Passage Of Republican Health Care Bill Looking Less Likely

The Freedom Caucus may be mollified, but moderate Republicans and the Senate aren't. Meaning that repeal and replacement of Obamacare is becoming less likely.

congress-healthcare

The House Freedom Caucus may have decided to support the revised bill to repeal and replace the Affordable Care Act, but that doesn’t mean that it’s smooth sailing from here. As I noted yesterday, Republican leaders still need to worry about getting support from other members of the House GOP Caucus and, even if they do, there’s still the complicated issue of getting the measure through the Senate even if the bill is allowed to proceed under the Senate’s reconciliation rules rather than having to face a sixty-vote cloture vote. So far, it’s not looking good.

First up, there’s the news today that House Republican moderates are balking at the revised bill:

The moribund Republican health care bill received a jolt of life when the conservative House Freedom Caucus endorsed a revised version of the measure. But a leading GOP moderate criticized the reshaped legislation as a conservative exercise in “blame-shifting and face-saving” that wasn’t winning new support from party centrists, leaving its fate unclear.

The embrace by the hard-line Freedom Caucus Wednesday supplied fresh votes and momentum for GOP leaders, who also lined up behind the plan and crave a legislative victory for themselves and President Donald Trump. Opposition by most of the caucus’ roughly three dozen members was a major factor when House leaders canceled a vote on the legislation last month in a mortifying setback for the party.

The changes would let states escape a requirement under President Barack Obama’s health care law that insurers charge healthy and seriously ill customers the same rates. They could also be exempted from Obama’s mandate that insurers cover a list of services like maternity care, and from its bar against charging older customers more than triple their rates for younger ones.

Conservatives embraced the revisions as a way to lower people’s health care expenses, but moderates saw them as diminishing coverage because insurers could make policies for their most ill — and expensive — customers too costly for them to afford.

“I have always campaigned on making sure that no one is denied coverage based on pre-existing condition,” said Rep. Leonard Lance, R-N.J., who said he remained opposed to the legislation.

The Freedom Caucus turnabout also shifts pressure for passing the bill — a top priority for the GOP — onto party moderates. They are certain to come under intense lobbying from the White House and party leaders to jump on board.

Speaker Paul Ryan, R-Wis., said the proposal “helps us get to consensus,” but stopped short of saying it would win them enough votes to finally prevail.

Keeping GOP options for quick action alive, the House Rules Committee approved special procedures that could allow a sudden House vote on a health care bill through Saturday, though that seemed unlikely.

In a statement, the Freedom Caucus said while the new package “still does not fully repeal Obamacare, we are prepared to support it to keep our promise to the American people to lower health care costs.”

Many moderates opposed the initial Republican bill before the latest proposed changes, and there were no signs that the revisions converted any of them into supporters. The legislation does things they oppose, including cutting the Medicaid health insurance program for the poor and providing less generous federal subsidies to help people buy coverage than under Obama’s law.

The changes were authored by Reps. Mark Meadows, R-N.C., chairman of the Freedom Caucus and Tom MacArthur, R-N.J., one leader of the moderate House Tuesday Group, along with White House help.

But Rep. Charlie Dent, R-Pa., another and longer-tenured leader of that 50-member centrist organization, told reporters that those in his group who were against the bill “remain opposed.” He also lashed out at conservatives for advancing the revisions.

“This is simply a matter of blame-shifting and face-saving” for a bill going nowhere, Dent said. He said that if the House measure survives, revised or not, it would be substantially rewritten in the Senate, where it faces broad opposition.

Right now, there is talk about a possible vote on a replacement health care bill as early tomorrow, but nothing firm has been scheduled and it seems unlikely right now that it will. At the very least, it’s clear that nothing will pass without the support of a substantial portion of these moderates, and the changes that have been made to appeal to the Freedom Caucus have, somewhat predictably, only served to turn them off further on a bill that most of them were already inclined to vote against last month. The only thing that the changes that were made to appease the House Freedom Caucus appear to have done is to make the moderates more adamant in their opposition to the bill, meaning that it’s even less likely that they can be convinced to support it. Given that Paul Ryan has already said that they would only bring the bill up if they were sure that they had the votes, that suggests that it’s unlikely that we’ll see a vote on the new bill this week and more possible that we may never see a vote on it at all.

