About a month ago, when the Senate Republican leadership unveiled its initial health care proposal, it was widely assumed that the less conservative GOP senators wouldn't like the plan. Party leaders, however, were confident that the so-called "moderates" would succumb to pressure and toe the party line.
"Moderates always cave," one senior GOP aide said at the time.
This was certainly true in the House, where more centrist lawmakers proved to be useless, and it appears that Senate Majority Leader Mitch McConnell (R-Ky.) hopes that it's true in the upper chamber next week. The Huffington Post explained that the new GOP is "basically the same as the old one."
[T]he revised version of the Better Care Reconciliation Act ― which McConnell pulled two weeks ago because too few Republican senators planned to vote for it ― remains a vehicle for massive cuts to Medicaid, less financial assistance for people who buy private health insurance, and the return of skimpy junk insurance policies and discrimination against people with pre-existing conditions. Taxes on the rich would remain, but health care companies would enjoy a major tax cut.
The Senate Republican leadership, in other words, is still counting on the so-called "moderates" to cave. Today's proposal is effectively a dare to the Collins/Murkowski wing of the GOP conference.
In the wake of failure in June, McConnell was presented with a daunting challenge: opposition to the original iteration of his plan was so broad among his own members, the Majority Leader needed to move his bill to the left and the right simultaneously.
To that end, as NBC News' report documented, McConnell tweaked his original proposal in some ways to appease more centrist members: the bill now includes, for example, more money for treating the opioid epidemic and keeps the Affordable Care Act's tax on investments, which affects the wealthy.
These are pretty modest changes, largely unrelated to the concerns raised by the bill's less conservative opponents. At the same time, however, McConnell also moved the bill to the right in more dramatic ways, including Sen. Ted Cruz's (R-Texas) measure about empowering insurers to sell plans that ignore the ACA's insurance safeguards alongside plans that do.
Vox's Ezra Klein explained what would happen if private insurers can start offering plans that deny people coverage for pre-existing conditions and sidestep essential health benefits.
What will happen here is clear: The plans that have to offer decent coverage to anyone who wants it, no matter their health care history, will become a magnet for the old and the sick or the soon-to-be-sick, as they can't afford, or perhaps can't even buy, the other plans. That will drive premiums in those plans up, pulling younger, healthier people into the non-compliant plans.The Senate bill thinks it has a fix: a roughly $200 billion fund to offset the costs of sick enrollees. So, in short, what the GOP bill attempts to do is to rebrand high-risk pools as Obamacare plans and make them subsidized dumping grounds for the sick and the old, while everyone else buys insurance in a basically unregulated market.This is a very bad idea for anyone who is sick, has been sick, or is likely to get sick. It attacks the core changes Obamacare made to build insurance markets that serve the sick, the well, and, crucially, everyone in between.
Again, putting an idea like this one in the new-and-not-improved version of the blueprint is a direct challenge to "moderates."
We'll know more about the broader effects of the bill once the Congressional Budget Office releases a score, but there's very little here to suggest Republican Plan 2.0 will be much of an improvement over Republican Plan 1.0 on points such as taking coverage from tens of millions of Americans. Those who saw the first version as a regressive disaster will be equally repulsed by what GOP leaders unveiled today.
As for the bill's prospects, it's only been two hours since McConnell's latest bill has been available, but it already appears to be in trouble. The next procedural step would be a motion-to-proceed vote on the Senate floor, and in this case, it will need at least 50 votes to move forward, which means no more than two GOP senators can break ranks.
Already, three Senate Republicans -- Kentucky's Rand Paul, Maine's Susan Collins, and Ohio's Rob Portman -- have suggested they'll vote no on the motion to proceed. If those votes hold, the bill will die.
Update: Despite some reports that Portman was inclined to vote no, he is, as of this afternoon, officially undecided.