Majority Leader Mitch McConnell threatened his 51 disciples in the Senate and his party with the gravest injury imaginable. If they don't pass his unpopular bill to "repeal and replace" Obamacare in the next few weeks, he may make them sit down with Democratic senators and work out a health care law that would be acceptable to nearly all Americans.
He wouldn't dare! Does he not remember what has accrued from bipartisanship in the past — Medicare and Medicaid and all their many corrections and expansions, veterans medical care and, yes, even the great Democratic achievement Social Security, where Republicans got in on its original enactment and its scores of corrections over its first 70 years?
OK, it is probably an empty threat. McConnell, after all, is the father of partisan gridlock. It was he who ordered a bank of Republican senators in 2009 to cease working on the Affordable Care Act with Democrats on the Senate Finance Committee or face reprisals by the GOP caucus. He was so wary this spring that a Democrat might give a piece of advice or get a peep about what the bill did that he did not let even some of the 13 Republican men he said would write the Obama repealer know what was in the bill until his staff had finished writing it. It is the first time that either party has skipped the committee process in drafting major legislation.
But the Senate bill he produced has now assumed the status of the most unpopular piece of legislation in modern times. Republican governors have quailed at the impact it would have on their states — 22 million people losing their insurance, huge budget problems for state governments that Republican governors and legislators would have to deal with, far higher premiums and out-of-pocket costs for sicker, older and poorer people.
Even Arkansas's John Boozman, a more faithful disciple McConnell has never met, is said to be withholding support. Sen. Tom Cotton, who is supposed to be one of the authors, is silent, obviously hoping the bill never comes to a vote.
Arkansas would be devastated more than any state, except possibly Kentucky. If the Senate bill becomes law, some 367,000 more Arkansans will be uninsured by 2022, when the Medicaid provisions really kick in. The state government would lose $1.5 billion in federal health care funding in 2022 — a huge hole in the budget that would have to be made up with tax increases or abandoned medical services for some subset of the population — children, the elderly frail, the disabled, children's colonies?
It's a pointless exercise, but what might "amend and improve" look like if McConnell worked across party lines? First, you'd have to agree that it would be called a Republican reform — "Trumpcare" or "McConnellcare." Trump will praise and embrace anything they pass.
Both recent Trumpcare efforts take two giant steps: eliminating Obamacare's taxes on very rich Americans and corporations involved in health care and eliminating the individual mandate, the requirement that healthy people buy insurance without waiting until they get sick or else pay some taxes for the uncompensated care they are apt to get. Repealing both of those forces Republicans to take the steps that end coverage for 22 million people and hike the premiums and co-pays of others. The taxes pay for the reforms and extend the solvency of Medicare, and the mandate makes it possible for insurance companies to hold down premiums. Both the Senate and House bills set out to slash and someday eliminate Medicaid, the vast program that at some point affects nearly every family in America through nursing-home care, disabled children and adults or family poverty.
So what could Dems and Repubs do together? With a couple of words, they could fix the clumsy language in the Affordable Care Act that House Republicans used in a court challenge of the government's cost-sharing of deductibles and co-pays of low-income policyholders. They got a ruling from a judge appointed by President George W. Bush that the payments had to stop. It is on appeal, ultimately to the Supreme Court where Trump has inserted a judge who will rule against Obamacare on any point of law. It has unsettled the markets, and insurance companies don't know whether to get out altogether or raise their premiums sharply in anticipation.
They could fix the "family glitch," the inept wording in the law that often keeps family members in employer programs from being eligible for premium subsidies.
Charles Gaba, who runs a health care blog, proposed 20 changes in Obamacare, including expanding Medicaid in the last 19 states, each effected by a few words but which together would solve about all of Obamacare's problems.
Kerr-Mills (our man Wilbur D. Mills) was the original Medicare and Medicaid, enacted in 1960. It was a total flop with fewer than 1 percent of the elderly and poor gaining coverage after five years. After a landslide victory in 1964, Lyndon Johnson asked Mills and Republican leaders to fix it and after a few weeks they had. Our own Governor Hutchinson and Republican governors across the country are begging the Republican Congress now not to break it. What an opportunity!