The Back & Forth: GOP health care plan hits a wall

Buzz blog contributors who cover politics for The Star regularly chat about recent political news from Kansas, Missouri or our nation’s capital.

This week, The Star’s Bryan Lowry catches up on the news he missed while he was on vacation in a Gchat conversation with the Star’s resident health expert, Andy Marso. That conversation has been edited for flow.

Bryan: Hey man, so what did I miss while I was away on vacation? Any big news in the world of health care?　

Andy: Well, the GOP health care saga continues to wind toward a vote to repeal Obamacare... maybe.

Word is they're going to vote on something Tuesday, but they don't think they have the votes. And they've delayed before.

Bryan: Yeah, I was sitting on a beach when my phone started buzzing that Jerry Moran had torpedoed the Senate bill. I had to mute it. What was the reaction here?　

Andy: Hard to describe. Not necessarily shock, because he had clearly been wavering for a while. He didn't like parts of the bill and he definitely didn't like the process of drafting it and he'd made that clear publicly.

But a lot of people still expected him to be a good soldier. McCain's absence may have been a game-changer for the whole thing. The GOP couldn't lose another vote, so once that happened it was clear the bill didn't have the votes to pass. That's when people who had been on the fence, like Moran, jumped ship.

Bryan: But now he's backing the repeal-only bill? His main argument against the other bill was its impact on rural health care. How would a repeal-only bill affect heavily rural states like Kansas and Missouri?　

Andy: CBO (Congressional Budget Office) says that repeal-only would result in about 32 million more uninsured nationally, which would more than double the current number (about 28 million). It wouldn't be as drastic a change in states like Kansas and Missouri that didn't expand Medicaid, but a major disruption to the Obamacare exchanges, which are the source of insurance for more than 200,000 people in Kansas and Missouri.

Bryan: I had a GOP aide recently suggest to me that it may be easier to pass a repeal-only bill, delay it and then gradually pass replacement measures after that with bipartisan support. That reminds me a bit of the approach that the Kansas Legislature took with school finance and things got pretty down to the wire in Topeka.

Any thoughts on that approach? Would passing a repeal-only bill send the health industry into even more upheaval than it’s currently in?　

Andy: It creates an artificial deadline but doesn't create any guarantee of crafting good policy before then. Any repeal bill would have to give insurers at least a two-year horizon before it goes into effect. 2018 policies are already being written and premiums have to be locked in by end of September.

That's the only way to make repeal-only work: delay the effective date a year or two, which creates a sense of urgency for parties to come together and pass something else before the effective date.　

Bryan: Speaking of uncertainty, you've been tracking the situation in Missouri where some counties were in danger of not having any insurer in their health exchange next year. What's the current status of that?　

Andy: Every county should have at least one insurer, as it stands now. Centene's entry into the Obamacare marketplace was a real game-changer, as it looks like they're going to sell in all the counties BCBS Kansas City vacated. That also includes Johnson County and Wyandotte County in Kansas.　

Bryan: Thanks, man. I feel like I just took a college course in health policy. One final question: Did you miss me while I was gone?　

Andy: Well, of course. It was wayyyy too quiet around here.

Follow Bryan Lowry @BryanLowry3 and Andy Marso @andymarso on Twitter.

This story was originally published July 21, 2017 at 3:48 PM with the headline "The Back & Forth: GOP health care plan hits a wall."