The Slatest

Right on Schedule, Senate Conservatives Are Throwing a Fit Over Health Care

Sen. Rand Paul.

Saul Loeb/AFP/Getty Images

Kentucky Sen. Rand Paul, shortly after Senate Republicans’ breakfast meeting discussing the newly unveiled Better Care Reconciliation Act, insisted that there were still some “unknowns” for which he needed answers. My strong suspicion is that those unknowns won’t do the trick. This is not the Obamacare repeal bill that Paul wants, to the extent that it’s an Obamacare repeal bill at all.

“Conservatives have always been for repealing Obamacare, and my concern is that this doesn’t repeal Obamacare,” he said as he was walking back to his office through the Capitol tunnel.

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“What I’m seeing so far is it keeps 10 out of 12 regulations, it continues the Obamacare subsidies, and I think ultimately will not bring down premiums,” he continued, “because instead of trying to fix the death spiral of Obamacare, it simply subsidizes it with taxpayer money to insurance companies.”

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Paul said “we” would have a statement later Thursday afternoon. Though he wouldn’t say who would be party to that statement, rumors spread late Thursday morning of a triumvirate of senators who would announce opposition to the bill in its current form. If Paul is one of them, then the other two will likely be his conservative comrades, Texas Sen. Ted Cruz and Utah Sen. Mike Lee.

I asked an aide to a conservative senator if that was the group.

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“And more,” the aide replied.

Who else might be opposed to the bill from the conservative perspective?

Wisconsin Sen. Ron Johnson is also displeased and doesn’t know if he’ll have enough time to digest the bill before the planned vote next week. But the rushed process isn’t his only concern. He’s worried that “there’s not enough” in the bill to bring down premiums. He’s talking about one specific (and very popular!) Affordable Care Act regulation, which the BCRA keeps on the books.

“The primary driver of premium increases is guaranteed issue,” he told reporters, referring to the ACA provision that bars insurers from rejecting customers. The House-passed bill didn’t touch guaranteed issue, either, though it did give states the option of waiving community rating protections that ensured sick people could afford the plans insurers were required to offer them.

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“Who would buy auto insurance if you could buy insurance after you’ve crashed your car?” Johnson said. “Well, that’s the exact same reason that guaranteed issue, when it’s been passed in states, is collapsing insurance markets, is collapsing the Obamacare market.” He would prefer that people with pre-existing conditions be taken care of through high-risk pools.

So conservatives are pissed. But don’t expect their objections to kill the bill. We’ve seen this act before.

In the House, the conservative Freedom Caucus held a press conference the day the American Health Care Act was unveiled declaring that they couldn’t support it in its original form. They won deregulatory concessions, and moderates (and some rank and file) were tossed a few bucks to swallow it down. The harsher long-term Medicaid cuts in the Senate bill—the biggest policy story here—apparently aren’t enough to balance the bill’s somewhat less “mean” treatment of the individual market. So conservatives will try to take moderates for a ride. It worked in the House, and it can work here, too.

Update, 2:39 p.m.: I was right! Senators Paul, Cruz, Lee, and Johnson have issued a joint statement:

Currently, for a variety of reasons, we are not ready to vote for this bill, but we are open to negotiation and obtaining more information before it is brought to the floor. There are provisions in this draft that represent an improvement to our current health care system, but it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their health care costs.

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