Without enough votes to pass the Better Care Reconciliation Act or the Obamacare Repeal Reconciliation Act, reports are surfacing that the Senate may turn to a new, less familiar option this week. That option, dubbed “skinny repeal,” would repeal only the individual and employer mandates and the tax on medical devices. While its name suggests its impact would be slight, skinny repeal would have serious negative consequences.

First, skinny repeal is likely a “Trojan horse.” Passage of “skinny repeal” – or something like it – would shift the focus to a House-Senate conference committee, where it would need to be reconciled with the House-passed American Health Care Act, a bill President Donald Trump called “mean.” Sen. Bill Cassidy also roundly criticized that proposal, saying: “I am a critic of the American Health Care Act. I think it’s to set up tax reform and all the money used for coverage is instead going to be used to pay down the bill for tax reform.”

Once the skinny repeal bill is sent to a conference committee, anything could happen. There are no rules governing who sits on the conference committee, and their deliberations would occur in secret. There likely would be no drafts for review or public hearings. There would be no engagement with experts or governors, and no way for non-conference members to weigh in. Whatever bill gets constructed by the conference committee would face up-or-down votes in the House and Senate, and could not be amended.
While the “skinny repeal” effort is almost certainly a means to prolong debate and send the bill into conference, it also would be hugely disruptive for people who buy coverage on the individual marketplaces and who have pre-existing conditions. The Congressional Budget Office (CBO) estimates that repeal of the individual mandate would result in six million fewer people enrolled in the individual marketplaces by 2020. That’s nearly half of the 13 million who are projected to buy health insurance on the marketplaces under current law. The majority of those who would leave the marketplaces would be young and healthy people who have relatively low health care costs. The older and less healthy would remain in the marketplaces, which would drive up their premiums. According to CBO, in 2018 premiums would rise by 20 percent for those who remain in the marketplaces, an average increase of $1,238 per year. Additionally, CBO projects the repeal of the employer mandate would result in 5 million fewer Americans receiving employer-sponsored insurance by 2020. 

Rather than allowing themselves to be backed up against a wall, Louisiana Sens. Bill Cassidy and John Kennedy should reject the skinny repeal proposal, put an end to this divisive process, and work toward solutions that are in the best interests of the Louisianans they represent.