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It’s Looking More And More Like Congress Will Fail To “Repeal And Replace” Obamacare

congress-healthcare

Senate Republicans are running out of time in the effort to come up with a bill to repeal and replace the Affordable Care Act:

It’s decision time for Senate Republicans’ years-long quest to repeal Obamacare.

Senate Majority Leader Mitch McConnell of Kentucky is holding a series of consequential meetings Tuesday that likely will deliver a frank assessment of whether the divided Republican Conference can overhaul the law with their narrow majority.

Senate Republicans can lose only two votes and still repeal and replace the law via a fast-track process that sidesteps Democratic filibusters. McConnell and his leadership team hope to have a preliminary framework submitted to the Congressional Budget Office by the end of the week and a floor vote by month’s end, Republican sources said. The bill is not drafted or finished, but Republicans said they were zeroing in on a final product.

“The policy options have been narrowed. And there are still some big decisions that have to be made, a lot of issues that will really be up to our members to decide,” said Sen. John Thune (R-S.D.) after a meeting of the party’s 13-member healthcare working group.

Yet a number of Republicans have been pessimistic about the effort over the past month. Rank-and-file senators are keeping expectations low, and Senate Majority Whip John Cornyn (R-Texas) said ultimately there will be a vote and the GOP will “let the chips fall where they may.”

“We still have a ways to go,” said Sen. Jeff Flake of Arizona on Tuesday morning of leaders’ aggressive timeline. “We’re still a ways off.”

“I think it’s more likely to fail than not with the Republican Party only,” said GOP Sen. Lindsey Graham of South Carolina, who prefers that the law collapse and force a bipartisan solution.

The working group, along with several other interested senators, huddled first Tuesday to review the party’s progress; then the entire conference gathers for lunch, where McConnell will take the GOP’s temperature on the party’s healthcare principles. After observing a slideshow prepared by leadership, Sen. Bill Cassidy (R-La.), who has been outspoken about his concerns with the party’s direction, said he was feeling increasingly comfortable and “very encouraged” by Republicans’ plans.

“It’s very cognizant of preexisting conditions. … of course it’s not everything I want, but that’s life,” Cassidy told reporters.

Medicaid has been the thorniest issue for the GOP. Republicans are divided both on when to wind down the enhanced funding under Obamacare’s expansion and how much to control spending in the overall program.

“What I see is more and more concerns about Medicaid as a component of” the bill, said Sen. Jerry Moran (R-Kan.).

Yesterday Politico reported that Senate Republicans were aiming for floor votes on health care reform sometime in June, but it’s unclear at this point when exactly that would be, which is important because the number of legislative days left before the traditional summer recess is quickly running out. According to reports, there would not be final votes in the Senate until after a bill is presented and the Congressional Budget Office has a chance to score the proposed legislation, something that didn’t happen to the revised version of the American Health Care Act that barely passed the House of Representatives last month. If the Senate GOP sticks to that plan, then the process of CBO scoring would likely take at least a week or more, leaving the Senate little time to consider the bill before the short recess for the Fourth of July that will occur between now and the start of the summer recess. Additionally, the longer the Senate bill sits out there the more it will be picked apart by conservatives and liberals alike, both of whom are likely to find more than enough to criticize just like they did with the AHCA. We are at the point right now where it’s not at all clear that Mitch McConnell has the 50 votes he would need to get a bill passed (with Mike Pence’s tie-breaking vote), By the time we get to the point where the Senate is ready to start voting on the bill, it’s entirely possible that there will be enough opposition from both conservative and moderate Republican Senators that, even under the relaxed rules that the so-called “reconciliation” process which allows the Senate to avoid the need to meet a sixty vote threshold, to make it impossible to pass anything through the Senate.

Even if a bill does make it through the Senate, that doesn’t bring Congress any closer to successfully completing the “repeal and replace” process that it undertook just three months ago, and there’s no guarantee it will succeed. It’s already clear that whatever passes the Senate, it will not be the bill that passed the House in May, and it could differ from that bill in several important respects. The major differences are likely to be those that concern the expansion of Medicaid that was permitted under the Affordable Care Act, the grants that law provides to the states for expanding Medicaid coverage in their states, and in the way that provisions such as the coverage mandate for people with pre-existing conditions work. These are the very parts of the AHCA that were changed in order to garner just enough support to get the AHCA through the House, and changing them significantly is likely to make it problematic for Republicans to get support from members of the conservative House Freedom Caucus and the moderate Tuesday Morning Group. If the matter is referred to a House-Senate Conference Committee, that is likely to slow the process down to the point where there may be no opportunity to produce a bill that could pass both chambers before the summer recess. If that happens, the odds of Congress passing a health care reform bill at all this year will decline significantly.