As if that weren’t bad enough for the prospects of this bill, Republican Senators are also balking at the revised bill:

The House may finally be on its way to scrapping Obamacare, but don’t expect the Senate to go along: Any plan sent over will undergo major surgery — and survival is far from assured.

The hurdles in the upper chamber were on vivid display Wednesday as House Republicans celebrated their breakthrough on the stalled repeal effort. The compromise cut with House Freedom Caucus members won over the right flank, but the changes will almost surely make it harder to pick up votes in the more moderate-minded Senate.

Not to mention that some Senate conservatives still seem opposed to the emerging House deal.

“The Freedom Caucus has done a good job of trying to make the bill less bad,” Sen. Rand Paul (R-Ky.), one of the lead Senate agitators against the House health care push, said Wednesday. “For me, it’s a big stumbling block still that there’s taxpayer money that’s being given to insurance companies, and I am just not in favor of taxpayer money going to insurance companies.”

Phil Novack, a spokesman for Sen. Ted Cruz , also indicated that the conservative Texas firebrand isn’t sold, saying “significant work remains” in the Senate, “specifically to address Obamacare’s insurance mandates and enact major patient-centered reforms that will further reduce the cost of health care.”

Sources say it may take more than a month for any House health care bill to run through the traps in the Senate, including internal party discussions and an analysis of how the measure would affect the deficit and insurance rolls. No committee hearings are planned because Republicans don’t want to give Democrats a public forum to bash an effort they are not involved in. And similar to the Senate’s dim view of the House’s proposal, the lower chamber may not ultimately be able to pass whatever the Senate is able to produce on Obamacare.

Plus, a procedural rift is beginning to emerge within the GOP, with several Republicans questioning whether reconciliation — the fast-track legislative process that circumvents a filibuster, and thus the need for Democratic support — is even the best avenue for health care overhaul efforts.

Few Senate Republicans are currently engaged in the health care efforts. Several GOP senators declined Wednesday to wade in to the specifics of the revised plan drafted by Rep. Tom MacArthur (R-N.J.) and Freedom Caucus Chairman Mark Meadows (R-N.C.), taking pains to note that senators will probably have to rewrite it anyway.

“It isn’t discussed a lot over here,” said Sen. Chuck Grassley (R-Iowa). “Except for the hard work of [Susan] Collins and [Bill] Cassidy, there’s hardly anything being done.”

Senate Majority Whip John Cornyn (R-Texas), the party’s chief vote counter, also downplayed any notion that the new House version of an Obamacare replacement will sail through the Senate intact.

“Once they pass a bill, my assumption is, the Senate’s going to take a look at it but not necessarily be rubber-stamping what they’re proposing,” Cornyn said. “So I would anticipate that we’ll do what we used to do all the time which is, the House will pass a bill, we’ll pass a bill and then we’ll reconcile those in a conference committee.”

That last part, of course, assumes that the Senate will get anything from the House to begin with. As I note above, the prospect of that happening anytime soon seems fairly low. Even if it happens, though, it’s likely that what emerges from the Senate will end up being unpalatable to the more conservative elements in the House, thus putting House leadership back in the same quandary it’s in right now since whatever emerges from the conference committee would have to be voted on again by the House, and any changes to mollify moderates would likely mean the loss of conservative votes. All of this is a long way of saying that the odds that the GOP will actually be able to pass a ‘repeal and replace’ bill are shrinking, anyone who says anything to the contrary is just making up facts at this point.

