But going forward with expansion still requires 75 percent approval from both the House and the Senate, and that may remain a tough climb. Rep. Nate Bell, a prominent voice in the conservative wing of the House, told me in an interview earlier this week that — while he has great respect for the Republicans at the center of the negotiations — if forced to vote now, he would vote No.
At the end of the day, I like the direction that things are going but unless somebody can show me some better numbers…I haven’t seen any math yet that works. I’m still in the cautiously optimistic but largely skeptical column. I don’t see workable math. If I had to vote today based on what I know I would be a no.
Generally I have some concerns about what the details are and what we’re going to do. Right now what I see is just a whole bunch more money coming in to a system that nobody’s proven to me can work.
Bell also brings up a concern mentioned by those "couple of liberal grad students." If, as Republicans believe, private insurance will offer better care — why should the current pool of disabled or extremely poor Medicaid recipients not get the same benefit as the expansion pool?
The issue for me is the underlying quality of care. When we have folks that currently are in that bottom 17 percent that aren’t necessarily getting good quality care and we’re going to turn around and offer what is probably higher quality care to other people just because of timing, that makes me nervous. I want the best possible end results for the folks who truly are unable to provide health care for themselves.
Here's the rub:
I believe that Obamacare is an absolutely unsustainable program. Since that’s my fundamental belief, I don’t know that hastening its demise helps anybody. Fundamentally, I’d like to see the legislative process work and it be reformed into something that would actually work as opposed to just further hastening the fiscal demise of the nation.
I can only go based on the data that I have. As I understand it the private proposal is probably [a higher] net increase in spending. I believe that there will be some cost savings within the existing framework but I haven’t seen $750 million a year in cost savings. That’s on top of the underlying program which I already thought spent too much. Clearly, I have some spending concerns. I’m not saying that somebody can’t show me a path that makes it work but I haven’t seen it yet.
I actually think Bell's perspective is more coherent here than some of his colleagues. Expansion will cost money, and this will probably cost more. Bell doesn't like that. This approach also, despite routing the money through private companies, involves the government spending lots of money to provide health insurance. It uses more of the Obamacare/Romneycare strategy of publicly subsidized private insurance in lieu of a direct public expenditure but...Bell doesn't like the Obamacare/Romneycare strategy!
Not many Republicans have gone on the record with doubts about the new framework, but Bell said he is not alone.
"That feeling is out there," he said. "There are lot of people that aren’t necessarily willing to verbalize it."
That said, Bell was quick to say that it meant a lot to him that the key Republicans working on the "private option" have a lot of credibility among conservatives.
Sen. Dismang, Sen. Sanders, Rep. Burris and Rep. Westerman are all guys that I have absolute confidence in.... Those guys are part of a group of folks that I’ve been very close with and I trust them. At the end of the day, if they walk out and say, this is a good deal, I'm certainly going to scrutinize it very, very hard but they are conservative guys who have done their homework, and I'm going to give a lot of credence to what they tell me.
This fits with my (to over-dramatize) "Nixon to China" theory. If this deal is going to be sold to Republicans in the General Assembly, it helps to have combative arch conservatives doing the selling.