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.
