‘Skinny Repeal’ Bill Poses Big Risk to Medicaid

There is a lot of talk now about the Senate passing a “skinny repeal” bill at the end of the current floor debate — which could come as early as tomorrow. Rumor has it that the skinny bill would leave Medicaid out since it has been hard to appease all sides of the Republican caucus, especially the expansion versus the non-expansion states.

So we don’t know exactly what will be in the “skinny” repeal bill (current rumors are that it will repeal the individual mandate, the employer mandate, and the medical device tax) but it is clearly designed to avoid the current infighting on Medicaid and just pass something to get to conference with the House. Republican Senators who are worried about losing their state’s expansion may see this as a viable path to yes, and Senator Heller (R-NV) today indicated exactly that.

Leaving aside the damage that this approach would cause through destabilization of the individual insurance market that would send premiums soaring for the moment, should Senator Heller and his fellow Senators who have worried about the massive Medicaid cuts feel better?

Most definitely not.

Last night, after watching the vote which defeated a version of the Senate’s bill (BCRA), I tweeted “The real challenge for Medicaid is if McConnell convinces 50 Rs to vote yes on something at the end of this debate to keep process going.” I said that because a vote to move forward moves the bill into conference with the House — where all of the threats to Medicaid will be alive and real and the process itself will become even more secretive. Moreover, the longer the process goes on, the more momentum to get to yes grows. Jonathan Cohn wrote a great piece about this today by the way.

Sadly, my fears that this was the game plan were confirmed today by Majority Whip Senator Cornyn (R-TX). He said as much today to a group of reporters – noting that the virtue of the skinny bill was to get to conference where Medicaid would be back on the table.

I worry a lot about scaring families who rely on Medicaid and CHIP for their coverage. Some of them read our blog. But as I also tweeted the other day, we have a lot to worry about right now. Even the “skinniest” of repeals passing the Senate would threaten Medicaid with severe cuts — the backbone of children’s public coverage.

Read Part II of this blog series to learn more about the impact of the  “Skinny Repeal” bill.

Joan Alker is the Executive Director of the Center for Children and Families and a Research Professor at the Georgetown McCourt School of Public Policy.