Skinny repeal: Yet another terrible health care idea from the GOP

Our view: With all other options failing, Republicans are turning to an Obamacare repeal plan that doesn’t even address their own concerns about the ACA

Just when you thought Republicans had exhausted the universe of bad ideas for repealing and replacing the Affordable Care Act, Senate Majority Leader Mitch McConnell appears poised to pull out yet another loser: the “skinny repeal.” What’s so bizarre about it is that it does nothing to address — and even exacerbates — the aspects of Obamacare that have been driving the effort to repeal and replace the act for the last decade. It is at best a cynical ploy to make conservative voters believe Republicans have followed through with their years of promises to repeal the ACA, and at worst, it’s a sneaky plan to ram through a more radical bill with even less transparency than the GOP has managed so far.

Since the Senate voted 51-50 to start debate on a health care bill Tuesday (with Vice President Mike Pence breaking a tie and Sen. John McCain making a dramatic return from a diagnosis of aggressive brain cancer to even get the party to that point), it has remained clear that the GOP lacks anything approaching consensus on how to move forward. A comprehensive repeal-and-replace bill — which would have showered the affluent with tax breaks while leading to 23 million fewer people with health coverage after a decade — didn’t come close to getting 51 votes, much less the 60 it would have needed to move forward. This afternoon, the Senate followed that up by rejecting the idea of a repeal without replacement, which offered the prospect of ballooning insurance premiums and 32 million more uninsured after a decade.

The next idea on tap, “skinny repeal,” which sounds a bit like a bad, new drink from Starbucks, would involve repealing only a handful of particularly unpopular elements of Obamacare: the individual mandate to purchase insurance, a requirement that large businesses provide health benefits, and a tax on medical devices.

The last of those three is probably the least significant; the Congressional Budget Office estimates that repealing the tax — which has over the years been criticized by Democrats and Republicans alike — would save medical device manufacturers less than $20 billion over 10 years. Repealing the employer mandate, while a cause long championed by the U.S. Chamber of Commerce and other groups influential with the GOP, would similarly have a relatively minor effect. It requires firms with 50 or more employees to offer health insurance. As of 2015, before the provision took effect, 96 percent of U.S. private sector firms of that size already did so, according to the Kaiser Family Foundation.

But repealing the individual mandate would be a big deal. The Congressional Budget Office estimates it would increase the number of uninsured by about 15 million over 10 years, mainly as a result of people no longer choosing to buy coverage in the individual market but also because fewer would get coverage at work or enroll in Medicaid. Meanwhile, because those forgoing coverage would likely be disproportionately healthy, repealing the individual mandate would make the insurance pool sicker and older, driving up rates and leading to more insurers dropping out of the marketplace.

In other words, a “skinny repeal” would make the problems Republicans are citing as the reasons Obamacare must be repealed far worse. It wouldn’t satisfy those who worry that the repeal-and-replace bills aren’t conservative enough, since it would do little eliminate the ACA’s taxes or its Medicaid expansion — much less advance the far right’s grander policy ambition of gutting Medicaid altogether. Nor would it offer many reassurances to moderate Republicans who can’t stomach the increase in the ranks of the uninsured predicted under the previous GOP plans.

Really, the only person who could like it is President Donald Trump, who seems intent on finding some way to claim that he repealed Obamacare, no matter what the actual policy involved entails.

The only other plausible explanation for moving forward with the “skinny repeal” is the idea that Senate passage would trigger negotiations with the House on some new iteration of repeal-and-replace that Senator McConnell might hope to cram through his chamber. Even if he could accomplish that, he would do well to heed Senator McCain’s warning: “The Obama administration and congressional Democrats shouldn’t have forced through Congress without any opposition support a social and economic change as massive as Obamacare. And we shouldn’t do the same with ours.”

We could quibble a bit with Senator McCain’s recollection of history — the idea of passing Obamacare without any Republican support was a last-ditch tactic for Democrats, not the starting point as it was this year for the GOP. But the essence of what he said was true. There is room for middle ground on health care, and the Republican Party — not to speak of Americans as a whole — will be better off the sooner Congress starts to find it.

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