weight. Dr. Robert Hartwig, an expert on the ACA and finance professor at the Darla Moore School of Business, said, "[This] is simply not an option. It would be a huge strategic error on the part of Republicans."
Hartwig continued: “The idea of just letting Obamacare fail as the president has stated, is not something that I think is going to resonate with voters. Voters will say you have had two years with control of the House, the Senate and the White House and you have had a total of a decade to develop an alternative and you are going to say that you can’t do anything about it?”
Neither legislative option seems to have enough support in the Senate to pass. Republicans may have to fend with the understanding that they will be held accountable for premiums continuing to rise and insurers continuing to fall out of the exchanges. Keeping the 2018 midterm elections in mind, the Republicans may have to work with Democrats to negotiate reforms to the ACA.
In an increasingly partisan era of politics, a compromise may sound odd, but this is how legislation has been historically developed in this country. The ACA was put together with very little Republican input and now, it seems, both sides are going to have to come together and work out the issues that everyone sees as problematic.
“I think we’re fast approaching that the only option is going to be for Republicans and Democrats to sit down together and to develop a workable solution that addresses the problems in the Affordable Care Act,” Hartwig said.