END OF 2018 OPEN ENROLLMENT PERIOD (42 states)

Time: D H M S

Obamacare repeal *MAY* (repeat, *may*) be dead after all...which would leave the GOP w/only 2 choices...

On Tonight's Episode of As the Stomach Churns...Three ACA repeal-related stories hit the web practically on top of each other.

First, from Sahil Kapur of Bloomberg Politics:

Republicans' Struggles to Replace Obamacare Feel Like Deja Vu All Over Again

Republicans in Congress are hitting roadblocks as they try to devise a plan to replace Obamacare, stuck over issues like how to structure tax breaks they want to give people to buy insurance.

...Republicans, who have spent more than six years vowing to smash the Affordable Care Act, swept into control of the White House and Congress pledging a swift repeal. But they’ve made little progress in deciding how to do that, or what should come next.

...Republicans agreed on vague concepts such as tax breaks, letting insurers sell across state lines and letting states run Medicaid.

But then they hit a wall.

The key quote to me is this rather unfortunate one by AZ GOP Senator Jeff Flake, who's up for re-election in 2018. I wouldn't be at all surprised to see this line used in an attack ad by his Democratic opponent:

Cantor, now with investment bank Moelis & Co., argues that GOP leaders failed to achieve consensus in 2014 because, with a guaranteed veto from then-President Barack Obama, they lacked a forcing mechanism to achieve consensus. But other Republicans see a potentially larger obstacle today: They have to live with the consequences of their actions.

"We’re firing with real bullets now," said Senator Jeff Flake of Arizona.

Pro Tip: When you're talking about policy changes which could potentially result in thousands of your own constituents dying, you might want to avoid using phrases like "firing real bullets". Just an suggestion.

Anyway, this was followed up in short order by this one-two punch:

First, from Peter Sullivan of The Hill

Freedom Caucus vows to oppose weakening ObamaCare repeal

The conservative House Freedom Caucus voted Monday night to oppose an ObamaCare repeal bill if it does not go as far as the repeal measure that passed in 2015, drawing a line in the sand that could complicate Republican repeal efforts. 

Conservatives have been pushing for the 2015 repeal bill, which kills the core elements of the law including its subsidies, taxes, mandates and Medicaid expansion, to be brought up again. But the move Monday night to oppose an effort if it falls short of that bill is a significant new development.

...along with this take from Matt Fuller of the Huffington Post:

Conservatives Take Hard Line On Obamacare Repeal, Putting GOP In A Bind

Conservatives in the House Freedom Caucus voted among themselves Monday night to band together and support only an Obamacare repeal that, at a minimum, is as aggressive as the bill that the House and Senate passed in 2015, putting GOP leaders in a bind with their conference and perhaps even threatening the possibility of passing a repeal.

The group of roughly 35 to 40 House conservatives voted to take this official position ― meaning it received the support of at least 80 percent of the members and is therefore supposed to be the position of all members ― amid some GOP consternation that Republicans ought to focus more on repairing the law rather than repealing it, as well as heavy voter pressure in many districts to leave the law intact.

“If it’s less than the 2015 [bill], we will oppose it,” Freedom Caucus Chairman Mark Meadows (R-N.C.) told a small group of reporters Monday night.

This is a major problem for the GOP's "repeal/replace/repair/whatever" strategy. As Fuller noted in a series of tweets:

Trent Franks says he fears the Obamacare repeal is in "mortal danger."

— Matt Fuller (@MEPFuller) February 14, 2017

Big news on Obamacare tonight: Conservatives will oppose any repeal that preserves the Medicaid expansion.https://t.co/FH9NKde0xj

— Matt Fuller (@MEPFuller) February 14, 2017

Reminder: There's either ~12.6 million (or ~14.5 million) people are enrolled in Medicaid specifically via ACA expansion whose coverage is at risk from this provision alone.

There's a not insignificant part of me that thinks the Obamacare repeal died tonight. https://t.co/FH9NKde0xj

— Matt Fuller (@MEPFuller) February 14, 2017

In addition, as former Obama speechwriter Jon Favreau noted:

This is very big. GOP doesn't have enough votes in the Senate to end Medicaid expansion, which means they wouldn't be able to pass anything https://t.co/6dmI5toqmQ

— Jon Favreau (@jonfavs) February 14, 2017

Now, before everyone gets too excited, given the endless twists and turns that this whole stupid saga has taken, everything above could easily change tomorrow, and then change again the next day. The GOP is pretty much flailing about, trying everything and anything at this point, and at the same time, Trump changes his mind more often than most people change their underwear, so anything "true" tonight could be meaningless by the morning.

