The bitter argument over repealing and replacing the Affordable Care Act reaches a climax of sorts this week in the U.S. Senate.
Anyone who’s ever been sick or expects to be should pay close attention to three stories from Washington:
▪ The Congressional Budget Office will issue a report on the expected impact of the new GOP health care alternative, known as the Better Care Reconciliation Act. The CBO score is expected to still show millions of Americans will lose Medicaid coverage if the measure becomes law.
Republicans will boo the umpire, and some may try to ignore the CBO’s conclusions. You should not: The projections will be a significant part of the debate.
▪ The Senate parliamentarian may weigh in on a part of the bill known as the Cruz amendment, named for the Texas senator. Ted Cruz wants to allow insurers to sell inexpensive insurance policies to healthy people, while crowding the sick into costlier comprehensive plans.
But the parliamentarian may decide Cruz’s amendment can’t pass with a simple majority (don’t ask why). If that happens, the amendment will collapse.
▪ The Senate itself will consider a “motion to proceed” to start debating the bill. It takes a simple majority.
Already some Republicans are claiming the motion is a mere technicality. “This isn’t a vote on the merits of the bill,” Sen. Lamar Alexander told Politico. “This is a vote on whether to even talk about it.”
If Moran and his colleagues vote yes, the path will clear for Senate Majority Leader Mitch McConnell to offer his own substitute bill in a week or two. Then he’ll dare Republicans to vote against it — President Donald Trump, he will say, has to have a victory.
It will be hard for senators like Moran to defy the president and oppose a health care reform bill that close to the finish line. The best way to stop the Senate bill is to avoid any debate, a concept Moran surely understands.
Already two GOP senators have said they’ll vote against starting debate. One more, and the bill dies.
Then what happens?
Congress will likely cobble together a short-term rescue package for places where Obamacare exchanges are in trouble. Republicans will insist on a price — Democratic votes to raise the debt ceiling, for example.
Then everyone can move on to tax reform and the budget.
That would address the immediate problem but would not solve Obamacare’s fundamental challenges, which all sides acknowledge.
But defeat of the Senate GOP alternative might give health policy experts in both parties enough breathing space to work on important ideas addressing those shortfalls. Just last week a conservative writer suggested offering every American catastrophic coverage, paid for by taxes.
The money would come from ending the tax break for insurance provided by an employer. If every American had guaranteed coverage for major illnesses, the cost of private insurance would plummet, and the tax break would be worth less.
It’s an intriguing idea. It will get no traction until Congress clears away the brush by ending the repeal-and-replace meme the GOP has pushed for seven years.
Kansas is watching Moran, who may be the deciding vote.