Senate Republicans’ Obamacare repeal effort is on track to blow up before it even gets started.The GOP is well short of the votes needed to bring its bill to the floor, and party leaders and President Donald Trump are kicking into overdrive to save their imperiled health care overhaul.At least four Republican senators, Susan Collins of Maine, Rand Paul of Kentucky, Dean Heller of Nevada and Ron Johnson of Wisconsin, have signaled they could oppose a key procedural vote that will occur either Tuesday afternoon or Wednesday. A number of other senators, like Shelley Moore Capito of West Virginia and Marco Rubio of Florida, are undecided.
Imperiling the Better Care Reconciliation Act of 2017 is the politics of Medicaid. In the House, majority Republicans faced an uphill but less steep task in passing their version of the reconciliation bill because proposing to reform Medicaid into a federal block grant program affected far fewer constituents. Because members of the Senate represent their entire states, scaling back Medicaid affects a lot more people and consequently has far greater repercussions and political peril. Since the federal share of Medicaid makes up a large percentage of state budgets, governors are also understandably concerned over the loss of federal share funds.
The backers of the House and Senate bills have bitten off more than they can chew by proposing wholesale reform of the five-decade-old Medicaid program. They’ve made their job even harder by trying to substantially overhaul Medicaid funding at the same time as the Patient Protection and Affordable Care Act’s insurance market reforms — all within the narrow procedural confines of a budget reconciliation bill that make it questionable it would pass parliamentary muster.
Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email