HOWEVER...

Assuming that full (or even "partial") repeal really is dead, that leaves Congressional Republicans, Donald Trump and new HHS Secretary Price only two options that I can think of:

1. "STEAL THE CREDIT": Pull a complete 180º and FULLY EMBRACE the Affordable Care Act after all...

This would include things like:

  • Scrapping their CSR lawsuit and ensuring CSR payments going forward
  • Restoring the very Risk Corridor payments that they killed a couple of years ago (and seeing how a federal judge just ordered part of the payments to be made, this would be wise)
  • Tom Price not going out of his way to issue "hardship exemptions" whenever possible, not trying to "bury" the exchange websites, etc.
  • Trump not killing the marketing/outreach efforts and so forth

...basically, you know, implementing the law in good faith and in the most efficient, effective fashion which they can.

This would be the rational, decent thing to do, and might even be politically smart; the angle here is "Democrats are so incompetent we had to take over their stupid law just to make it work properly!", etc etc.

Of course, if they go this route, they'll also try to save face by making some sort of changes--tinkering around the edges, perhaps literally changing the name of the law to "TrumpCare" or whatever and declaring victory:

The Republicans in CONGRESS are highly unlikely to go this route, but I could easily see Trump doing so, so who the hell knows?

or...

2. "BLAME THE VICTIM": Continue to deliberately sabotage (either actively or "passively" via inaction) and keep the carriers in the dark about WTF they actually have in mind.

I've written several posts explaining why this is the case, but this one brings it all together:

Yup. It's true that some carriers might have been considering dropping out of the exchanges in 2018 regardless...but between Trump winning, the GOP going full-speed ahead with repeal plans, Trump's executive order, the GOP not having the slightest clue what, if anything, they would replace the ACA with (or when that might take place), and the initial filing deadlines bearing down on the carriers like a freight train, some of the major players are already seriously talking about bailing BECAUSE OF THE TRUMP/GOP-INDUCED UNCERTAINTY.

I cannot stress this enough: IF the individual market collapses next year, it will be primarily due specifically to deliberate sabotage and uncertainty created by the GOP.

And for the record, here's the official timeline for carrier participation on the federal exchange (I presume the dates are a bit different for the various state-based exchanges, but we're still talking about just a few months here).

As I noted at that entry, the carriers have had just about enough of the GOP jerking them around. They aren't necessarily opposed to the law being repealed, but they need to know what the situation and rules are going to be, and they need to know soon. And again, a 2-3 year "delayed repeal" isn't gonna cut it anymore either; why should they stick around the exchanges for the next year or two (when they might keep losing money or, at best, make a tiny profit) if they know the plug is gonna be pulled right after that anyway?

The exchanges are a long-term investment strategy. If they think they're not gonna be around long enough for them to make up their prior-year losses and then some, why wouldn't they just cut their losses and wash their hands of the whole thing? Hell, Aetna recently proved that they're willing to pull out of a market they're profitable in, so even that's no guarantee of them sticking around.

Needless to say, Door #2 seems far more likely. It involves continuing to sabotage the law in death-by-a-thousand-cuts fashion, mainly by simply letting go of the wheel, saying "I'm shocked, shocked I say!!" when the carriers all head for the door for 2018, and then trying to pin the blame for the market collapse on Obama/the Dems/the ACA itself.

I'm pretty sure they'll try this because they already admitted that this is their plan back in December: 

That could lead to a mess for the roughly 10 million Americans currently getting coverage through the government-run marketplaces — and backlash against the GOP.

...But the enticements most likely to keep insurers in the exchanges are the ones in Obamacare that Republicans spent years denouncing as industry “bailouts” — subsidies that were supposed to insulate plans from big losses.

...Many Republicans would prefer to argue the Obamacare markets were already in their death throes before they took charge — the question is whether they can get away with it.

“The first question I think they’re trying to figure out is, do we actually own it for 2018?” said one health care lobbyist, speaking on background. “If premiums spike and plans exit, can we still blame it on Obama and get away with it? That’s one of the threshold questions that I don’t think they’ve answered.”

If you had asked me this question in December, I would probably say that yes, they can get away with it. However, thanks to the incredible organizing and educational efforts of groups like Indivisible, the Woman's March, etc etc, I'd say this is a much tougher call nowadays.