Senate GOP Faces Another Make Or Break Week On Health Care Reform
The Senate GOP's effort to 'repeal and replace' the Affordable Care Act is headed for a bumpy ride.
Senate Republicans got back to work on Monday after spending a week in their home states with the leadership focused on getting to a vote on a bill to repeal and replace the Affordable Care Act through the upper chamber before the summer recess begins at the end of the month. As I noted in my post yesterday, though, while most Senators were out of town there was still work going on in the background during the recess in an effort to come to some kind of agreement that would address the concerns of both conservatives and moderates that made it impossible for the upper chamber to vote on a bill before leaving town. So far, though, there are few signs that they’re any closer to success than they were when the July 4th recess began eight days ago. Axios is reporting this morning that the plan is to have a revised bill ready for release on Thursday, with the hope that the Congressional Budget Office could score the new legislation by early next week, something that is necessary under Senate rules before Senators can begin consideration of the bill on the floor. At the same time, though, CNN is reporting that the Senate GOP’s health care plans are in such disarray that the entire effort could be near the point of collapse:
Republican senators returning to Washington Monday sounded exasperated and downright deflated about their unpopular bill to overhaul the health care system.
Some are even beginning to wonder out loud what was an unthinkable prospect a year ago: the GOP could be forced to ditch its efforts to get rid of Obamacare.
“Better than 1%. Not yet above 2% in my opinion,” a senior Republican source told CNN on the chances the health care bill will pass Senate at this point.
Fresh off the recess, members seemed to be unclear on how Majority Leader Mitch McConnell could bridge the divide within the conference.
“I think we have the information we would need if we’re willing to use it. If we’re willing to be honest about what has caused the collapse of these markets and address it forthrightly, not being concerned about the political implications, but actually fix the problem,” said Sen. Ron Johnson, a Republican from Wisconsin who has been vocal about his frustration with the process. “I think we have the information to address it. I’m not sure we are going to address it, and that is enormously frustrating for me.”
At Tuesday’s Senate GOP policy lunch, the first real indications of the week on which direction leadership is moving may emerge — and it’ll be an opportunity for leaders to take the temperature of the conference on how they’re feeling after the hiatus.
Maine Sen. Susan Collins insisted that barring a “complete overhaul” of the current bill, she simply couldn’t support the legislation. She too called for bipartisan dialogue.
“I don’t want to see us make the same mistake and pass an overhaul of the law without a single Democratic vote,” the GOP moderate said on Monday. “We get far better legislation when both parties work in good faith to reach a solution.”
Arizona Sen. John McCain was characteristically blunt: The Senate bill is on its last legs, he said, and Republicans should think about joining forces with Democrats.
“My view is it’s probably going to be dead,” McCain said Sunday on CBS’s “Face the Nation.” “If you shut out the adversary or the opposite party, you’re going to end up the same way Obamacare did when they rammed it through with 60 votes. Only guess what? We don’t have 60 votes.”
One aide to a Republican senator closely involved in health care negotiations said Senate Republicans were simply not “any closer” than they were before recess, and that for now, it was hard to see the path to 50 “yes” votes.
“It’s easy to get to 40 or 42 yes’s,” the aide said. “Getting to 50? I don’t know.”
Until we actually see a revised bill and start getting reactions from the GOP caucus it’s going to be hard to tell just where the repeal and replace effort stands in the Senate. One thing we know for sure is that there are at least ten Republican Senators who were on record as opposing the original version of the bill that was released in late June, and that those Senators include people as diverse as conservatives such as Rand Paul and Ted Cruz and more moderate members of the GOP caucus such as Maine’s Susan Collins, Wisconsin’s Ron Johnson, Alaska’s Lisa Murkowski, and Ohio’s Rob Portman. Crafting a bill that would please enough of these people to get Mitch McConnell to the point where he has at least the fifty votes that he would need, along with the Vice-President’s tie-breaking vote, to get a bill through the Senate. Even if that’s successful, of course, there would still be the matter of getting the agreement of the House of Representatives on a bill that is likely to end up being substantially different from what the House passed, by just a slim two-vote margin, just about a month and a half ago. Moreover, even if the Senate goes get something passed, it’s unlikely the House will act on it before the recess that starts at the end of the month and that health care reform will remain in limbo for much of September while both chambers go through the annual exercise of going down to the wire on consideration and passage of a new budget for the Fiscal Year that begins on October 1st.