FILED UNDER: Congress, Health Care, US Politics, , ,
Doug Mataconis
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. Before joining OTB, he wrote at Below The BeltwayThe Liberty Papers, and United Liberty Follow Doug on Twitter | Facebook

Comments

  1. al-Alameda says:

    In a “normal” congressional world, Republicans would meet with Democrats and work out fixes to ACA and be done with this bulls***.

    Okay, that concludes my gratuitous reference to an all but extinct political environment – a world in which legislators take a practical bi-partisan approach to an important issue and come up with solutions that generally please the legislators if not the 27% of voters who hate everything that government does.

  2. Scott says:

    You know it is bad when there is a rush to pass legislation before people can react. Does the House Republicans believe that since the Senate won’t pass it that they are safe to vote yes without consequence? I never overestimate the voting public but even that game has its limits.

    It is clear that the ACA is bad Except for all the other plans.

  3. Scott says:

    @al-Alameda:

    27% of voters who hate everything that government does.

    Except their Social Security and Medicare.

  4. gVOR08 says:

    @Scott: And the gubbmit better keep their hands off them.

    More seriously, old people, who are heavily dependent on SS and Medicare, are the most reliable voters for GOPs who want to kill, or at least privatize, both. The electorate really are a box of rocks.

  5. Tyrell says:

    So millions of people will remain without health insurance because of the Obama Care catch 22: can’t afford the high cost, yet don’t qualify for the subsidies.

  6. JohnMcC says:

    “Blame shifting and face saving…” are the two activities that keep the present Administration and House leadership busy.

    Saw an interview with Congressman Donovan (R of–I think–Staten Island) telling MSNBC that he is reacting negatively to the revised AHCA Bill as ‘a Republican who represents an urban district.’ Which to a large degree says what needs to be said. He is realizing that his constituents don’t get to claim membership in the same tribe as the ‘Freedom Caucus Republicans’.

  7. Pete S says:

    @JohnMcC:

    He is realizing that his constituents don’t get to claim membership in the same tribe as the ‘Freedom Caucus Republicans’.

    Hell, I don’t think they can claim residence on the same planet.

  8. Slugger says:

    Let me repeat a prediction that I made two months ago. The GOP presidential candidate in 2052 will campaign on repealing Obamacare.
    Roe v Wade is from 1973. In the ten presidential elections since then repeal has been a plank. During this time the GOP has had more victories than defeats, but the job hasn’t got done. Strange.

  9. gVOR08 says:

    @Slugger: Yeah.I’d noticed that. As an issue, Roe v Wade is gold for them. As an accomplishment it’d be useless.

  10. Kylopod says:

    The basic situation is one of conflicting incentives. The Trump White House desperately want to pass something they can call “Obamacare repeal.” But most Congress members (or, at least, enough of them) don’t have any real incentive to pass such a bill. Those right-wingers who are the most adamantly anti-Obamacare can always say the bill wasn’t right-wing enough, and therefore they probably can safely oppose such a bill without being suspected of being closet Obamacare supporters. The more “moderate” members of the party not only stand much to lose from voting for a bill that will take away coverage from their constituents, but typically represent swing districts where “I voted to repeal Obamacare” isn’t likely to impress voters.

    The ultimate reason the GOP is at this impasse isn’t Trump, who is merely a symptom of the problem. The reason is that the party’s crusade against Obamacare was, from the start, completely incoherent. While there have always been conservatives and libertarians who sincerely oppose the idea of universal health care, the GOP never made that case to the public; their campaign against the law was based on misleading the public into believing that the law was harmful to people’s existing coverage and that their own plans would remedy that problem, whereas the reality was virtually the polar opposite. They could get away with this deception as long as they weren’t in power. Now, they have no excuse.

  11. Kylopod says:

    @Slugger:

    Let me repeat a prediction that I made two months ago. The GOP presidential candidate in 2052 will campaign on repealing Obamacare.
    Roe v Wade is from 1973. In the ten presidential elections since then repeal has been a plank. During this time the GOP has had more victories than defeats, but the job hasn’t got done.

