'Skinny Repeal' Is Literally the Least Republicans Can Do. But It's Not the Last.

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After months of narrow votes and depressing failures, Senate Republicans are finally prepared to vote on their last, best chance to do something about Obamacare. It's dubbed the “skinny repeal,” and would essentially repeal the individual mandate and the employer mandate, along with the medical device tax.

It is, quite literally, the least Senate Republicans can do. So that's what they're going with.

At face value, this skinny repeal is an underwhelming and frustrating piece of legislation, especially considering the major reforms that the House-passed AHCA (and the Senate-proposed BCRA) made to Medicaid and Obamacare's regulations. After everything that was originally on the table, this is all that we're getting?

Indeed, if the skinny repeal is signed into law as the final chapter of the seven-year Obamacare repeal saga, it will be very disappointing.

Except this may not be the end. Nor can it be.

Axing the individual mandate, which requires every American to purchase health insurance or face a penalty, is no small feat. It's been called the “beating heart” of the Affordable Care Act, because it forces millions of consumers to prop up otherwise lackluster health insurance exchanges. So important - and controversial - was this mandate that conservatives used its questionable constitutionality as a vehicle to have the Supreme Court strike Obamacare down (it ultimately did not succeed).

What's more, the individual mandate has been a thorn in the side of Republicans trying to square the impacts of their proposals with the CBO, which has estimated that repealing the mandate alone would prompt 15 million to “lose” (that is, voluntarily drop) their health insurance. This (flawed) assumption allows the CBO to score any and all Republican repeal plans that axe the mandate with uninsured numbers in the 20 millions, without making the critical distinction that the vast majority of those people will have willingly let their coverage go.

So, as healthcare wonk Avik Roy points out this morning in the Washington Post: if Republicans erase the individual mandate from current law, the CBO would be required to adjust its baseline for scoring future repeal bills. That would almost certainly alter the optics and provide a more honest assessment.

Aside from that, unless Republicans are looking to make matters worse, the GOP cannot repeal the individual mandate and call it a day. The Obamacare marketplaces are already unstable, and millions of people heading for the exits would almost certainly cause premiums to continue rising - if no other action is taken.

The Republicans can pass their skinny repeal now. They can claim a small victory. They can deny the CBO the tool its been using to come up with sensational scores. Then they can go back to the drawing board, build consensus around a bigger bill, and go from there.

For supporters of Obamacare repeal, that's the optimistic scenario here.

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