Senate Republicans unveiled their health care bill on Thursday. The question now becomes whether this obvious effort to court more moderate members of the party will erode the support necessary for passage.
The legislation differs in many ways from the House version and will no doubt undergo a transformation in the next few weeks as various interests delve into the details. Even the president said more negotiation was necessary to secure a workable product. And at least three of the GOP’s more libertarian senators — Rand Paul, Tom Cruz and Mike Lee — believe the measure falls too short of an outright Obamacare repeal.
They’re right. But voters keep rewarding the party with legislative majorities only to see infighting impede progress. A failure to act will only bolster the perception that Republican campaign rhetoric is simply empty chatter. Allowing the perfect to be the enemy of the good — or, in this case, the decent — carries its own inherent political risks.
The bill itself is a mixed bag, but its major concepts and its cost-control aspects are certainly preferable to the critical patient that is Obamacare. It’s worth noting that as Democrats hyperventilated with boilerplate balloon juice before even seeing the GOP proposal, insurers continued to flee the Obamacare exchanges and costs maintained their skyward trend. Doing nothing would be a dereliction of duty.
To appease more centrist Republicans and protect one flank from partisan attacks, the bill keeps a handful of Obamacare provisions, including protections for those with pre-existing conditions and the subsidy schedule for low-income Americans. Political realities are what they are.
In addition, the measure seeks to repeal a host of stealth tax hikes included in the misnamed Affordable Care Act and more slowly phases out money promised for Medicaid expansion in the states than the House bill. The latter is relevant to Nevada, where Gov. Brian Sandoval gobbled up the federal carrot only to see costs soar as enrollment in the program increased well beyond projections.
In fact, taxpayers can’t be expected to fund en perpetuity an open-ended entitlement that now encompasses able-bodied adults. The Republican plan to transform Medicaid into a capped block-grant that states may tailor to their own needs is at the heart of the GOP’s reform effort and makes eminent sense. Under the proposal, states will still receive generous federal funding to take care of the least fortunate, including children and the elderly.
One key vote is Nevada Sen. Dean Heller. His seat is one of the few in the upper chamber that Democrats believe they can flip in 2018, and he has faced a constant barrage of attacks from leftist operatives, particularly over the Medicaid issue. Sen. Heller has long argued for the repeal of Obamacare. He badly miscalculates, and risks alienating his core supporters, if he believes that any capitulation on health care will quiet the progressive mob.