I can’t get no Sasse-isfaction

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Defector of the Day: Ben Sasse

Each day leading up to the Senate vote, we'll take a closer look at a Republican senator who seems to be on the fence on the Better Care Reconciliation Act, what they want, and what role they're likely to play in the debate. Today we focus on the unlikely remarks of Nebraska's Ben Sasse.

Mark Wilson / Getty News Images

The prevailing strategy in Congress for months now has been to pass a plan to repeal and replace Obamacare at the same time. There was, in January, a bit of chatter about "repeal and delay," where Congress would quickly pass a repeal plan and, a few years into the future, figure out the replacement. That idea was quickly shelved for a number of reasons, including that more moderate Republican senators would never support such a plan.

Now, however, Sen. Ben Sasse (R-NE) wants repeal and delay back on the table. During a morning appearance on Fox News, he argued that Congress ought to repeal the law outright and shelve the replacement for a later date if they can't come to a deal by next Monday. Here's what he said:

I want maximum repeal. However much repeal we can do under these arcane budget reconciliation rules. I want a conversation about real replace. To date, we have been trying to do those two things at once and not making enough progress. I still hope that process can work. ... If we don't get this resolved by the Monday of next week, July 10 ... I'm writing a letter to the president this morning urging him to call on us to separate them.

President Trump took to Twitter exceptionally quickly to follow Sasse's exact instructions.

This strategy landed with a thud on Capitol Hill. Aides told Axios's Caitlin Owens that this approach was "not going to happen" and had had "zero" chance of moving forward.

It's easy to see why the repeal-and-delay strategy has appeal. It allows Republicans to quickly deliver on a campaign promise and leave the hard stuff, like coming up with an entirely new health plan, for later. Back in February, legislators floated the idea of passing a bill that repeals Obamacare two or three years into the future, setting a window to write the replacement plan.

But Republicans gave up on repeal and delay back in January precisely because they couldn't get enough support for the policy. A wide range of senators from the moderate Lisa Murkowski (R-AK) to the very conservative Rand Paul (R-KY) detested the idea of putting off the replacement until a later year. Experts, meanwhile, warned that Obamacare would collapse in the interim: Who wants to sell coverage on a marketplace they've been told is shuttering two years down the road?

If anything, the resurgence of repeal and delay exemplifies how malleable the president's views on health policy remain. In January, Paul reportedly convinced the president that this was not a good strategy. One Ben Sasse appearance on Fox News later, he apparently has reversed course.

The positions of senators, however, are not quite as flexible, which makes it difficult to see this approach gaining serious traction on the Hill anytime soon.

Chart of the Day

Journal of Surgical Research

A study of emergency room visits for firework injuries reveals the victims are typically young adult men. The Journal of Surgical Research looked at 25,691 emergency room visits for fireworks-related injuries between 2006 and 2010. The results are, well, not surprising (hat tip to Vox's Brian Resnick for flagging this study on Twitter).

Kliff’s Notes

Your daily top health care reads, with research help from Caitlin Davis

Today's top news

• "Projected Drop in Medicaid Spending Heightens Hurdle for G.O.P. Health Bill": "Projected Medicaid spending under a Senate Republican bill to repeal the Affordable Care Act would be 35 percent lower after two decades, the Congressional Budget Office said on Thursday in a new report, which detailed how Medicaid changes would cut more deeply as they go fully into force." —Robert Pear and Thomas Kaplan, New York Times
• "GOP senator calls for ObamaCare repeal first, replacement later": "Sen. Ben Sasse (R-Neb.) told Fox News on Friday that if Republicans can't pass a bill to replace ObamaCare soon, they should repeal the entire law and work on a replacement later. Speaking on 'Fox and Friends,' Sasse said that if progress isn't made by July 10, he'll call on the president to separate the process." —John Bowden, the Hill
• "White House denies moving to 'plan B' on healthcare after Trump tweet": "The White House is denying that they've moved to "plan B" on healthcare after President Trump suggested repealing and replacing Obamacare separately, instead of simultaneously, on Friday. 'The president hasn't changed his thinking at all,' deputy White House press secretary Sarah Sanders said Friday during the White House briefing." —Alex Pappas, Washington Examiner

Analysis and longer reads

• "State Single Payer And Medicaid Buy-In: A Look At California, New York, And Nevada": "Three states’ legislatures, California, New York, and Nevada, have developed high-profile state-driven solutions to address consumer access and price-related concerns. While state-led waiver initiatives such as those from Alaska and Oklahoma are meant to provide an incremental stabilizing force to their respective markets, the models that California, New York, and Nevada legislatures proposed could fundamentally reshape the framework of state health markets more akin to what Massachusetts did 11 years ago." —Douglas Hervey, Sean Mullin, and Austin Bordelon, Health Affairs
• "How Republicans Can Fix American Health Care": “Obamacare in its present form does bear down hard on Republican voters outside coal country. It does stress the country’s finances. It does offend their ideological instincts. What’s needed now is something practical: incremental reform in a conservative direction. Here’s where that reform could start in the 'mend it don’t end it' Obamacare era.” —David Frum, the Atlantic
• "Health Care's Crushing Lack Of Competition": "Driven by lack of competition, ever higher prices are being paid to hospitals, doctors and insurers without leading to better outcomes. It’s time to implement a competition policy for health care before Americans crumple under a system that is devouring family and government budgets." —Martin Gaynor, Farzad Mostashari, and Paul Ginsburg, Forbes
• "Healthcare issue delivers nothing but pain for Nevada's embattled Sen. Dean Heller": "This is Heller’s dilemma. Despite a Republican constituency urging a repeal of Obamacare, he refused to back the Senate bill that Majority Leader Mitch McConnell wanted to vote on this week, joining a handful of other senators who forced a delay past the congressional Fourth of July recess. He was mindful the Medicaid expansion remains popular in Nevada, with its large population of service-industry and minimum-wage workers." —David Montero and Mark Z. Barabak, Los Angeles Times

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