In the end, the House of Representatives passed the American Health Care Act, the Republican bill to repeal and replace the Affordable Care Act, in a remarkably short period of time. The bill was introduced to the public two months ago yesterday in mid-March, at which point it came under severe criticism from all sides. Democrats and many members of the public attacked the bill for the extent to which it would impact the more popular provisions of the PPACA, such as the provisions covering people with pre-existing conditions, the provisions that allowed children to remain on their parents’ policies up to age 26, and the expansion of Medicaid that gives access to healthcare coverage to people in tens of thousands in states that choose to take advantage of the expansion. This resulted in several weeks of raucous Congressional town halls at which Members of Congress, most of them Republicans, faced largely hostile audiences in events reminiscent of similar town halls in 2009 and 2010. In Congress itself, meanwhile, the bill faced pressures from both conservative Republicans who believed that the law didn’t go far enough and moderate Republicans who thought it went too far, especially concerning the aforementioned provisions of the PPACA. Further problems ensued when the Congressional Budget Office estimated that as many as 24 million people would lose coverage if the proposed bill became law and other economic analysis indicated that it would result in significant tax cuts for the wealthy while older people and people with pre-existing conditions would likely face increased premiums and deductibles that could price them out of health care coverage even if it was available for them. Because of this, the bill failed to garner enough support in the initial effort to pass it prior to the Easter recess and it seemed as though the effort was dead in the water. Behind the scenes, though, House Republicans continued working on the bill and managed to get enough support from both conservative and moderates to pass the bill last Thursday, albeit but the slimmest of all possible margins. The entire process took roughly 59 days and came on day 105 of Donald Trump’s Presidency.
As the Politico Playbook notes this morning, though, the process is likely to slow down significantly now that the bill is headed to the Senate:
The health-care hot potato is now in Senate Majority Leader Mitch McConnell’s (R-Ky.) hands. But expect this phase of the fight to look much different than it did in the House. McConnell is a much different operator than House leaders. He’s calm and cool, and does not get rattled easily. He doesn’t really succumb to pressure. We expect the Senate is going to take its time cobbling together whatever Obamacare repeal bill it can — it could take many months, insiders tell us. We expect the process to unfold like this: the Senate takes a while, the House and Trump begin to get angry and lash out at the Senate. By the way, the House is out this week, the Senate is in session.
This observation comes just a day after one Republican Senator revealed that her colleagues plan to start from scratch on the issue and basically scrap the AHCA as it was passed by the House:
A Republican senator said on Sunday that her colleagues plan to “start from scratch” when the House’s American Health Care Act goes to the Senate.
Susan Collins of Maine said on ABC’s “This Week” that there are major questions surrounding the health care bill the House passed on Thursday. According to Collins, the bill, which is part of the GOP effort to repeal Obamacare, would undergo major surgery.
“First of all, the House bill is not going to come before us,” Collins said. “The Senate is starting from scratch. We’re going to draft our own bill. And I’m convinced that we’re going to take the time to do it right.”
Critics claim the new legislation could make health care unaffordable, cause people to lose coverage — which Health and Human Services Secretary Tom Price denied on Sunday — and could go down as a major political blunder when the 2018 midterm elections roll around.
Collins was critical of the bill because she believed there were too many unknowns, noting that the Congressional Budget Office (CBO) still hadn’t provided an analysis of the new bill, and she added that she would be troubled by a bill that would defund Planned Parenthood.
House Speaker Paul Ryan, the architect of the bill, claimed that Republicans had received two CBO scores for the current bill during his appearance on ABC’s “This Week.”
NBC News is only aware of one CBO score that the GOP had received for its health care legislation, and that was provided for an older version of the bill that failed to make it to the floor of Congress. That CBO score was published on March 13 — nearly two months ago.
(…)
Collins indicated that there would be a fair amount of “ironing.” When asked whether she would support the American Health Care Act as it stands today, she demurred.
“Speaker Ryan today said that he hoped that the Senate would improve the House bill,” Collins said. “I think we will do so and that we will come up with a whole new fresh approach that solves the legitimate flaws that do exist with the ACA, where we have seen, in some markets, insurers fleeing so people won’t be able to buy subsidized insurance. But it will keep some of the benefits of the ACA.”
None of this should really come as a surprise, of course. From the beginning of this process in the House, Senators on both sides of the aisle and from each side of the Senate GOP Caucus have been critical if not downright dismissive of the effort in the House of Representatives. The response from Senate Democrats, of course, is not at all unexpected and it’s unlikely that we’ll see any member of that caucus crossing the political aisle to help Republicans on this issue in any way. Within the GOP Caucus, meanwhile, the divisions are not dissimilar to those that the bill faced in the House, with conservatives such as Rand Paul and Mike Lee pushing for alternatives even more conservative than the demands that were made by the House Freedom Caucus and more moderate members like Collins voicing many of the same concerns as the House moderates of the so-called Tuesday Morning Group. Additionally, as I’ve mentioned before, many Senators have expressed concerns about changes that might be made to the Medicaid expansion provided for by the PPACA that would significantly increase the costs borne by the States and potentially throw many people out of the market for insurance and thus unable to afford health care treatment altogether. In Ohio alone, one report suggests that the AHCA as passed by the House could cost the state between $16 and $22 billion in Federal Medicaid funding and result in three-quarters of a million people losing Medicaid coverage. It is because of this that Ohio Senator Rob Portman, a Republican, recently voiced his concerns with the House bill. Portman has also been named as part of a group of conservative and moderate Republicans who reportedly are already talking informally about drafting their own alternative to the AHCA. In addition to these concerns, the House bill will likely face an early test in the Senate over whether or not it can be considered under the expedited debate and voting rules known as reconciliation that allow a bill that meets certain budgetary criteria to pass the Senate with a simple majority rather than first needing to pass the sixty-vote cloture threshold. As I’ve said before if the AHCA fails to meet the test for reconciliation then it is already dead on arrival in the Senate. If it does, it’s likely to make it through the Senate in name only and that what will emerge will be something significantly different from what the House voted on last week.
One point worth remembering in all of this is that what we’re likely to see unfold here is a great example of the Senate fulfilling the purpose that the Founding Fathers intended for it when the Constitution was drafted and being considered for adoption. During the 1787 Constitutional Convention, there was great concerning vesting significant power in a Congress that was close to the people lest it be subject to popular passions and whims that, based on the influence of writers such as Locke and Montesquieu as well as the historical record, the Founders wished to avoid. As a result, Article One of the Constitution places significant limits on what Congress can and cannot do. Further limits were established by the Bill of Rights. Additionally, in addition to creating a branch of the legislature that was directly elected by the people in Congressional Districts, the Founders created a Senate that was meant to represent the wider electorate of the individual states. At first, the makeup of the Senate was comprised of members chosen by state legislatures, but that changed in the early 20th Century when the 17th Amendment was adopted as part of a series of reforms inspired by the “Progressive” movement of the time. Despite the change in how Senators are selected, the purpose of the Senate has remained largely the same, and we’ve seen several examples, both for good and for ill, where the Senate slowed down the progression of a measure passed by the House, if not stopped it entirely.
That seems to be what is likely to happen with health care reform, and while Republicans may complain they ought to take solace in the fact that the Senate is doing exactly what the Founders intended for it. Given that they are such strict Constitutionalists, they should like that. Right? Right? Bueller?
