Republicans’ path to fulfilling their seven-year effort to undo the Patient Protection and Affordable Care Act (PPACA) is getting narrower by the day, according to a report from Kaiser Health News (KHN). The latest snag concerns whether people with pre-existing health conditions should have guaranteed access to affordable coverage, as the PPACA mandates. An amendment that would let states waive some of those requirements has garnered the votes of reluctant conservatives but has left more-moderate Republicans on the sidelines.
GOP House leaders say they are still working to muster a majority to pass the bill, which was originally scheduled for a floor vote in March. KHN suggests some ways that effort could play out.
1. The House passes the bill soon.
Approval in the House would send the measure to the Senate, where the fight will be very different, according to KHN. Congress is using a special budget procedure that allows the bill to pass with 51 votes in the Senate. There are only 52 Republicans in the Senate, so they can’t afford to lose more than two GOP votes, assuming every Democrat opposes the measure. In that case, Vice President Mike Pence would be needed to break a tie.
2. The House walks away from the debate.
The House could simply decide to leave health care for another day—or another year. That would be a major setback for President Trump, who campaigned on a promise to “repeal and replace” the PPACA as soon as he took office.
But if the PPACA truly implodes, as Trump has predicted––meaning insurers drop out of so many areas that millions of people have no insurance options––it could trigger an entirely different health care debate.
3. The House turns its attention to tax reform.
Health care is not the Republicans’ only major priority. So is an overhaul of the federal tax code. But the GOP wants to use the same budget reconciliation procedure to pass its tax plan, and that’s a problem.
In order to make sweeping tax changes under expedited budget rules, the House and Senate would have to move on to a fiscal 2018 budget resolution, which would override the 2017 budget blueprint. But as soon as it does, the protections for the GOP’s health bill would expire.
There is another option. Each budget resolution can allow one spending bill and one tax bill to be protected by reconciliation rules. So Congress could simply start the process over with a 2018 budget resolution that would allow it to move on tax reform and changes to the PPACA simultaneously.
4. Congress tries to overhaul the PPACA piecemeal.
The House could abandon the budget process and simply pass bills without regard to whether they have an effect on the budget. The first step would likely be for the House to repeal the PPACA wholesale. Then it could take up smaller pieces of legislation, such as a bill that would allow health insurance to be purchased across state lines––a favorite idea of Trump’s. Those bills, however, would require 60 votes in the Senate, which is unlikely given Democratic opposition.
If the GOP efforts to bring wholesale change to the PPACA are exhausted, it may be possible for moderate Republicans to craft legislation with Democrats to fix some of the problems that both parties see in the law.
5. The Senate eliminates the legislative filibuster.
The Senate earlier this year abolished the need for 60 votes to fill a Supreme Court seat, which led to the approval of Trump’s nominee, Neil Gorsuch. Trump has also been calling for Republicans to get rid of the filibuster for legislation.
But a legislative filibuster is the last protection for a Senate minority party, and Republicans know they will someday be that minority again. Senate Majority Leader Mitch McConnell (R-Kentucky) has said repeatedly that he has no intention of taking that step.
Source: Kaiser Health News; May 3, 2017.