Speaker Paul Ryan (center) and House Majority Leader Kevin McCarthy (left) (Chip Somodevilla/Getty Images)

How The US Senate Could Stall or Defeat the AHCA

Banking on the chamber of last resort.

The American Health Care Act has passed the House in the biggest move yet by the GOP to repeal the Affordable Care Act. The party that the White House threw in the Rose Garden yesterday was premature. The AHCA still has one massive roadblock: the United States Senate.

The Razor’s Edge

A 217–213 vote in the House gets the job done, but it doesn’t account for the doubts that still stand in the Senate. With a razor thin majority in the Senate, the GOP can only have two defections. The same legislation that was labeled consensus building in the House can turn into a divisive mess in the Senate.

The House GOP managed to steal victory from the clutches of defeat on this legislation. The far-right wing of their caucus had no intention of voting for this legislation, and that would have doomed the bill. It only survived due to some intense 11th hour finagling that isn’t as likely to fly in the Senate. The same concerns are likely to reappear, and many Senators have already voiced dissatisfaction with the new legislation.

Now that the House has passed a bill, it’s on the Senate to get to work. That shifts the battlefield of public opinion squarely into their chamber, and moderate Republicans will not appreciate that.

The Conservative Backlash

Steering the bill up the middle will not make conservatives like Ted Cruz, Rand Paul, or Mike Lee very happy. Convincing them to vote for a bill that has been guided to safe ground will be extremely difficult.

That leads to a clear solution that has been banging around in the minds of Senators and pundits alike: rewrite a Senate version of the bill. Where this becomes problematic is the House. They’ll have to vote on the Senate’s revised version of the AHCA, and it is likely to encounter massive opposition from the House Freedom Caucus.

Moderate members of the House will probably be singing the praises of this moderated approach soon because it gets them out of the jam of voting for the original legislation.

Medicaid

The ACHA cuts Medicaid by $800 billion and stops the expansion of the program in its tracks. Tens of millions will likely end up uninsured, but the Senate will not let these changes coast through to a final version of the bill.

The debate over protections for those with preexisting conditions in the House is to their version of the AHCA as Medicaid will be to the Senate version of the bill.

Medicaid protects upward of 70 million low income Americans, and Obamacare was a large part of the expansion of its coverage. Even conservative stalwarts like Tom Cotton have voiced concern about cuts that go this deep into the heart of the program’s ability to serve its purpose.

Private Insurance

The House version of the AHCA allows states to decide whether or not insurance companies can charge people more for preexisting conditions. States will be required to establish high-risk pools. Those who will likely incur higher medical costs are forced into these pools which drastically disadvantage those who fall under the ever expanding new list of what now counts as a preexisting condition.

The protections that Obamacare provides for those with preexisting conditions are massively popular across the country, and that makes them an electoral third rail in the magnitude of Social Security. Centrist Republican Senators are the most vulnerable if the changes to these protections are signed into law.

Many in the Senate worry that the ACHA will explode premiums and the new subsidies based on age will leave young Americans out in the cold and uninsured.

What’s the CBO say?

The original CBO report on the ACHA from March 2017 was lackluster at best. It’s anticipated that millions of Americans would lose health insurance under the ACHA.

“CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law.”

Those numbers do not bode well for anyone who supported the legislation in the 2018 midterm elections. The most striking and salient details of the CBO markup come in its summary.

  • 24 million more Americans uninsured by 2026.
  • $337 billion in savings over the next decade.

If you divide it out, for every American uninsured by 2026, the federal government will only save in the ballpark of $14,000.

These estimates are based on the original version of the legislation. The vote on this particular version of the bill was cancelled due to lack of support in the House. The new CBO estimates have yet to come out, but the old report should serve as a sturdy benchmark.

It’s ironic that the GOP pushed the new version of the AHCA through to a vote before the CBO score, because this is exactly what Speaker of the House Paul Ryan vehemently opposed during the drafting and passage of Obamacare in 2009 and 2010.

So what’s it all mean?

The Senate is not going to pass the House version of the AHCA in its entirety. Many aspects of it may remain intact, but even the impending Senate version of the bill is still likely to fail because of the political fallout tied to the risk of exploding premiums and essentially making coverage for those with preexisting conditions unaffordable.