The final thing to note, of course, is that all of this work on health care reform will be taking place at the same time that Congress is dealing with a host of other issues. Perhaps at the top of the list of other priorities lies the budget for the Fiscal Year that begins in October, which will be taking up the time of committees in both Houses for much of the time between now and the summer recess. If this work isn’t done before Congress returns from its recess after Labor Day then Congress will face a crunch time in September as it races to get some kind of funding bill put together prior to midnight on September 30th. Additionally, the House is supposed to be considering and putting together some kind of comprehensive tax reform bill even though, so far, all they’ve gotten from the White House so far is a list of talking points that don’t come anywhere close to being what is needed for them to even start considering the matter at the committee level. Over on the Senate side, the upper chamber is still dealing with Executive Branch appointments that the Trump Administration has only slowly been churning out, including a number of top Ambassadorial appointments that remain as unfilled as they were when I wrote about the issue in May. Finally, hanging above all of this is the Russia investigation, which is clearly only just beginning in both the House and Senate Intelligence Committees.

With that much on its plate, the odds of Congress being able to get a health care reform package that can pass both the House and Senate on the President’s desk before the recess seems bleak. Were I a betting man, I’d be betting that we’ll get to the beginning of August when the recess begins with no health care reform bill, no tax reform bill, a Fiscal Year 2018 budget that is so incomplete that people will likely be talking about the risk of a government shutdown, and a White House largely paralyzed by the Russia investigation and a President with a Twitter habit that continually undercuts whatever agenda his aides are trying to push on a given day.

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About Doug Mataconis
Doug holds a B.A. in Political Science from Rutgers University and J.D. from George Mason University School of Law. He joined the staff of OTB in May, 2010 and also writes at Below The Beltway. Follow Doug on Twitter | Facebook

Comments

  1. Neil Hudelson says:

    I’ll believe it (and be happy) when I see it. House Obamacare repeal looked dead, dead, dead until they announced a deal on a Tuesday and passed it on a Thursday. I’m an adherent of Josh Marshall’s rule “Moderate GOP will always cave.

    Highly-rated. Helpful or Unhelpful: Thumb up 32 Thumb down 0

  2. Mark Ivey says:

    They could of just re-tweeked some language in Obamacare, and then Trump posts on Twitter that its Trumpcare. Problem solved.

    But Nooooooooooooooooooooooooooooooooooooo. . . . . .

    Like or Dislike: Thumb up 4 Thumb down 0

  3. Facebones says:

    Mitch is not a stupid man. If he doesn’t have the votes, he’ll table it. Then he can blame the Democratic filibuster once the reconciliation window is closed.

    Like or Dislike: Thumb up 4 Thumb down 0

  4. Daryl's other brother Darryl says:

    @Facebones:

    Mitch is not a stupid man. If he doesn’t have the votes, he’ll table it.

    Or have a vote and then move on. Show the base they tried but couldn’t get it done. They need to get past this if they are ever going to do anything. 156 days in and they have accomplished bubkis.

    Like or Dislike: Thumb up 4 Thumb down 0

  5. MarkedMan says:

    Everyone is focused on the Trump agenda, but the more pressing issue is that the Republican Party is literally (in the literal sense of that word) unable to govern anymore. And almost all complex legislation needs more than just being left alone to survive. It needs to be tweaked and updated, and something as complex as Obamacare should have been getting these adjustments since the 2nd or 3rd year. To date, because the Republicans are incapable of negotiation, it hasn’t had any adjustments. Think about that. It speaks to the amazing effort and care that went into it that it has survived this long. But it won’t continue to exist without, at the very least, an assurance to the private insurance companies that the reimbursement structure will be honored going forward. And payers and providers both have figured out loopholes and workarounds for the parts that are meant to keep the costs down. This is the natural course of human commerce and the legislation should be adjusted to close these down.

