Ross Douthat, a conservative columnist for the New York Times, thinks he has found a way out. He counsels Republicans to think small.
The “timid” bill he recommends would have four parts. It would
1) repeal the fines on people who go without insurance, and in its place impose a waiting period if those people try to return to the insurance rolls;
2) repeal some of Obamacare’s taxes, such as those on medical devices, but not all of them;
3) “maintain the stabilization funds that the Senate legislation pays to states and insurers to help cover the sickest Americans and keep exchange prices from spiraling upward”; and
4) put a per-person cap on Medicaid spending, but a less “draconian” one than the one in the Senate bill.
Parts one and three of Douthat’s proposal are already in the Senate legislation. What he wants, then, is the Senate bill with smaller tax cuts and smaller cuts to future spending.
Under the Senate bill, the federal government would cover a smaller share of the costs of Medicaid beneficiaries who are above the poverty line: less than the current 90%, but still more than half. While Douthat does not spell it out, I think his argument makes the most sense if he has in mind cutting that percentage by a smaller amount.
Douthat does not suggest that this fiscal retreat would lessen Democratic opposition to the Republican bill. And it wouldn’t. Greg Sargent, a liberal columnist at the Washington Post, has signaled how Democrats would react: Raising the levels of taxes and spending in the bill while leaving the rest of it in place, he writes, would be a Republican “scam.”
I suspect that the bill would remain roughly as unpopular as it is now. The chief rallying cry of the opposition has been that the Senate Republican bill would throw 22 million people off the insurance rolls. That’s the estimate of the Congressional Budget Office, which is generally taken as holy writ in this debate even though the assumptions behind the estimate are dubious.
The CBO says that around 15 million of those people would leave (or never join) the insurance rolls because of the end of the fines. Reduced Medicaid enrollment would account for four million of those people.