The Skinny on the GOP's Last Resort on Health Care: 'Skinny Repeal'

By Tessa Stuart, Rolling Stone

27 July 17

Just one more Republican could decide whether 15 million Americans have health insurance a year from now

enate Republicans voted by a razor-thin margin on Tuesday to open debate on legislation that would at last fulfill the party's seven-year promise to repeal and replace Obamacare. Where that debate will end, though, is still anyone's guess. Late that night, the first of three separate plans Republicans will consider this week – the Better Care Reconciliation Act, hand-crafted under the direction of Senate Majority Leader Mitch McConnell – failed to win the necessary votes.

On Wednesday afternoon, the Senate took up debate on a bill passed by a Republican majority in 2015, which would have repealed the Affordable Care Act without putting in place a replacement plan. This measure also failed.

Conservatives increasingly appear to be pinning their hopes to option C: so-called "skinny repeal." The skinny repeal bill would repeal some of the historically unpopular provisions of the Affordable Care Act while keeping most of the framework in place. Republicans plan to target the ACA's individual mandate – the part of the health care bill that requires individuals to either have insurance or pay a fine for not having it.

For years, Republicans have rallied their base around the idea that the government shouldn't force its citizens to pay for health care if they don't want it. (The penalty, which is paid when one's taxes are filed, is $695 a year, or 2.5 percent of one's household income.) Not one of the Republican-authored health care plans includes the individual mandate.

There is a practical reason why the Affordable Care Act included the individual mandate, though: People without insurance rack up huge health care bills, and they don't pay those costs themselves – the rest of the population does. Back in 2008, before the ACA went into effect, the uninsured generated $116 billion in health care costs, and paid for just 37 percent of those costs.

Compelling everyone to be part of the health insurance market makes health care cheaper for everyone. In fact, the Congressional Budget Office estimates that people who buy insurance will see their premiums increase by 20 percent.

Not only will premiums go up, but repealing just the mandate and nothing else would leave some 15 million more Americans uninsured than if it it were left in place. Seven million fewer people would be insured under Medicaid, six million fewer would purchase insurance either through or outside of the insurance marketplaces, and two million fewer would be covered by insurance through their employers.

Insurance companies say repealing just the mandate would mean "steep premium increases and diminished choices." Economic experts advise it would bring the health care system to an "almost complete collapse." Nevertheless, Republican senators seem poised to approve it. Asked Wednesday about his position on skinny repeal, GOP Sen. Dean Heller told reporters, "I think I'd support it." Rand Paul also has signaled the bill would have his support.

With Sens. Lisa Murkowski and Susan Collins both expected to oppose the measure, just one more Republican could decide whether 15 million Americans have health insurance a year from now – and whether millions of others are paying a lot more. The final vote is expected Friday.