The House may finally be on its way to scrapping Obamacare, but don’t expect the Senate to go along: Any plan sent over will undergo major surgery — and survival is far from assured.
The hurdles in the upper chamber were on vivid display Wednesday as House Republicans celebrated their breakthrough on the stalled repeal effort. The compromise cut with House Freedom Caucus members won over the right flank, but the changes will almost surely make it harder to pick up votes in the more moderate-minded Senate.
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Not to mention that some Senate conservatives still seem opposed to the emerging House deal.
“The Freedom Caucus has done a good job of trying to make the bill less bad,” Sen. Rand Paul (R-Ky.), one of the lead Senate agitators against the House health care push, said Wednesday. “For me, it’s a big stumbling block still that there’s taxpayer money that’s being given to insurance companies, and I am just not in favor of taxpayer money going to insurance companies.”
Phil Novack, a spokesman for Sen. Ted Cruz , also indicated that the conservative Texas firebrand isn’t sold, saying “significant work remains” in the Senate, “specifically to address Obamacare’s insurance mandates and enact major patient-centered reforms that will further reduce the cost of health care.”
Sources say it may take more than a month for any House health care bill to run through the traps in the Senate, including internal party discussions and an analysis of how the measure would affect the deficit and insurance rolls. No committee hearings are planned because Republicans don’t want to give Democrats a public forum to bash an effort they are not involved in. And similar to the Senate’s dim view of the House’s proposal, the lower chamber may not ultimately be able to pass whatever the Senate is able to produce on Obamacare.
Plus, a procedural rift is beginning to emerge within the GOP, with several Republicans questioning whether reconciliation — the fast-track legislative process that circumvents a filibuster, and thus the need for Democratic support — is even the best avenue for health care overhaul efforts.
Few Senate Republicans are currently engaged in the health care efforts. Several GOP senators declined Wednesday to wade in to the specifics of the revised plan drafted by Rep. Tom MacArthur (R-N.J.) and Freedom Caucus Chairman Mark Meadows (R-N.C.), taking pains to note that senators will probably have to rewrite it anyway.
“It isn’t discussed a lot over here,” said Sen. Chuck Grassley (R-Iowa). “Except for the hard work of [Susan] Collins and [Bill] Cassidy, there’s hardly anything being done.”
Senate Majority Whip John Cornyn (R-Texas), the party’s chief vote counter, also downplayed any notion that the new House version of an Obamacare replacement will sail through the Senate intact.
“Once they pass a bill, my assumption is, the Senate’s going to take a look at it but not necessarily be rubber-stamping what they’re proposing,” Cornyn said. “So I would anticipate that we’ll do what we used to do all the time which is, the House will pass a bill, we’ll pass a bill and then we’ll reconcile those in a conference committee.”
Weeks after the spectacular collapse of Obamacare repeal efforts last month, MacArthur and Meadows struck a deal with new language that would allow states to opt out of several key Obamacare provisions, such as its ban on charging sick people higher premiums and the so-called essential health benefits mandate that requires insurers to provide a set of minimum benefits.
The new language was enough to earn the formal endorsement of the Freedom Caucus, but House moderates who were opposed to the previous plan remain wary of backing a proposal that could cause constituents with pre-existing conditions to lose affordable health care coverage. In fact, the new plan may be having the reverse effect on some centrists: Rep. Mike Coffman (R-Colo.) had supported the initial Obamacare replacement but now says he’s a “maybe.”
Influential Senate Republicans also raised doubts about whether the new House proposal is workable.
“I think the better approach is to stabilize the insurance pool,” said Cassidy, who is shopping around his own Obamacare replacement measure with Collins. “So one, I’m glad they’re working on common ground. But two, I’m not sure their approach is where I think it will most lower those premiums.”
If legislation does manage to clear the House, it’s unclear whether it will get official sign-off from the Senate parliamentarian to qualify for the fast-track reconciliation rules. Under the so-called Byrd rule, only provisions that affect the budget can be taken up under reconciliation.
One senior Senate Republican official said Wednesday that the MacArthur-Meadows language has been reviewed in the Senate, and — for now — “we believe it would” not be ruled out of bounds for reconciliation.
Still, the GOP source cautioned that a final ruling on whether it passes reconciliation muster will have to wait until an official Congressional Budget Office score and Democrats make their case to the Senate parliamentarian. On Wednesday, Democrats were adamant that the new health care deal would not fly under the Byrd rule. A spokesman for Minority Leader Chuck Schumer (D-N.Y.) the GOP effort “is almost certainly going to run afoul” of Senate restrictions.
A separate Republican source familiar with party strategy said it would likely take a month under the most optimistic circumstances to finish a repeal-and-replace bill under reconciliation rules. There is much work to do: Senators are likely to make Medicaid cuts less severe, deliver more money for opioid funding, make tax credits for the middle class more generous and rework the House’s waivers from Obamacare’s requirements.
The CBO will also have to score the legislation, an assessment that many House Republicans seem unconcerned with, senators said in interviews Wednesday. Many lawmakers requested anonymity to candidly discuss a sensitive matter that divides Republicans.
“If they release text and try to vote on it 26 hours later, it’s a problem. It’s a complicated topic a lot of representatives don’t understand. It’s not an area of their expertise,” said one GOP senator. “They can send it to us, but we’re not going to rush it over here.”
In interviews with senators across a broad ideological range, there was growing irritation with attempts to ram complicated legislative language through the House and expect the Senate to clean it up. Some GOP senators suggested that a bipartisan bill may be the only way to overhaul the health care system in a lasting manner.
“I don’t know if this bill is better … the worst thing we can do is replace it with a Republican-only alternative that doesn’t drive down costs, that doesn’t improve access to care,” said Sen. Lindsey Graham (R-S.C.). “A Republican-only bill to replace a Democratic-only bill is not what I hope for. I hope for a bipartisan bill.”
Graham is not alone. Several senators said they worry that the current three-step plan — repeal and replacing through reconciliation, making executive action changes to the law and working with Democrats to fix the rest — is unrealistic.
Republicans wonder: Why would Democrats work with Republicans after watching their primary achievement from Obama’s presidency gutted on a party-line vote?
“I would just like to see us maybe show the American people we can work through a normal process. We’ve got majorities in both houses,” said a second GOP senator. “We shouldn’t [use reconciliation] on anything.”
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