Using health-care tax credits as a centerpiece is a hallmark of Republican plans, and this one is similar to what John McCain proposed as a presidential candidate in 2008, said John Goodman, a veteran health-policy analyst who advised Sessions and Cassidy on their plan over the last 18 months. “This is the reform they should have adopted in the first place,” he said. As Goodman sees it, the Sessions/Cassidy bill will ultimately be a replacement for Obamacare because while the exchanges are “grandfathered in” people will ultimately choose to opt out as more insurance companies leave and premiums and deductibles increase. (The lawmakers’ decision to keep the exchanges at all, Goodman said, was for “political” reasons.)
Don’t count on much bipartisan support for the bill, despite the fact that it keeps the Obamacare exchanges intact. Democrats won’t go for anything that guts the individual and employer mandates, which, they note, originated as Republican ideas in the 1990s. But they are cheering the Sessions/Cassidy bill as a small vindication of their long-standing position that Republicans would eventually come around to, or at least get used to, Obamacare. “After more than six years, we are glad that at least two Republicans have given up on repealing the Affordable Care Act,” said Drew Hammill, the spokesman for House Minority Leader Nancy Pelosi.
The question for Sessions and Cassidy is whether splitting the difference will win them many votes at all. Under Ryan’s direction, House Republicans are intent on coalescing around a health-care plan—if not an actual bill—in the coming weeks, but the task force of committee chairmen leading the effort is expected to embrace a proposal that fully repeals and replaces Obamacare, consistent with the party message. And when the speaker was asked about the Sessions/Cassidy bill earlier this week, he offered something far short of a ringing endorsement. “I don’t even know what his bill does,” he said initially, before adding: “The point is, everybody should feel free to offer their ideas. That’s Congress.”
Sessions is pitching his bill as one that is aimed not so much at the 12.7 million people who are getting their insurance directly through the Obamacare exchanges but for the millions more who are not. “You’ve got to recognize that health care, for at least another 150 million Americans, is getting not only more expensive but is in doubt,” he said. “The Affordable Care Act did not cure the problems of the uninsured.” Republicans, Sessions said, need to have “a fair, well thought-out bill” to bring to voters this fall. The challenge is persuading a conservative base, and a conservative Republican conference in the House, on a truce with Obamacare that many still aren’t ready to stomach. Sessions and Cassidy are stepping out ahead, unsure if anyone will follow. “I’ve spoken to every member, and they find it intriguing and interesting,” Sessions told me, “and they by and large have said to me, ‘Great, go sell it.’ And that’s what I’ll do.”