The United State Senate left for its 4^th of July recess without taking a vote on the repeal and replacement of Obamacare. The Senate bill as originally offered (here) was very similar to the bill the House passed in May. (here) The timing on Medicaid reform varies somewhat and the tax credits to assist lower-income people purchase health insurance are of different amounts. Yet, the goals of both bills are the same.

The tragedy is that Senate Republicans voted multiple times over the past seven years to repeal and replace the Affordable Care Act (ACA), knowing that President Obama would veto the bills. Now that there is a Republican in the White House eager to sign any repeal and replace legislation, Republican Senators are forced to live with their votes.

Interestingly enough, the American public was solidly opposed to Obamacare until the past few months. Proponents of the ACA and their organized supporters have recently made an all-out push to scare Americans that people will die without Obamacare.

The ACA essentially has two parts – the health insurance exchanges and the Medicaid expansion.  The exchanges are in a death spiral because of adverse selection. Young and healthy people are priced out of the exchanges, leaving more expensive older and sicker individuals. As premium prices go up, fewer young and healthy people will sign up, causing prices to rise even further. Ultimately, unless the government bails out the insurance companies, carriers will leave the exchanges altogether.

Both the House and Senate bills shift people out of the doomed exchanges and into the individual insurance market using tax credits. Both bills also encourage the use of high-deductable insurance with health savings accounts and attempt to allow the insurance companies to offer benefit mandate-light plans that the young and healthy would actually want and buy.

The original Medicaid is an entitlement that is not financially sustainable. The expansion under Obamacare only compounds this fiscal problem. Both the House and Senate bills address this Medicaid fiscal crisis with the first ever reform of the entitlement. Last year state and federal governments spent $545 billion on Medicaid. At a modest six percent health care inflation rate, without reform, the cost of Medicaid over the next 10 years will be $7.6 trillion. Although the Republican bills cut $750 billion to $880 billion from Medicaid, this represents only about 10 percent of the estimated cost over the next 10 years. (here)

The bills also give states more control over their own Medicaid programs and allow the states to identify and prioritize the most vulnerable. It is disingenuous to say that if states cut 10 percent out of their Medicaid entitlements people will die. The personal stories and scare tactics now in the media are breathtaking.

Senate Republicans have been talking the talk for the past seven years. It is now time to walk the walk and take the vote that will give patients the best chance at maintaining choice and quality, while protecting the most vulnerable in the United States. If the Senate does not take this opportunity to repeal and replace Obamacare, Congress will undoubtedly move on to other issues. Incrementally, entitlement by entitlement, the country will then move further toward a centrally-planned, government-run health care system.