Public Health: ‘Skinny’ Obamacare Repeal Would Clash With Republicans’ Health Care Promises

Fewer people would probably be covered under Medicaid, too. Over the last few years, signups for Medicaid have increased substantially, even among people who could have been covered before Obamacare expanded eligibility. Many of those people presumably didn’t realize they qualified for Medicaid and first tried to buy private insurance because of the mandate, before learning that they could get Medicaid and not have to pay a premium. Without a mandate, fewer people are likely to find their way into the program.

The Congressional Budget Office thinks that eliminating the individual mandate would have substantial negative effects on the insurance market, raising prices and reducing enrollment. It is hard to imagine that more insurers would wish to participate in this smaller, sicker market. The budget office still needs to evaluate a skinny repeal bill, but it seems likely that the reductions in coverage from a mandate repeal would save the federal government enough money for the bill to comply with budget instructions.

It is worth considering these effects in the context of Republicans’ criticisms of Obamacare itself. On the Senate floor Tuesday, Mr. McConnell assailed the health law as building unstable insurance markets and providing too little consumer choice. A skinny repeal would probably exacerbate those effects.

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Graphic: How Senators Voted to Consider the Republican Health Care Bill

President Trump has often criticized Obamacare as making insurance premiums too costly, with deductibles that are too high. Repealing the individual mandate would increase premiums and do nothing about deductibles.

Republican leaders have assailed the health law’s large tax increases. This bill would repeal only one tax.

Congressional Republicans have complained about Obamacare’s burdensome insurance regulations, which limit consumer choice. All of those would stay on the books under skinny repeal.

Republicans have also said they want to make structural reforms to the Medicaid program, as other health bill drafts would do. The skinny repeal plan leaves Medicaid as is, including its expansion under Obamacare to cover more poor adults. (This may be a plus for several moderate senators who were concerned about Medicaid cuts in the other bills.)

There has been a mismatch all along between many of the Republicans’ critiques of current law and the likely outcomes of their reforms. But earlier bills grappled with the issues by trying to deregulate insurance markets or provide stabilization funds, even if analyses suggested that the changes would still increase consumer costs and the number of Americans without insurance. A skinny repeal bill, instead, leaves those policy goals to the side in an effort to find a slender majority of votes.

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