The Senate's Historic ACA Vote
Last week, the U.S. Senate approved legislation that would repeal the majority of Obamacare. The bill will almost certainly pass the House. From there, it will go to the president's desk, where it faces an even more certain veto. Even so, we are witnessing a historic moment.
The House and Senate have held dozens of votes to repeal Obamacare in whole or in part. Congressional Republicans have even worked with President Obama to repeal or curtail portions of the law. But while full-repeal legislation has passed the House, nothing like the bill that just passed the Senate has come anywhere near the president's desk.
The Senate bill goes even further than a partial-repeal bill the House passed just weeks ago. That bill would have eliminated Obamacare's individual mandate, employer mandate, and other taxes. But it would have left most of Obamacare's pillars — including its Medicaid expansion and taxpayer subsidies for exchange coverage — intact. House Republicans might have preferred to go further, but they felt constrained by what they thought could pass the Senate.
Senate Republicans had different ideas about what could pass the Senate. In one fell swoop, they put their House colleagues to shame both by passing a stronger repeal bill and by reminding them to let senators worry about what can pass the Senate.
The Senate bill would repeal the mandates and other provisions included in the House bill, as well as Obamacare's two major entitlement programs — its Medicaid expansion and subsidies for exchange plans — and smaller forms of corporate welfare to Obamacare's participating insurance companies. That's a majority of Obamacare.
Health-care entitlements are supposed to be a political third rail — touch them, and you die. This Senate vote means majorities in both chambers of Congress will approve a bill repealing not one but two health-care entitlements. Congress and President Obama already repealed one of Obamacare's entitlements — a long-term-care program called the CLASS Act, which crashed and burned before it could launch. But the Medicaid expansion and exchange subsidies have already taken effect. That alone makes yesterday's vote historic.
Even more remarkable, it is doubtful Republicans will suffer at the polls for it. Republicans have done well by running against Obamacare. Most recently, Matt Bevin won the governor's race in Kentucky by campaigning against Obamacare's Medicaid expansion, which his predecessor implemented.
The history-making doesn't end there. A bill repealing the majority of Obamacare is now almost certain to land on President Obama's desk. It is not often that presidents have to veto a law repealing most of their signature legislative achievement.
Finally, the vote is historic for what it portends: It proves that America is just one presidential election away from repealing Obamacare. Every Republican candidate for president has promised to repeal Obamacare in full, and with this vote, Republicans have established that they can repeal at least this much of the law with a simple majority in the Senate. If they maintain their position in Congress and, under a GOP president, enact a similar bill in 2017, most of Obamacare will be gone for good, and what's left will become much easier to repeal.
With that prospect on the horizon, states that have not implemented Obamacare's Medicaid expansion will now be even more reluctant to do so. This vote may even encourage Governor Bevin to make Kentucky the first state to withdraw from the expansion.
Opponents should keep reminding voters why Obamacare has been unpopular for more than six solid years.
Atop the lies and lawlessness that have reduced Obamacare to an illegitimate law, Obamacare is failing patients. Staggering premium increases of 39 percent or more, scandalous and rare before Obamacare, are now ubiquitous. Even with premiums skyrocketing, patients' choice of doctors is narrow and the coverage skimpy. Enrollment has stalled. Insurers are headed for the doors and begging for bailouts. Obamacare has thrown millions out of their health plans, including those with cancer and other serious conditions, and threatened their access to care. It will continue to do so until Congress and the president repeal it.
When that happens, Republicans and Democrats should replace Obamacare not with "Obamacare-lite," but with reforms like large health savings accounts (HSAs), which would drive down medical prices and deliver an effective tax cut of $9 trillion — greater than the Reagan and Bush tax cuts combined.
Yesterday's Senate vote brought America closer to enacting health-care reforms that actually make health care better, more affordable, and more secure, particularly for the most vulnerable. That's history worth making.
Michael F. Cannon (@mfcannon) is director of health-policy studies at the libertarian Cato Institute.