This is the way the Obamacare war ends — not with a bang, but a whimper.
Senate Republicans are essentially passing on what was once supposed to be the Next Big Obamacare Fight — the confirmation of a new Health and Human Services secretary. Fourteen Republicans sided with Democrats on a procedural vote Wednesday, clearing the way for Sylvia Mathews Burwell to win confirmation quickly, easily, and with bipartisan support.
There are practical reasons not to pick a big fight over Burwell: She was already confirmed 96-0 for a different job, and she’s well regarded as a skilled manager.
“I think there’s just a fatigue amongst elected Republicans on Obamacare.”
But her nomination was a pretty obvious hill on which Republicans could stage another battle in their years-long war against Obamacare. They chose not to. And after this, there simply aren’t that many hills left on which to fight.
It’s not just Burwell: Anti-Obamacare bills in the House have gotten tamer lately — some of them look an awful lot like fixing obvious problems with the law, something conservatives once swore they’d never do. There are fewer big-ticket hearings, and even those are often poorly attended. Anyone who’s been around Capitol Hill and health care for the past four years can see it — the anti-Obamacare fire just isn’t burning as hot as it used to.
“I think there’s just a fatigue amongst elected Republicans on Obamacare,” said Dan Holler, communications director for Heritage Action, in an interview conducted last month. “There seems to be this hesitancy to talk about Obamacare much.”
In part, any fire dies down over five years. But the temperature on the right also got a lot lower after 8 million people signed up for coverage through the health care law’s exchanges.
Heritage Action and some of its closest allies — Sens. Mike Lee and Ted Cruz — tried to stoke the flames once Burwell’s nomination passed (with bipartisan support) out of committee and came to the Senate floor. But they only went so far, demanding answers to a series of questions about the health care law.
“Until the President agrees to offer meaningful relief to the millions of people hurt by Obamacare, we should not confirm this nominee,” Cruz said in a statement following Wednesday’s procedural vote.
Even that, however, is significantly dialed back from Cruz’s rhetoric ahead of last year’s government shutdown, when he taunted his fellow Republicans by arguing that a vote to keep the government open was “a vote to fund Obamacare.”
It wasn’t — almost all of Obamacare’s funding was separate from the bill Cruz blocked. But precisely because of the traits that make Burwell hard to oppose — her talent for management, and her appetite for policy — a vote for Burwell probably is a vote that will help the Obama administration more effectively implement the Affordable Care Act.
Yet Cruz hasn’t tried seriously to put his party on the spot. When asked last month whether Republicans should force a broader confrontation over the Burwell nomination, Cruz responded with a well-worn line about using every opportunity to showcase Obamacare’s failings.
None of this is to say that Republicans now support Obamacare, which they very much do not, or that it won’t be a problem for Democrats in this year’s midterms, which it will.
The law is unpopular, and its critics feel more strongly than its supporters. But with public opinion locked in place for months, “Obamacare” has become almost a party-ID question or a buzzword, rather than a dynamic issue.
The Obamacare war has been a constant in politics since 2009, with peaks and valleys of intensity. The peaks have almost always been tied to some external development — from the law’s passage, to the Supreme Court decision upholding it, to delays in the employer mandate, to the blundering launch of HealthCare.gov, to a wave of cancellation notices.
If past is prologue, don’t bet against more delays and policy flubs by the administration. But barring any major mistakes, Republicans don’t have a lot of openings left to force the health care law back into the headlines.
The GOP will get some mileage out of 2015 premium increases as rates trickle out over the summer. But at least so far, the hikes are far smaller than what most critics predicted. No one likes a 15 percent premium increase, but that doesn’t look so terrible compared with critics’ predictions that premiums would skyrocket by as much as 300 percent. Some carriers are even cutting their prices for next year.
Another round of plan cancellations will also hit shortly before the midterms, although health-policy experts say this one will probably be much smaller than last year’s.
Whatever openings the GOP can find, though, have to compete with a stronger-than-ever Democratic response: 8 million people signed up for coverage through Obamacare’s exchanges. Another 3 to 6 million enrolled in Medicaid.
The enrollment numbers beat the White House’s own projections, and certainly outstripped Republicans’ gleeful predictions that people would reject the law’s coverage. And they represent a comeback from the law’s worst, most glaring failure — the launch of HealthCare.gov.
Holler acknowledged last month that “there’s a lot of good news for the law,” but said Republicans should still focus on premiums and the administration’s unilateral delays.
Burwell’s nomination wasn’t the perfect venue, he said — the Senate’s minority party doesn’t have much leverage to stall nominees any more, and Burwell has a particularly strong reputation. But he put most of the onus on Republicans.
“Most of this, I think, is fatigue,” Holler said.
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The nonpartisan Congressional Budget Office has released its score of the House-passed American Health Care Act, which would replace Obamacare. According to the CBO, the bill would reduce the deficit by $119 billion by 2026, while leaving 14 million more Americans uninsured in 2018 than under current law, a number swelling to 23 million by 2026. Further, insurance premiums would balloon 20 percent in 2018 and five percent in 2019 before the waiver provision in the legislation would kick in. The provision allows states to apply for waivers and permit insurers to offer skimpier plans, which would likely entice younger and healthier individuals to buy health insurance while potentially pricing older and less healthy Americans out of insurance plans. House Republicans approved this bill in late April without waiting for the CBO score.
Republican Sen. Lindsey Graham said Wednesday during a Senate Appropriations subcommittee hearing that President Donald Trump's budget is little more than recycling bin material. "The budget proposed by the president doesn't have a snowball's chance in hell of passing," Graham said. Graham had previously opposed the budget over its nearly 30 percent cut to the budget of the State Department. The budget slashes spending on domestic priorities while increasing military spending.
Senate Majority Leader Mitch McConnell said Wednesday that he doesn't yet know the formula towards gaining passage of an Obamacare replacement in the Senate. "I don't know how we get to 50 (votes) at the moment. But that's the goal," McConnell said. The House passed an Obamacare replacement bill which has been widely seen as dead on arrival in the Senate, and McConnell has put together a working group of Republican Senators working towards creating health care legislation which could gain the support of at least 50 Senators.
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