After years of voting to repeal the Affordable Care Act, congressional Republicans are stumbling now that they have majorities in Congress as well as a chief executive ready to sign their bill.
After weeks of behind-the-scenes bill-writing, House Republicans released their long-awaited repeal bill of the ACA, aka Obamacare, late on Monday. The bill — known as the American Health Care Act — was, admittedly, only one part of a three-step process.
“This is the beginning of the negotiation … If they were to remove the objectionable items from their repeal and replace, it would essentially be [clean] repeal.”
It faced massive opposition from both the moderate and conservative wings of the GOP almost immediately. Moderates howled over the draw-down of Medicaid expansion in the leadership bill. Conservatives slammed how much of the original law would be left in place, the lack of movement on key free market promises, and new provisions seen as expanding government control over the health care system.
What now to do in 2017 depends on which Republican you ask. Members of President Donald Trump’s administration and House Republican leadership will say this bill has a way forward and that repeal and health care reform cannot be done at once.
Conservative congressional members and activist groups believe full and unconditional repeal is an immediate must.
“Clean Repeal”
On Tuesday afternoon, the House Republican bill was panned by conservatives long waiting for repeal of the hated Obamacare, passed in 2010. At a gathering of conservative Republican senators and representatives outside the Capitol Tuesday, elected officials took turns beating the proposed repeal-and-replace bill.
“There’s the leadership plan that was brought forward, which I believe, when you look through it, is Obamacare in a different form,” said Rep. Jim Jordan (R-Ohio), the former chairman of the conservative House Freedom Caucus.
“This is … a step in the wrong direction,” said Sen. Mike Lee (R-Utah).
A common refrain at the Freedom Caucus press conference with Sens. Rand Paul (R-Ky.) and Lee was a question about repeal in 2015. Why couldn’t the Republican Congress simply vote for repeal, as they did in December 2015, when every GOP member of Congress voted to yank Obamacare in whole?
Paul called it “clean repeal.”
Addressing all of the issues that Paul and other Republicans want in a “clean repeal” may not be possible. Republicans don’t have the 60 votes needed in the Senate to move forward.
Republicans have 52 seats in the Senate. They would need eight Democrats to move forward with a repeal-and-replace option outside of the process known as reconciliation.
“The bill that goes through reconciliation and only requires 50 votes in the Senate in order to pass,” said Tom Price, secretary of Health and Human Services, during an interview Tuesday on “The Laura Ingraham Show.”
“There’s some things that you can do in that and there’s some that you can’t do just because of the rules,” Price said. “I know that’s a process argument, but that’s the truth.”
Three Steps
And it is the truth. One health care policy expert who has concerns about the Republican first draft told LifeZette that the first phase has to contain all the things that can be done via budget reconciliation, which only needs 51 Senate votes.
The next step, the second phase, would be Price’s move. As HHS secretary, Price will exercise his power to affect up to 1,400 health care regulations, as empowered by the law.
The final step, according to House Speaker Paul Ryan (R-Wis.), would be a second bill, with items that can be filibustered because of their nature. The “Phase 3” bill will be moved almost simultaneously with the American Health Care Act, Ryan explained in a Tuesday afternoon press conference with House Majority Leader Kevin McCarthy (R-Calif.).
One big item in this secondary bill will be a favorite of President Donald Trump and many conservative groups: It will allow the purchase of health insurance beyond a customer’s state lines. Unlike automobile insurance, health plan customers have been confined to the state in which they live.
Opponents of the current draft think that provision can be added now.
“Such an injection of competition would lead to hundreds of billions of dollars in savings, nullifying any argument by congressional Republicans that this provision cannot be included in the current bill,” said Club for Growth President David McIntosh in a statement.
Conservatives also expressed concern that a number of taxes and mandates (although not the hated “individual mandate”) are left in place.
“Republicans should be offering a full and immediate repeal of Obamacare’s taxes, regulations, and mandates, an end to the Medicaid expansion, and inclusion of free-market reforms, like interstate competition,” said McIntosh.
The Heritage Foundation’s political arm, Heritage Action, has also blasted the current draft in a statement.
“If Republicans move forward with this bill, they will be accepting the flawed premises of Obamacare,” said Heritage Action CEO Michael A. Needham. “Instead, they should fully repeal the failed law and begin a genuine effort to follow through on their seven-year promises to create a free market health care system.”
Yet Paul, of all people, seems to realize the House bill is an “opening bid” from Ryan and Trump. Democrats have been dealt out. The only people needed to pass Phase 1 are the conservatives and libertarians like Paul, Lee, and Jordan.
“This is the beginning of the negotiation,” said Paul, admitting Vice President Mike Pence has been contacting House Freedom Caucus members, and that Cabinet members have been setting up appointments with conservatives. “If they were to remove the objectionable items from their repeal and replace, it would essentially be [clean] repeal.”
That would be possible, since congressional Republicans and the administration have made clear the bill will be considered under regular order — a process that would allow the bill to be amended to win conservative votes.
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