    The Republicans have made many bad choices that has destroyed their ability to legislate. Three obvious ones:

    1) Gingrich’s 50%+1 strategy. He articulated this as ensuring that no bill passed with anything more than 50% + 1 vote needed. If you got, say a bipartisan 65%, it was a waste. He would add things Democrats didn’t like until he only had 50% + 1 vote. Back then, this could still mean a mix of Democrats in the bill, but the error of working together on problems was effectively ended.

    2) The second strategy: if any bill couldn’t get a majority of Republicans, it would never be brought to a vote. (It is often attributed to Hastert, but I’m not sure if it was actually locked into place by him.) To the Repubs, this seemingly had many benefits. They wouldn’t give any talking points to their political opposition by allowing Democratic bills to come to a vote. They wouldn’t have to go on record voting against a bill that might very well be popular. But it had two major, major drawbacks. The first was that it effectively killed a centuries old tactic: if a bill needed to be passed for the good of the country but was anathema to one or more of their own special interest groups, they could do the right thing with political coverage by letting the opposition bring it to a vote and passing it with predominantly minority votes and a few safe or retiring votes from their own party. The second major drawback was that, combined with the Gingrich 50% + 1 rule, it has turned the parties into near unanimity in opposition on important votes, meaning that the Repubs have to get nearly every single Republican vote, and they have a lot, and I mean a lot, of very stupid, very doctrinaire members.

    3) Rushing to back Citizens United 100% rather than seeking new legislation that would reign in the billionaires. This has meant that the Koch Brothers and others like them can use their billions to primary sensible Republicans out of office. And that has meant that literally any Republican with a modicum of intelligence and the courage of their convictions is an ex-office holder. The NY Times has a very interesting article today on how in 2008 Newt Gingrich co-sponsored legislation with Nancy Pelosi in 2008 to take serious measures to reduce global warming. McCain ran on the fact that he would be more effective in combatting climate change than Obama. But two or three years later almost to a man the Repubs were a bunch of nincompoop climate change deniers. They lay a large part of the blame on the sudden ability of the Koch brothers to wipe out any Republican that supported a carbon tax (or anything else that might hurt their business interests) by investing as little as $50K or $100K in a primary and revving up their astroturf groups to get the tea-bagger marching morons out in force. A year after the Citizens United case the Republican Rep who had sponsored the Carbon Tax bill in the house and gotten it passed was speaking about it in the third person as “something that didn’t meet todays needs”. He had barely survived a Koch sponsored primary opponent. Now he was a good, obedient toady.

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  6. Mr Bluster says:

    …and a President with a Twitter habit that continually undercuts whatever agenda his aides are trying to push on a given day.

    Republican Sen. Bob Corker, chairman of the committee, was visibly stunned to hear from reporters that Trump appeared to take credit on Twitter for the countries’ decision to sever ties with Qatar.
    “The President?” he responded to a scrum of journalists who asked him to respond to the President’s tweets. “When did that occur?”

    Like or Dislike: Thumb up 6 Thumb down 0

  7. Kylopod says:

    @Mark Ivey:

    They could of just re-tweeked some language in Obamacare, and then Trump posts on Twitter that its Trumpcare.

    That was a theory some people had of what Trump would do. Actually, I first started hearing this theory in 2012, only it was a suggestion of what Romney might do if he won.

    You might think Trump and Romney don’t have much in common, but actually they do. Both men are (a) lying phonies (b) have a past indicating that they have no particular animus toward the principles underlying Obamacare. So the idea that either of them would do this has a certain ring of plausibility to it. It is the sort of thing you could easily imagine them having the chutzpah to attempt. Especially Trump, with his habit of slapping his name on products he had no hand in producing.

    Ultimately, though, the notion was never feasible. While there undoubtedly is a contingent of the party consisting of people with such attitudes as liking Kynect but hating Obamacare, and that group would easily lap up such a stunt, the party is still run by people who really do want to slash the social safety net–to the extent they believe they can get away with it. As for Trump himself, he’ll sign practically anything his handlers call “Obamacare repeal,” but he’ll leave the details to Congress.

