We know — the Republican health care effort has been declared dead many times, so this is not a prediction. But it's time to at least consider what happens if Senate Republicans can't get their act together and pass a health care bill next week.
The bottom line: The health care storyline won't end. It will be like a season finale — with the next season beginning the next day.
Here are the political realities:
Conservatives will push for a repeal-only bill next. Unlike Senate Majority Leader Mitch McConnell, conservative groups were thrilled when President Trump tweeted that the Senate should try the repeal-first strategy. In their view, nearly all congressional Republicans already voted for a 2015 budget bill that repeals most of the Affordable Care Act — so they should just pass that again.
- If that doesn't happen, conservative groups will hammer GOP leaders for not living up to their repeal promises — and if moderate Republicans don't vote for it, they'll get an earful, too.
- "They'd have to explain why they're damned liars" after campaigning on repeal for seven years, says Jason Pye, vice president of legislative affairs for FreedomWorks.
The individual insurance market will still need help. It's not as if it's healthy right now. The Centers for Medicare and Medicaid Services reported yesterday that there was a 38% drop in the number of health insurers who filed to offer ACA health insurance next year.
The fate of insurer subsidies still has to be resolved. The Trump administration won't want to keep paying for the cost-sharing reduction subsidies for low-income customers without funding from Congress. So Congress would have to decide whether to fund the subsidies on its own.
The ACA will be run by an administration that hates it. By now, HHS secretary Tom Price and CMS administrator Seema Verma have spent so much time promoting the law's failures that they'd have trouble switching gears and trying to make the law work.
Any bipartisan talks will be 'small ball.' Even if moderate Democrats agree to start negotiating a "repair bill" with Republicans, the only ideas they've mentioned so far are relatively narrow, like Sen. Tim Kaine's proposal to create a permanent reinsurance program for the individual market.