Go Back to the Drawing Board
On Monday night, House Republicans released their plan to replace Obamacare that long had been kept under lock and key. The plan, called the American Health Care Act, has been met with substantial backlash from people on all sides on the political spectrum to say the least. Here’s just some of the response some Congress’s most conservative members:
Why the push back on the plan rolled out by House Republican Leadership? 1) The plan does not actually “Repeal and Replace” as Republicans have run on since the 2010. The plan only “repairs” Obamacare as the authors of the bill admit. Why after years of campaigning on “Repeal and Replace” would the House leadership choose to take another route? It is complicated but basically you need 60 votes in the Senate to pass a bill and avoid a filibuster. Republicans only have 52 seats and are not holding their breath that they can convince 8 Democrats to vote with them. So to curtail this problem Republicans are using a budget reconciliation process that only requires a simple majority and cannot be filibustered. The only problem with this option is the there is a limit on the changes you can make through reconciliation. This is why the bill more or less just trims the edges of Obamacare instead of a full repeal and replace that was promised.
2) Many of the key issues, such as regulations involving people with pre-existing conditions, Affordable Care Act are not solved in the plan.
3) The new plan creates a massive new entitlement by way of tax credits that replace the Obamacare subsides. These tax credits are not given out by need based on income but instead by age which is puzzling.
4) The plan does not begin phasing out the Medicare expansions that were brought into effect under Obamacare until 2020. This is a problem because if this held off until 2020 the likelyhood of it actually happening is slim to none.
This is pretty short summary of all the problems, if you want a more in-depth analysis from someone with way more expertise on this issue check out Michael F. Cannon’s analysis for the Cato Institute.
So the kinda bill sucks but what now?
Republican Leadership will no doubt try to push through the AHCA despite the backlash. I hate math but let’s do some congressional voting math really quickly. Assuming the bill passes the house, which is not certain by any means at this point, Senate Majority Leader Mitch McConnell needs 51 votes to send the AHCA to the President. When you count every Democrat (48), Rand Paul (1), and Mike Lee (1) you already have 50 people voting against the bill. This does not include other conservative members that have not stated their position at this time such as Ben Sasse or Ted Cruz. It also does not include the 4 moderate Republican senators that vowed to oppose any bill that does not sufficiently protect people currently covered in the Medicare expansion that have not stated positions at this time. Even if no other Republican senator comes out in opposition, the optics of needing a Mike Pence to break the tie is not a scenario that Mitch McConnell is going to invest capital in. Short of gutting the plan through amendments to appease opponents inside the Republican party, the American Health Care Act is dead upon arrival.
Back to the drawing board for Republicans
It is extremely frustrating that after six years of campaigning on the idea of “Repeal and Replace” that the Republican leadership did not have a plan ready that had the approval of all the members of its caucus. Republican leadership needs to go back to the drawing board.
I can already hear the opposition to this idea. Conservatives shouting it down,“WE WANT REPEAL AND REPLACE NOW WE HAVE WAITED 6 YEARS.” I 100% agree with this sentiment but I also understand a very important fact: if this “repair” of Obamacare fails the Republicans will be wiped out in the upcoming elections. The Democrats passed Obamacare while holding 60 Senate seats, 257 House seats, and the 30 Governorships. The wake of Obamacare’s failures left the Democrats now with 48 Senate seats, 194 House seats, and 16 Governorships. If this Republican “repair” fails, say goodbye to the majorities in Congress and the Presidency and hello to large Democrat majorities that will upon arrival reinstate Obamacare or install a new single-payer system.
What should the strategy be for the new plan?
I have three ideas:
- Plan on using the same reconciliation process strategy but with a new bill that all Republicans in Congress can get behind. This is obviously more easily said than done. Putting together a bill that both centrist Susana Collins (R-Maine) and libertarian Rand Paul (R-Kentucky) can agree on is no small task. One could imagine though that spending a few weeks letting all the members of Congress hash out a new bill would produce some kind of compromise everyone could agree on. Republican leadership would also be smart to consult with Republican governors that will be tasked with more responsibility in the new plan.
- The second option is what I would consider the white flag option. It is extremely unlikely to happen but arguably the option that would leave Republicans least vulnerable. The white flag option would be to work with the Democrats to put together a plan that is a compromise and could garner support from around 10 moderate Senate Democrats. It is a stretch but one could imagine that the 10 Senate Democrats facing reelection in 2018 in states that Trump carried in 2016 would be willing to work something out. If carried out this plan would get the “bipartisan” tag, which carries enormous weight in the political realm. Would this lead to the best healthcare plan for the American people? Most likely not but it is a last resort option for Republicans.
3. A third option and my personal favorite: just pass Rand Paul’s replacement plan. :))))
What will Republican leaders actually do? Hard to know but right now they are just trying to sell the American Health Care Act to the public hoping to gain enough support to pressure opponents into submission. Short of some pretty significant amendments this strategy is not going to work.
The good news? The healthcare policy fun is just beginning!!
