Will states be able to clean up the health care mess?

Gov. Dannel Malloy and the Connecticut General Assembly have not arrived at a compromise to close a budget shortfall of about $5 billion over the next two years, but they are getting close. If and when they do, however, the real work will need to begin.

U.S. Senate Majority Leader Mitch McConnell, R-Kentucky, put a bill to repeal and replace the Affordable Care Act under fast-track consideration Wednesday. Called the American Health Care Act, the measure narrowly passed the House last month. It is unlikely to pass the Senate without major changes, but the lesson here is clear: Contrary to popular belief, this thing could really happen.

Few thought it would in March after House Republicans failed to get their act together. Many thought replacing Obamacare (the ACA’s nickname) was unlikely, because President Trump’s campaign staff is under investigation for possible ties to Russia. Many were skeptical for other major reason: the president fired the man principally responsible for leading that investigation, James Comey. The former FBI director is set to testify to Congress Thursday He released a prepared statement today suggesting Trump engaged in obstruction of justice. U.S. Rep. Al Green, D-Texas, said Tuesday that his staff had begun drafting articles of impeachment. And yet here we are. I suspect the last thing Connecticut lawmakers want to do is figure out where another $8 billion is going to come from if Congressional Republicans succeed in repealing and replacing Obamacare. U.S. Sen. Chris Murphy, Connecticut’ junior senator, estimated that $8 billion is about how much would be lost in Medicaid funding over 10 years if his Republican colleagues were to pass the House bill. Nationally, about 23 million Americans could go without health insurance. More than 110,000 Connecticut residents get coverage under Obamacare.

State lawmakers know something big is coming, and they are getting a taste of the immense challenge ahead. The state Senate passed a measure unanimously Friday to require insurance companies to provide coverage to women and children in the event that Congressional Republicans succeed in repealing Obamacare.

Again, this was unanimous, but the governor took umbrage with the measure, saying lawmakers were making demands of insurance companies just as insurance companies, like Aetna, are shopping around for states more amenable to their needs. Malloy said in a statement: “I seriously question whether the Legislature understands the impact that their actions have on the rising costs of health care.”

Not only is the Trump White House fielding a political firestorm, but it has forced insurance companies to pull out of state health insurance exchanges. Anthem announced this week it was leaving Ohio. It explicitly cited “uncertainty” as the reason, meaning the administration appears uncertain about enforcing the “individual mandate,” a tax on those who don’t buy insurance, and about obeying requirements to reimburse insurance companies.

Which brings us back to the U.S. Senate. Sabotaging Obamacare is giving Senate Republicans the rationale to move fast. House Speaker Paul Ryan has been saying for months, after all, that Obamacare is heading into a death spiral. Now that the Trump administration has made that wish come true, Senate Republicans need to act.

The problem is how. One idea currently getting play but that may prove categorically toxic is taxing those of us who get insurance through our employers. I’m not kidding. The Wall Street Journal reported last week that senators are looking at a plan to eliminate premium tax deductions for business and individual income tax. This is important for reasons that have nothing to do with health care.

If the new bill does not save nearly $120 billion over a decade, it will not qualify as a moneysaving measure, thus allowing it, according to Senate rules, to pass with a simply majority. Republicans hold 52 seats in the Senate. If not, the bill risks exposure to Democratic filibuster.

Here’s what all this really means. Even as the president is facing a crisis of legitimacy, Senate Republicans are searching for ways to fulfill a promise they have been making for eight years. But to do that, they may end up taxing people who get health insurance from their employers, which is to say a majority of Americans. And they may end up doing that, because they want to give Trump a win.

Make sense? Didn’t think so. But it doesn’t matter.

The states will have to clean up the mess, if they can. John Stoehr is a lecturer in political science at Yale and a New Haven resident.

John Stoehr