The more interesting question, of course, is what happens if the Senate fails to come to an agreement on a bill that can get to fifty votes. As David Nather notes at Axios, the result of such an outcome is likely to be one that pulls the Senate GOP Caucus in several different directions:
Conservatives will push for a repeal-only bill next. Unlike Senate Majority Leader Mitch McConnell, conservative groups were thrilled when President Trump tweeted that the Senate should try the repeal-first strategy. Vice President Mike Pence backed up that view on Rush Limbaugh’s show yesterday: “We ought to just repeal only” if the Senate bill fails.
In the conservative groups’ view, nearly all congressional Republicans already voted for a 2015 budget bill that repeals most of the Affordable Care Act — so they should just pass that again. (In reality, the only way McConnell is likely to put that vote on the floor is to end the issue, even if it fails.)
If that vote doesn’t happen, they’ll hammer GOP leaders for not living up to their repeal promises — and if moderate Republicans don’t vote for it, they’ll get an earful, too. “They’d have to explain why they’re damned liars” after campaigning on repeal for seven years, said Jason Pye, vice president of legislative affairs for FreedomWorks.
The individual insurance market will still need help. It’s not as if it’s healthy right now. The Centers for Medicare and Medicaid Services reported yesterday that there was a 38 percent drop in the number of health insurers who filed to offer Affordable Care Act health insurance next year.
The fate of insurer subsidies still has to be resolved. The Trump administration won’t want to keep paying for the cost-sharing subsidies for low-income customers without funding from Congress. So Congress would have to decide whether to fund the subsidies on its own.
The ACA will be run by an administration that hates it. By now, HHS Secretary Tom Price and CMS administrator Seema Verma have spent so much time promoting the law’s failures that they’d have trouble switching gears and trying to make the law work.
The problem with a repeal-only bill, obviously, is that it would lead to results that could end up having even more severe political consequences for Republicans than the passage of either the House’s American Health Care Act or the Senate’s Better Care Reconciliation Act. Estimates in the past have indicated that the number of people who would be left without insurance coverage after passage of a repeal-only bill would exceed even those estimated by the CBO to end up in that situation under either the AHCA or the BCRA. Primarily, of course, this will be due to the fact that repeal of the PPACA would mean the end of the expansion of Medicaid that has covered millions across the country, as well as an end to the bars on denying coverage to those with pre-existing conditions and the bar against a lifetime cap on coverage, as well as the end of the expansion of coverage under parental policies for children up to the age of 26. Because of this, it seems unlikely that a repeal-only bill would see much support from the moderates who are currently opposing the BCRA. Additionally, a repeal-only bill most likely would not qualify for consideration under the Senate’s reconciliation rules, which means it would be subject to the sixty-vote threshold to invoke cloture. If that’s the case, even a fully united Senate GOP Caucus would not be able pass a repeal bill. The best they’d be able to show that they tried. Of course, at that point, that may be all they are concerned about, saying that they tried and telling the base that they’ll be able to succeed if they get more money from the base to fill their bank accounts.
In any case, even in the rosiest of scenarios, it’s unlikely that we’ll see the Senate able to act on this until the very end of the month. Between now and then, there will be several potential roadblocks. The first comes this week with the question of whether they can even come up with a revised version of the BCRA that is worth making public. If they get beyond that hurdle, then next one will come over the next week as Senators weigh in on this revised plan and the CBO scores the new bill. That could end up being the point at which will learn if McConnell is even close to the minimum of fifty votes he would need to get the bill passed. All of this likely means that it’s unlikely that he’d be able to schedule a vote any time before the week of July 24th, which is effectively the final week of work before a summer recess that nobody seems interested in canceling. If the Senate leaves town without voting at that point, the odds that they’ll even return to this issue at any time before mid-October at the earliest are fairly low, and if that’s the case then the opportunity to take advantage of the reconciliation process will no longer be viable. All of this is a long way of saying that John McCain’s assessment that ‘repeal and replace’ seems to be dead in the Senate could end up being the most prescient observation of all.