    I happen to be pro-choice, but I think it’s a complicated, difficult issue where I can certainly understand the other side. At the very least, opposition to abortion is a coherent position that is found broadly among people across the economic spectrum.

    The GOP’s crusade against Obamacare isn’t really in that category. It is, by and large, a tribal reaction to Obama himself, fueled by many people who don’t even have a clear understanding of what the law does. There is no consistent moral or ideological argument at its core, and it’s anchored around the change to the status quo that occurred in 2009. I don’t expect this situation to last decades, when Obama would be in his 90s and most of the voters who were driven into a hate-filled rage by his presidency are long dead. It just doesn’t have the ideological legs that Roe does.

  12. gVOR08 says:

    Looks like we’ll dodge the bullet on healthcare again. But we still have to get through another three years and nearly nine months.

  13. michael reynolds says:

    @Tyrell:
    Because the GOP won’t work to repair the issues in Obamacare. Rather than fix the black president’s largely successful program, they want to kill it and according to the CBO, throw 24 million working class Americans off health insurance.

  14. teve tory says:

    @Slugger: When the GOP gets to replace Breyer, or RBG, or Kennedy, they’ll have 5 solid conservatives on the bench. How long do you think Roe will last after that?

  15. teve tory says:

    Kevin McCarthy just said no vote this week. No 100-day repeal and replace. SAD!

  16. Gustopher says:

    @teve tory: Honestly, given the age of some of them, I’m surprised Republicans are showing the restraint to not be pushing total bans now, so they can get to the court immediately after the next nominee is sworn in.

  17. Pch101 says:

    The United States is in dire need of a Republicanectomy.

  18. Slugger says:

    @teve tory: I believe one should approach all political maneuvers with skepticism no matter who they come from; maybe especially when they come from someone you like. Only your friends have a real chance to stab you in the back. I think abortion, guns, and now medical care are wedge issues and the positions are taken with as much sincerity as Newt Gingrich wedding vows.
    If you want to help overturn Roe, please make a donation to my fund.

  19. teve tory says:

    It will be a tragedy when Roe is overturned, but unfortunately I think the likelihood of those three justices making it three more years is low.

  20. Daryl's other brother Darryl says:

    “I loved my previous life. I had so many things going,” Trump said in an interview with Reuters. “This is more work than in my previous life. I thought it would be easier.”

    100 days of……fail.

  21. grumpy realist says:

    @teve tory: Even though am female, am getting fed up enough with the whole kabuki around Roe vs. Wade that I want to say “oh the heck with it, go ahead and repeal it already. Just don’t be surprised with the results.”

    I also think that the whole issue is going to be tipped over completely because of some of the latest advances towards developing an actual uterine replicator. Which I really, really want to see because such a development could jar both the pro-life and pro-choice sides out of the present rut of their arguments and force both sides to actually figure out what is it that they are arguing about.
    If abortion means you take the fetus out and pop it in a uterine replicator, then I can’t see what the so-called “pro-life” side has to complain about any more. Neither does the pro-choice side–woman isn’t pregnant any more, imposition on her body goes away.

    Knowing both sides, I suspect that things aren’t going to be that simple because what a lot of the pro-life people are arguing around isn’t exactly life-of-the-fetus but women’s sexuality and women not wanting to be pregnant. I have no doubt but that if uterine replicators become practical, there will suddenly be a “fetus’s rights” group which will argue for the right of the fetus to be incubated inside its biological mother, whether mom wants it or not. I also suspect that they will team up with the “adoptee’s rights group” who will also have had their arguments shot out from under their feet–I mean, it’s pretty silly to rant about “getting ripped away from my bio-mother” when the entity that gave birth to you is a collection of metal, membranes, and pumps, isn’t it?

    Let the amusement reign!

  22. HarvardLaw92 says:
  23. SenyorDave says:

    @HarvardLaw92: To quote a Simpsons episode, that’s about stupidest thing I’ve ever read”. Does Trump have incriminating photos of this woman?

