I’m not surprised by McCain’s comments, or Toomey’s for that matter. The real story though is about Senator McConnell who told a crowd of Kentuckians a few days ago that it will be necessary to take some sort of action with regard to the private insurance markets, if he cannot get to 50 GOP votes for his repeal and replace. He acknowledges that he will need Dem votes for this stabilization. This was interpreted to mean a bill to legislate cost reduction subsidies (CSRs) to insurance companies.
Trump is being cute about whether he will pay the CSRs next month. Recall that the health plans have to pay them whether or not the federal government funds them. So the health plans will have to raise premiums about 20% to make it work. Most exchange members will not be affected since the subsidies will increase (they are based on income). In fact, the net effect on the Treasury is negative since the higher premiums will put more people in the subsidized population. However, there will be lots of sticker shock, especially in the 10-15% of the exchange population too rich for subsidies. Rural markets are worse because there are more people who need the CSRs in them.
I believe that McConnell is making a frequently made mistake about insurance markets: there is long (months and months) of lead time before health plans can offer policies. In public private partnerships, the private partners do not take risk hoping that there will be a legislative fix at the 11th hour. The goose of poor exchange functioning this winter may well already be cooked. It is certainly cooked by the time McConnell’s repeal and replace bill fails and he starts a new bill to stabilize and rounds up Dem support and then gets it to the house and then get Ryan and Pelosi to pass it.
What is interesting is that McConnell apparently understands that letting this happen will be bad–for the GOP, and for the constituents in rural Kentucky to whom he is speaking. I think he under appreciates the fire storm that may result when GOP voters find that the party in complete control of the government has allowed big premium increases and bald counties.
The cooked goose will happen in the same time frame as the need to pass appropriations, manage the sequester and raise the debt ceiling. The last three all take Dem votes. I would not be shocked if Schumer and Pelosi link the four of them together and accomplish some good for the American people.