Repeal and Replace - A Sad Story

A story without a happy ending

On January 12, 2017, the Senate voted 51 to 48 along party lines to pass a budget resolution that contained wording that would allowing the repeal of Obamacare through a process called budget reconciliation. This path was taken because it was the only way the Republicans could avoid a filibuster by the Democrats.

By using the budget reconciliation process the Republican would need a simple majority of 51 votes to repeal Obamacare. Senate minority leader Chuck Schumer stated that he believed the reconciliation vote on a repeal would violate the terms of the Byrd Rule that requires reconciliation bills to deal strictly with budget matters. He went on to suggest that a GOP healthcare law would be challenged in court since the Byrd Rule is incorporated into the Budget Act itself.

The Byrd Rule would dictate that any bill that failed to provide substantial budget deficit reduction would not qualify under reconciliation and would be subject to filibuster. By going the budget reconciliation route the Republicans were avoiding a filibuster but forcing themselves to craft a bill that would not only improve health care for all Americans but also reduce the deficit.

♦ This would prove to be too high a wall to climb over.

On March 6, 2017, House Republicans announced their replacement for the Affordable Care Act (ACA) would be the American Health Care Act (AHCA). They had to withdraw the bill on March 24, 2017 after it was certain they could not garner enough votes to pass it. The result was in-fighting within the Republican Party.

On May 4, 2017, after considerable backroom dealing, House Republicans barely passed the American Health Care Act by a narrow margin of 217 to 213, sending the bill to the Senate for deliberation.

The nonpartisan Congressional Budget Office projected the House’s bill would increase the number of uninsured people by 23 million over 10 years, but would decrease the federal budget deficit by $119 billion over the same period (about 1%), mainly by cutting Medicaid coverage for lower income Americans. The bill met the requirements for reconciliation.

The bill was immediately attacked for being “cruel” and unfair. The bill would cut taxes largely for wealthy Americans while throwing the poorest and most vulnerable Americans to the wolves. If enacted, insurance premiums were projected to decrease for younger, healthier, and wealthier people, while older and poorer people would likely see their premiums increase.

♦ The bill went to the Senate where it was dead on arrival.

The Senate decided they would write their own bill. The country waited and prayed it would be a much kinder bill than the one the House wrote. Senate Republicans decided to compose their version of the AHCA in secrecy. A group of 13 Republican Senators drafted the Senate's substitute version in private, raising bipartisan concerns about a lack of transparency.

Members of their own party complained about being asked to vote on something they had no part in writing and in many cases had not even had a chance to read. In the end, the Senate bill went down in flames. Moderate Republicans refused to accept the harsh policies pushed by conservative Republicans.

♦ Backroom politicking could not produce 50 yes votes for a bill that would leave millions of Americans without health insurance.

The Senate bill while being a little less cruel than the House bill would still result in 22 million people losing health insurance. The Senate bill retained the House’s heavy tilt against the poor.

The Center on Budget and Policy Priorities estimated that the 400 highest-income taxpayers would receive $33 billion in tax cuts under the Senate plan. This would be equivalent to providing coverage to close to three-quarters of a million poor people. Even moderate Republicans found it unpalatable to throw so many people off of health insurance for the benefit of a few wealthiest Americans.

♦ No amount of lipstick on the pig could persuade moderates that this was good for America. The Senate bill failed to garner enough votes.

On July 25, 2017, the Senate under pressure from the President voted on a measure to at least have some debate on the American Health Care Act. The Senate vote was 50-50, largely along party lines with Vice-President Pence casting the tie breaking vote.

♦ The vote was mostly symbolic. It was a vote to allow an open discussion and a chance for fellow Republicans to get on record as having voted for something that at least sounded like a repeal of Obamacare.

The Senate, eager to leave town for vacation, went into a marathon session allowing Senators to introduce their pet amendments. Debate was limited and votes were taken in rapid succession. All amendments failed to cross the 50 vote threshold.

♦ As a last ditch effort, Senator Mitch McConnell pushed what became known as the “Skinny Repeal" package. It was hardly a repeal at all and this angered conservatives. It was an attempt to say they accomplished something.

The “Skinny Repeal” had many Republican senators saying they would vote for it if they could be sure the House would not pass it. News networks jumped all over this concept of passing something as long as it did not become law.

The bill would have eliminated some parts of Obamacare, including the individual mandate. Perhaps more importantly, its passage would have tossed the ball to a House-Senate conference committee, where a more comprehensive repeal plan could have been worked up.

There was no guarantee that the House would conference on the bill. The House could have just received it and passed it without change. This possibility worried many Republicans who had agreed to vote for it as long as it was not the final document.

♦ Senator John McCain wanted assurances that House Speaker Ryan could not give. McCain will go down in history as the guy that killed “Skinny Repeal”. His vote was a dramatic thumbs down. The Senate’s efforts failed miserably on live TV. Everyone headed home for vacation.

Update:

On Sept. 1, 2017, the Senate parliamentarian told lawmakers that under Senate rules they have until the end of September to pass an Affordable Care Act replacement using the reconciliation process.  After the end of September, they will need 60 votes to overcome a Democratic filibuster.  So far, Republican leaders have ruled out reviving their efforts to repeal Obamacare.  There seems to more focus now on a bipartisan effort to shore up the exchanges before the next round if enrollments begin this fall.

The main players to watch:

The main players on the GOP side are Senators Lisa Murkowski (R-Alaska), Susan Collins (R-Maine) and John McCain (R-Arizona).

• Lisa Murkowski jockeys to get concessions for Alaska but in the end votes NO.

• Susan Collin holds a lot of news conferences to say she is deeply troubled.  Susan Collins has become a pretty reliable NO vote.

• John McCain is in favor of discussing and has expressed frustration with his party not including Democrats.  John McCain appears to be the only Republican at this time with a functioning moral compass.

♦ The Democrats have no main players.  They were not even invited to the game.

What next ?

Most Americans worry about increased government spending but they also think the government should ensure everyone has health insurance not just the opportunity to purchase insurance, provided they can afford it. The Republicans are split on this point.

♦ All the debate around various Republican plans has actually lead to an increase in popularity for Obamacare. More people have come to understand what would be lost if Obamacare were to be repealed.

Most people did not know until now that Obamacare affects a wide portion of the American population, not just a few self-employed individuals. Many seniors never realized they too would lose new benefits provided by Obamacare. The debate shined a light on Medicaid. More people now understand that Medicaid is a lifeline for so many people ranging from our youngest citizens to seniors living in nursing homes.

Many moderate Republicans are calling for a bipartisan approach, to negotiate with the Democrats. Unfortunately, the conservative wing of the Republican Party is steadfast against that.

♦ The conservatives are divided over whether the government has any business at all in the healthcare markets. House Speaker Ryan says health care is a “market item” that should not be subsidized. Sick people must pay for themselves.

The longer the Republicans remain consumed by this issue, the likelier voters are to start blaming them for their many complaints about health care.

A collapse of the individual market would not look good for the party in power, especially after President Trump has spoken of his desire to kill off Obamacare.