  24. Daryl's other brother Darryl says:

    @HarvardLaw92:
    That woman is drowning in the kool-aid.

  25. Pete S says:

    @HarvardLaw92: @SenyorDave: @Daryl’s other brother Darryl:
    i don’t watch CNN and I didn’t see a picture of her with the tagline. Are sure this writer really exists?

  26. MarkedMan says:

    What is sad about this whole charade is that the media no longer even asks: “Could you get enough Democrats to join the Republicans so you could get a bill passed?” It literally does not even occur to anyone any more that you could get a deal on many, many bills, with 80-90% Republican support and 10-25% Dems. This is the way our government used to work before the modern Republican Party.

  27. HarvardLaw92 says:

    @Pete S:

    Yea, I looked into her. She’s apparently their token Republican.

    She’s like a better educated, more PhyillisSchaflyesque version of Republican Barbie.

    Her writing at ATL is something (revolting) to behold …

  28. Pch101 says:

    @MarkedMan:

    If the Dems are smart, they’ll let the Republicans shoot each other in the foot and withhold support from anything that comes from the GOP.

    Those days of bipartisan deal cutting on major issues are over. The GOP is a tumor that wants to establish a one-party dictatorship. This should be treated as a war, because it is.

  29. Kylopod says:

    @HarvardLaw92:

    She’s apparently their token Republican.

    The way you phrase that suggests she’s the only Republican there. In fact, she isn’t even their only slobbering Trump sycophant. There’s also Jeff Lord (who was a moron long before Trump entered the political scene, and that hasn’t changed). And who can forget how the network hired former Trump campaign manager Corey Lewandowski who signed an NDA prohibiting him from criticizing Trump?

    This is how useful our “liberal” media is these days.

  30. HarvardLaw92 says:

    @Kylopod

    True. Perhaps “current marquee Republican” might be better.

  31. gVOR08 says:

    @grumpy realist: The child would still carry the genetic inheritance from the biological parents, which leaves some adoptee rights, at least to medical information, still relevant. And I somehow don’t see the religious right volunteering en masse to adopt.

  32. al-Alameda says:

    @Scott:

    Except their Social Security and Medicare.

    … their Social Security and Medicare, of which, those bozos apparently don’t know, happen to be federal government programs

    America, with the exception of slavery and the Civil War, we had a nice run, time for the meteor

  33. Monala says:

    @grumpy realist: Even if there is a uterine replicator, would it be able to gestate a baby for the whole 9 months? If so, then it seems like it would be used in conjunction with in vitro fertilization, and in place of surrogacy–and likewise be just as expensive as those options are today. So it would be used by wealthy women who want to have babies but can’t get pregnant, not by economically poor women who are already pregnant but don’t want to be.

    If the uterine replicator can’t gestate the baby for 9 months, my guess is that the fetus would have to reach a certain size (maybe 5 or 6 months?) before a transfer can take place. And as a woman who has been (willingly) pregnant and given birth, I can tell you that that a 5 or 6 month pregnancy is no less a burden on a woman’s body and livelihood. In fact, for many women, the earliest months of pregnancy are the worst in terms of health challenges.

  34. Monala says:

    @Monala: To add to my prior comment: any uterine replicator would probably be very expensive to use, and thus would be used for: 1) wealthy women in place of surrogacy; and/or 2) to help babies who are born prematurely have a chance at making it to full term. The women who typically have abortions — poor women who can’t afford a(nother) baby, or young women still in school or early in their careers – would be far down the priority list for using uterine replicators, and would be unlikely to be able to afford it anyway. So it would change nothing about the abortion issue.

  35. Matt says:

    @Tyrell: That problem exists because some states run by the Republicans refuse to expand medicare. I live in one of those states. Stop blaming the Democrats and/or Obama for a problem caused by the Republicans who are more interested in playing electoral games than helping their constituents….