Time for more physics. LOL! Schrödinger’s he

Time for more physics. LOL!

Schrödinger’s health bill: uncertainty is now paramount to the Republican strategy

Eventually, they have to open the box.

Updated by Tara Golshan Jul 27, 2017, 2:10pm EDT



Think of the Republican health care bill as if it were locked in a box.

The contents of this box remain unknown to everyone on the outside — but each Republican lawmaker has his or her own ideas of what could be inside it.

The goal is to keep the box moving without opening it, for fear that whatever is inside would be picked apart by various factions of the Republican Party, killing the Obamacare repeal effort altogether.

So instead, GOP leaders are trying to send the box from the Senate back to the House, where it will be either debated and reworked into a new health bill or voted on its merits without any further negotiation.

"The idea is to let people vote on what they want to vote on," Sen. John Cornyn (R-TX), the majority whip, told reporters Tuesday.

Better put, the idea is to let people think they are voting for what they want. In private, Senate Majority Leader Mitch McConnell (R-KY) has told some members that cuts to Medicaid will never go into effect, while Cornyn told reporters Medicaid reforms would be reintroduced in the House. The result has been a convenient uncertainty.

The Senate is trying to pass Schrödinger's health care bill, where every senator raises objections that leadership quietly assures them will be addressed in the final bill — if only they can keep the process alive. Paramount to this strategy is that no one can say with certainty what is in the box now, much less what will be in it at the end.

But this strategy is not a way to solve the GOP’s health care problem — they do not agree on a health care bill, or even on the goals of a health care bill. It’s just a way of restating it.

Eventually, congressional Republicans will have to open the box.

This box is whatever it needs to be to get to 50 votes

One by one, Senate Republicans are knocking down their options for repealing the Affordable Care Act. On a procedural vote Tuesday, nine Republicans voted against moving forward with the Senate’s revised health bill — the Better Care Reconciliation Act. On Wednesday, they voted down the Obamacare Repeal Reconciliation Act — a straight repeal bill.

Republican senators’ objections span the party’s ideological spectrum. Among moderates, Sens. Shelley Moore Capito (WV), Dean Heller (NV), Rob Portman (OH), Susan Collins (ME), and Lisa Murkowski (AK) have expressed concerned with proposed cuts to Medicaid.

All of them, except Collins, represent states that expanded Medicaid under Obamacare, and several have been struggling to combat an opioid epidemic in their states, which Medicaid has played a large role in combating.

Conservative dissenting voices, like Sens. Mike Lee and Rand Paul, say Republicans’ health care proposals don’t go far enough to repeal Obamacare. The party’s frustrations reach a consensus over process — one that has largely been done in secret and among leadership staff.

“To do that without holding a single hearing on what the implications would be for some of our most vulnerable citizens, for our rural hospitals and our nursing homes, is not an approach that I can endorse,” Collins, who voted against both the BCRA and the ORRA, said. “In my state, the implications of that give me great concern, particularly since we haven’t explored in a public hearing.”

Having failed to move forward with the BCRA and the ORRA during debate, Republicans are on the way to what looks like a “skinny repeal” of Obamacare — a bill that would do away with the individual mandate and employer mandate but leave Medicaid expansion and most of Obamacare’s regulations intact. It’s not clear what happens after that.

The vagueness of a skinny repeal has allowed Republican senators to attach their votes to contradictory premises. Some see it as the end of the road for health care debate, others as a continuation of negotiations.

Eventually, the Senate and House will have to stop bouncing bills back and forth, open the box, and reveal the contents.

Everyone has a different understanding of what this skinny repeal actually means.

If the Senate does manage to pass the skinny repeal idea, there is still a big question mark over what’s next.




As Sen. Bob Corker (R-TN) told reporters, the "content" of the skinny repeal bill is beside the point — it’s all about a "forcing mechanism" to conference with House, the idea being that negotiations with the House would produce a more robust plan.

That would include changes to Medicaid, according to Cornyn.

"I think people understand we'll address the Medicaid issue when we conference with the House," he told reporters Wednesday.

Leadership telling senators that whatever concerns they have will be fixed in conference committee is yet another way that everyone is allowed to pretend the bill they’re voting on satisfies their needs.

Heller, a vulnerable moderate from a Medicaid expansion state, has said he would support the repeal of the individual and employer mandate, specifically because it doesn’t touch Medicaid. "I'll be sure to vote ‘no’ on a conference bill bringing back Medicaid cuts," Heller said.

And Paul is all in for skinny repeal if it doesn’t go to conference at all.

“I would [be in] favor if we have a skinny repeal, just sending it over to the House and seeing if they can pass it rather than going to conference,” he said. “Conference committee to me means big-government Republicans are going to start sticking in those spending proposals."

That’s a nonstarter for many who are tying their support to this scaled-back repeal bill as a way to just continue negotiations.

“[Skinny repeal] is not a very good solution — it’s a solution if it keeps the process going so we can set up a more complete repeal and replace in the House-Senate conference,” Sen. Ron Johnson (R-WI) told Vox. “If this is the final product from the House-Senate conference that would be bad.”

Sen. Ted Cruz (R-TX) told reporters the same thing: This is all part of the “journey.”

“There’s no doubt that repealing the individual mandate and the employer mandate are good, positive steps,” he told reporters. “I hope we can do far more and provide really meaningful relief for rising premiums.”

The lack of consensus is convenient for now — it allows senators to get to yes. But it foreshadows more disagreement to come.

Eventually Republicans are going to have to open the box and vote

For now, Republicans can continue to hide behind the problems of Obamacare. They can continue their stand for lowering premiums and increasing choice, and decry the individual markets hemorrhaging insurers.

But eventually the uncertainty around the bill will have to come to an end.

The Republican strategy toward health reform has been a game of hot potato from the start. From the House, where moderates signed on to a bill in hopes that the Senate would fix it, to the Senate, where GOP leadership is hoping to pass on the problems to a House-Senate conference.

As Vox’s Ezra Klein explained:

The problem with health care hot potato is that if no one stops the game, the hot potato eventually gets passed to the country — and millions get burned. ... The GOP is creating a collective action problem where every individual legislator is rationally refusing to be the cause of the bill’s failure, but that could mean the entire party ends up responsible for its catastrophic success.

At some point, if they are truly dedicated to putting something on Trump’s desk, Republicans will have to unlock the box and put up their proposal to a vote.

And when that happens, Schrödinger’s health bill will be either dead or alive.