6 reasons Obamacare repeal (probably) isn’t coming back in 2018

“Obamacare repeal may be closer than you think.”

That was the headline from the Washington Examiner’s Quin Hillyer late last week. It was enough to send a shiver down my spine.

In the column (self-identified as opinion), Hillyer lays out that former Sen. Rick Santorum, Vice President Mike Pence and the minds behind the Graham-Cassidy Obamacare repeal plan haven’t given up their work. It could still be revived, he argued, especially now that the bipartisan health care talks have fallen apart. What do Republicans have to lose in pursuing their signature campaign promise, given that Democrats are already very energized for the 2018 midterms while GOP voters seem demoralized?

(Graham-Cassidy, which fell short on support in September, would have converted much but not all of Obamacare’s funding for Medicaid expansion and premium tax credits into state block grants while also allowing states to roll back the law’s protections for preexisting conditions.)

So how seriously should we take this? Are these just the extended death rattles of the GOP’s Obamacare failure? Or could the last act of the 115th Congress be another run at repeal?

To be clear, I don’t have any reason to doubt Hillyer’s reporting that Obamacare repeal planning is still underway and top Republicans, up to and including the vice president, are taking an interest. But I made the rounds today with the K Street insiders who guided us through the health care fight last year, and I found a lot of skepticism.

”I believe the part where they are working on something,” one GOP health care lobbyist told me. “I don’t believe there is any way it gets further than any of the previous attempts in this Congress. What’s the path to victory?”

Another Republican lobbyist laid out the problems in more detail:

Senate Republicans would need to pass a budget to set up the budget reconciliation process that allows a bill to advance with just 50 votes. It is not at all clear that they have the votes to do that, a third source said, which would make repeal impossible all on its own.

The GOP majority is even narrower than it was last year after Doug Jones won the Alabama Senate special election. Republicans have just 51 votes, so they can lose only one of their own. But on top of that, Sen. John McCain hasn’t been in Washington since December, so there are really only 50 Rs available, which means they can’t lose anybody.

Sens. Lisa Murkowski (R-AK) and Susan Collins (R-ME) have opposed every Obamacare repeal plan so far. Hillyer reported that conservatives are trying to tweak the Graham-Cassidy formula to make it better for the Maine and Alaska health care systems, which both expanded Medicaid, but that would be quite a reversal.

The CBO factor: Republicans are already going to get battered in the 2018 campaigns for voting for repeal plans that would have left millions more Americans without health insurance. Reviving repeal (the original Graham-Cassidy had an estimated 21 million in coverage losses) would give Democrats a fresh talking point. With the individual mandate gone now, the number might change but the story would likely be the same.

Let me add a few more.

Mitch McConnell wants to approve as many judicial and executive nominees as possible before the fall. Health care would eat into that time.
Everyone seems to forget that Sen. Rand Paul (R-KY) really, really, really hated Graham-Cassidy. I know nobody believes in Paul’s resolve, but he’s stuck to his positions throughout the repeal debate. As long as McCain is in Arizona for his cancer treatment, Paul by himself is enough to sink the bill.

”I think I have a better chance of being called up to replace LeBron in the playoffs than the Senate repealing Obamacare,” said a lobbyist for health insurers who clearly knows their audience.

”Nothing has changed other than McCain might not make it back to vote, which makes it even harder to pass,” the lobbyist said. “Why get egg on your face again when you can have a lasting impact by filling administration positions?”

I have a Miracle Max theory for Obamacare repeal: It is mostly dead, for all the reasons we just laid out. But mostly dead is slightly alive, as the miracle worker said.

As long as Republicans control every lever of power in Washington, Obamacare can never be completely safe. A Democratic House or Senate is the only true safeguard against repeal. We’ll know more about the long-term health of the law after the 2018 midterms.

But those political realities that stymied Republicans in 2017 are still the same — and if anything, the terrain looks even more difficult now.

This story appears in VoxCare, a newsletter from Vox on the latest twists and turns in America’s health care debate. Sign up to get VoxCare in your inbox along with more health care stats and news.

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