Back in early January, which seems like five years ago, Republicans passed a budget resolution through Congress, instructing House and Senate committees to deliver a plan to repeal and replace Obamacare under reconciliation rules (which only require a simple majority in both chambers) by January 27. We’re two weeks past that deadline, and not a single hearing has been held. GOP leaders have contradicted themselves eight different ways since then. First they said nobody would lose Medicaid coverage under their plan, and then they vowed to block-grant Medicaid, which would deliberately cut back coverage. Their most conservative members demanded a swift repeal under reconciliation, while key figures alternately floated ideas to let states retain the law, maintain the health-care-exchange subsidies until a replacement is finalized, and “repair” the ACA instead of repealing it. Senator Bob Corker, who tried to extend that January 27 deadline, acknowledged this week, “there’s not any real discussion taking place right now.”
With Donald Trump now suggesting Obamacare won’t get changed until 2018, insurers and hospitals uneasy, the right wing full of fury at Republican sellouts, and the left wing badgering their representatives with a force unseen in decades, you could be tempted to think that the whole project has run aground.
But the battle over health care really only began at 2:11 this morning, when the Senate cast the final vote confirming Tom Price as health and human services secretary. While Congress clearly doesn’t want to shoulder the burden of hashing out details for repeal and replace—because then they would be responsible for it—Price relishes the opportunity, and will get right to work. For the left, any assumptions of triumph should end today. To quote Senator Maria Cantwell this morning, “This is the first vote in the dismantling of the Affordable Care Act.”
Trump has consistently said he would not offer a health-care proposal until Price was installed. And Price comes in with his own well-documented plans, which he introduced practically every year of his congressional tenure. The Price blueprint assembles many stray Republican health-care theories, like health savings accounts, allowances for insurers to sell across state lines, tort reform, caps on the tax exclusion for employer health coverage, and high-risk pools for anyone rejected for a preexisting condition. Any time these ideas have been implemented at the state level or during George W. Bush’s administration, they failed to reduce the ranks of the uninsured or make health care more affordable. Most of the high-risk pools collapsed, because putting all the expensive patients into the same insurance pool is a self-evidently terrible idea.