When Mitch McConnell first uncovered the health-care bill over which he’d been laboring in secrecy, even the bill’s staunchest supporters noted a glaring omission: nowhere did the legislation address the so-called “death spiral” phenomenon. It’s an inescapable feature of health-care insurance markets: if individuals aren’t forced to buy health insurance or don’t face a penalty for choosing not too, they will only sign up for coverage when they get sick, making the overall insurance pool sicker and more expensive, and creating a nasty positive feedback loop of every-higher premiums. Taking a break from his vote-wrangling efforts, McConnell released an updated version of the Senate bill that addresses the problem—arguably, in the worst way possible.
The latest version of the Orwellian-titled Budget Care Reconciliation Act, which would repeal and replace Obamacare, now includes a provision that would prevent anyone who has more than a two-month break in their health-care coverage over the past year from purchasing insurance again for 6 months. This half-year waiting period, Vox reports, is designed to scare young, healthy individuals into buying health insurance, stabilizing insurance risk pools. But what it really does is punish previously healthy individuals at a time when they are the most vulnerable.
The “death spiral” issue is hardly a headache unique to Senate Republicans. Obamacare attempted to solve the problem with its individual mandate, which slapped uninsured individuals over the age of 26 with a tax penalty. House Republicans included a “continuous coverage” provision in their own Obamacare repeal bill, the American Health Care Act, which would impose a 30 percent surcharge on premiums for individuals whose insurance coverage lapsed. But neither Obamacare or the A.H.C.A. went so far as to impose a 6-month waiting period that could be a death sentence. The poorest, sickest people without insurance could, presumably, receive emergency medical care at hospitals and never pay their bills, as many did before the Affordable Care Act. But it’s not clear what would happen to someone without insurance, for example, who suddenly learned that they had Stage 3 cancer or another disease that would need to be treated by a specialist.
There is hope that Americans won’t have to experience such a nightmare scenario. In order to pass their Obamacare repeal bill, Senate Republicans are using a procedural tool known as budget reconciliation, which allows them to avoid a Democratic filibuster. But there’s a catch: Under the budget reconciliation rules, Republicans can only pass provisions that directly impact the federal budget, and it is unclear whether McConnell’s six-month waiting period violates this guideline.
Even if it is determined that the latest update to the Senate bill is allowed under budget reconciliation, it's still uncertain whether McConnell can garner enough votes for the legislation to survive the upper chamber. After the weekend, it became clear that the majority leader's vote count was on shaky ground. But in light of the Congressional Budget Office's estimate that 22 million more Americans will lose coverage under the Senate plan than under Obamacare, it seems unlikely that he can reach 50 votes.