    On the other hand, I definitely would not put it past Trump to claim he’d passed Obamacare repeal after nothing had passed.

    Like or Dislike: Thumb up 5 Thumb down 1

  8. SenyorDave says:

    @MarkedMan: If I ever met the Koch brothers, my first question would be “isn’t 80 billion dollars enough for you guys?” Apparently not, since they are willing to invest a billion or so each presidential cycle to ensure that the planet dies a little more, people’s wages stagnate, and health care is less affordable. They better pray that karma doesn’t exist.

    Like or Dislike: Thumb up 6 Thumb down 0

  9. Just 'nutha ig'nint cracker says:

    @SenyorDave: Bunker Hunt–of the cornering the silver market debacle fame–expressed it well.

    A billion dollars just isn’t what it used to be.

    And that was 30 years (!!!) ago. Imagine how little a billion dollars is now to that kind of yahu and then ask the question again.

    As it was in the beginning, is now, and shall be forever…

    Like or Dislike: Thumb up 0 Thumb down 0

  10. Moosebreath says:

    @Mr Bluster:

    “Trump appeared to take credit on Twitter for the countries’ decision to sever ties with Qatar.”

    Why not — it appears that the fake news that led to the split came from Russia:

    “US investigators believe Russian hackers breached Qatar’s state news agency and planted a fake news report that contributed to a crisis among the US’ closest Gulf allies, according to US officials briefed on the investigation.”

    Like or Dislike: Thumb up 10 Thumb down 0

  11. @MarkedMan: Nice post with excellent insight. I would add another point which is the disgusting GOP leadership that is using and tolerating Donald Trump, knowing full well it is wrong, simply to advance there own idealistic agenda.

    Like or Dislike: Thumb up 5 Thumb down 0

  12. DrDaveT says:

    @J.P. McJefferson:

    tolerating Donald Trump, knowing full well it is wrong, simply to advance there own idealistic agenda

    As Inigo Montoya said, “I don’t think this word means what you think it does.”

    Like or Dislike: Thumb up 4 Thumb down 0

  13. Tyrell says:

    “Running out of time” : you got that straight. Blue Cross is leaving many states. The giant Anthem is also leaving.

    One option would be for the states to pick this up somehow, but I don’t see a lot of them doing that. Many of them are still digging out of the recession and can’t take on any huge projects or programs. Another would be to just switch the Obama Care members over to a basic, no frills Medicare plan.
    People need to realize that a lot of the medical fees, costs, and charges can be negotiated. If you leave the hospital and still owe a lot of money after deductibles and co-payments, you can work out payments and most of the time they will cut the amount down, sometimes 50% or more. When I left the hospital I owed around $1500. They agreed to small monthly payments, then after about a year they sent a letter cancelling the rest ! A lot of these hospital charges are wildly inflated.
    See “Obama Care in death spiral”. “It’s Failing” Town Hall. “Obama Care Repealing Itself”

    Like or Dislike: Thumb up 0 Thumb down 2

  14. gVOR08 says:

    Maybe not so likely they’ll fail. Via the invaluable David Anderson at Balloon Juice, Andy Slavitt, Obama’s acting Director of CMS, says McConnell may be planning to do what the House did. Slap together some piece of crap and vote on it in a bum’s rush to beat the demonstrations at their offices and the CBO score.

    Remember this is a prerequisite in their plan to cut taxes for the Koch Bros et al. This is not something they can walk away from.

    Like or Dislike: Thumb up 3 Thumb down 0

  15. teve tory says:

    Blue Cross is leaving many states.

    Did you see the CEO of Blue Cross say a couple days ago that the trump administration and the House fucking around with CSR payments was why they had to ask for big premium increases this year?

    Like or Dislike: Thumb up 3 Thumb down 0

  16. Just 'nutha ig'nint cracker says:

    @teve tory: And you believed that? Understand, I’m sure that it’s a factor, but my cynical view is the health care consortia raise their rates based on a combination of market factors, “the money looks better in my wallet than yours” and “because we can.”

    Like or Dislike: Thumb up 1 Thumb down 0

  17. @DrDaveT: You’re right; perhaps “perverted”, “crooked”, “disingenuous”, “weird”, “creepy”, “sick”, “biased” or “insane” would be much better.

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