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Published: Thursday, March 09, 2017 @ 11:00 PM
As Republicans moved ahead in Congress this week with a plan to overhaul the Obama health law, GOP leaders set out an ambitious schedule over the next few weeks that could see a showdown on the House floor later this month over a health care reform plan that has the strong backing of President Trump.
"We promised to repeal and replace Obamacare, and now we are one step closer to giving families relief from this collapsing law," said House Speaker Paul Ryan on Thursday.
As I reported on the health care story this week, it quickly became apparent that many voters aren't quite sure about the procedural details involved in this legislative effort - so let's try to answer a few of those questions about what happens next on health care.
1. What has happened so far in the Congress. If you weren't paying close attention, you might have missed the Monday night rollout of the House Republican health bill. The GOP wasted no time in getting that plan before two committees on Wednesday, and after burning the midnight oil, both the House Ways and Means Committee and the House Energy and Commerce Committee approved the plan on a party line vote. "Next the bill goes to the Budget Committee as part of an open, transparent process," Speaker Paul Ryan said. That will be next week.
2. Why don't we know the cost of the GOP program? In the rush to get their bill hammered out and through two House committees, Republicans did not wait for a "score" from the Congressional Budget Office. So, right now, not only don't we have an estimate on how this will impact the federal deficit, but there also are not official figures on how many people would gain or lose health insurance coverage. It looks like those figures will come out next week, about the time that the GOP bill goes to the House Budget Committee. Critics argued that Republicans probably won't like the CBO report.
3. Republicans going with a three phase health care plan. There will be three parts to the Republican effort to overhaul the Obama health law, and this is where it starts to get a bit confusing for those who don't eat, drink and breathe parliamentary procedure in the Congress. Part 1 for the GOP is the bill that went through two committees this week, in the process known as "budget reconciliation." Part 2 will be regulations and rules that can be changed by the Trump Administration in the Department of Health and Human Services that impact health insurance. And Part 3 will be all sorts of other legislative ideas on health that don't qualify for the reconciliation bill - but those could face a filibuster in the Senate.
4. Why are there going to be two different bills? As my old across-the-street neighbor Jane points out in her above tweet, the GOP is leaving certain things out of the bill that is moving through Congress right now. That's because the rules of "budget reconciliation" don't allow the GOP to include items like, selling insurance across state lines, full repeal of the individual and employer mandates, and much more. All of that has to go in the regular bill, which would need 60 votes to get past any filibuster by Democrats in the Senate. Let me say it again - the first bill just needs a regular majority, the second one can be blocked by filibuster. The first bill is more limited, but the second one can include anything related to health policy.
5. Now we get to the false story lines of recent days. I've heard it all since Monday. "The Democrats passed their bill entirely by reconciliation." No, they did not. "The Democrats didn't need 60 votes when they passed Obamacare." Yes, they did. "Why are the rules different for Republicans?" The rules are not different for the GOP health care plan. The playing field is the same. The Democrats had to operate under the same rules and restrictions in the Congress. The biggest difference between 2009 and 2017 is simple - the Democrats had 60 votes in the Senate. The Republicans only have 52. So, the GOP can pass the reconciliation bill, but they'll need help from Democrats on a broader health care policy measure.
6. The Democrats passed two health care bills. I don't blame most of you for not remembering this, but Democrats had to pass two bills to do their health care plan in 2009 and 2010. First, the Senate mustered 60 votes to overcome a GOP filibuster, and on Christmas Eve 2009 approved what turned into the Affordable Care Act. Then, after they lost their 60 vote Senate super majority when Scott Brown won in Massachusetts early the next year, they had to come up with another plan. So, Democrats pushed through a budget reconciliation measure that made additional - but limited - health care changes. That bill was titled, the "Health Care and Education Reconciliation Act of 2010." Both of those plans made it through Congress in March of 2010, and President Obama signed them into law. The Republicans are basically trying to do the same thing in 2017.
7. The GOP repeal bill in 2015 was not a full repeal. I don't care how many times you try to tell me otherwise. The 2015 bill that was approved in both the House and Senate, and then vetoed by President Obama was NOT a full repeal. It was a reconciliation bill. You cannot have a full repeal of the Obama health law under budget reconciliation. It cannot happen. It did not happen for the GOP. That was not a full repeal. So, when you hear conservative groups and conservative Republicans say they should just pass the 2015 bill - sure, the Congress could do that - but it is not a full repeal of the Obama health law.
8. But can't the GOP overrule the Senate Parliamentarian? I have heard this one way too many times already. This idea is sort of the nuclear option of the health care debate. Change the Parliamentarian, or just have the chair overrule the Parliamentarian, and change the precedents of the Senate. That means you don't have to follow the limited rules under budget reconciliation, so you don't have to follow the Byrd Rule, and anything can go into a reconciliation bill. Technically, that could happen - though I find it hard to believe that would be an option for the GOP in the Senate. But there are Republican members of the House and conservative groups pushing exactly that, raising the hopes of their supporters. I can only imagine their reaction if it was Democrats using that strategy.
9. How about some highlights from the bill. Instead of trying to list what's most important, I'll just include a one page set of bullet points that Republicans are handing out to lawmakers. You can sort through it to see if it really tells the full story - critics of the plan will certainly say it does not.
10. So what is the time line here?Let's give you an idea of what we may see on the GOP health care bill:
+ This week brought approval of the GOP plan in two House committees.
+ Week of March 13 - House Budget Committee votes on GOP health care reconciliation bill. And we probably get a CBO score.
+ Week of March 20 - The bill heads to the House Rules Committee, which sets the ground rules for debate on the floor. In the search for votes at this point, the Rules Committee could make some late changes, known as a "Manager's Amendment." (When the Democrats made late changes like that in 2009, Republicans hit the roof.)
+ You could have a vote in the House that week, or the week of March 27, depending on how much arm-twisting is needed before the Easter break.
+ The week of March 20 and/or March 27, you could also see House action on the "second" health care bill, which would include all sorts of health care policy ideas that are not included in the reconciliation bill. The GOP leadership can then turn to any fence sitters and say, "See? You voted to repeal and replace."
+ If the House approves the health care bill, it goes right to the Senate - where it might need a little more work before a floor vote, as some Republicans have signaled their opposition.
My bottom line right now? I know there are a lot of Republicans raising red flags about the bill. But the same thing happened in 2009 and 2010. And the Democrats pushed it through.
Chances are the GOP can only get the first bill through both the House and Senate, while a filibuster might stop a broader health policy measure. But who knows?