What’s next for Obamacare reform in the Senate?

Yesterday, Senate Majority Leader McConnell announced that there would be no Senate vote on Obamcare reform legislation this week. Instead, the Senate will take up the matter of reforming Obamacare in July.

Also yesterday, GOP Senators met with President Trump at the White House. The purpose was to see how the pending bill might be altered so as to get at least 50 of the 52 Republicans to vote “yes.”

Based on second hand reports about the meeting and other developments, here, for what it’s worth, is my understanding of where things are:

Sen. Susan Collins has made it clear that she sees no revisions to the Senate bill that would cause her to vote for it. This is probably just as well. It would be unfortunate at several levels if the GOP tried to alter the bill to capture Collins’ vote.

However, McConnell now needs to keep defections from the center to one. If, say, Sens. Murkowski and Heller both vote “no,” McConnell can’t get to 50.

This probably means the GOP will have to move somewhat to the left on Medicaid reform. This issue is, I believe, the main hang-up for GOP moderates.

If all of the moderates except Collins come aboard, McConnell still needs all conservatives but one to support revised legislation. Sen. Rand Paul looks like a very hard sell, so Sens. Ted Cruz, Mike Lee, and Ron Johnson become crucial.

They can’t be won over on the Medicaid side — that would lose the vote of Heller and probably of Murkowski. But perhaps they can be won over on the market-based, regulatory side — in other words, by adding reforms that will overcome to a greater degree than has been attempted so far the stifling Obamacare regulations, giving more sway to market forces.

Senator Cruz has proposed an amendment designed to accomplish these things. It’s called the “Consumer Freedom Amendment.” Among other things, the amendment would allow insurers to sell slimmed-down, lower-premium plans (e.g., “catastrophe plans”) to consumers who don’t want to pay for all 10 medical services mandated by Obamacare.

To do so, insurers would also have to offer an Obamacare-compliant plan. But I see no problem with this. Give consumers a choice, rather than have the government decide.

Here, then, is the possible compromise that might get McConnell and Trump 50 votes: soften the Medicaid reform and add Cruz’s consumer choice concept.

I have suggested that the test for Obamacare reform legislation should be twofold: (1) is it better than Obamacare and (2) will it produce lower premiums/deductibles.

I set the bar this low because I recognize that Trump could use a “win” and congressional Republicans don’t want to face the electorate next year without having done something about Obamacare. At the same time, neither Trump nor congressional Republicans can afford to own health care legislation that does not lower skyrocketing premiums. Hence, the second prong of my test.

Both the House and Senate bills are an improvement over Obamacare, I think. With something like Cruz’s “Consumer Freedom Amendment” added, the Senate bill would be an even bigger improvement.

Cruz’s amendment also seems likely to produce a reduction in premium prices. Plans that don’t include all 10 of the required Obamacare elements, some of which are completely unnecessary for many consumers, should cost less than Obamacare-compliant plans.

Thus, although the compromise bill I’ve outlined above would still be seriously flawed, it strikes me, at least on first impression, as legislation the Senate should pass.

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