This week has the potential to be the most important of the year in healthcare, as the Senate could vote as early as Thursday evening on their version of a bill to repeal and replace major provisions of the Affordable Care Act (ACA). Majority Leader Mitch McConnell (R-KY) will likely bring the bill to the floor soon after the release of the Congressional Budget Office’s (CBO) score, which is expected early this week. Before any votes can be cast, the legislation will also need to undergo a review from the Senate parliamentarian to decide which provisions, if any, violate the chamber’s budget reconciliation rules. One of the key unknowns still remaining is whether a process for states to waive essential health benefits and other market reforms will survive the Senate parliamentarian’s analysis. The waiver process was added to the House’s version of the bill as an amendment from Rep. Tom Macarthur (R-NJ) and was essential to the American Health Care Act’s (AHCA) approval in the lower chamber.
The Week in Review
The Senate’s version of a health care overhaul was released with a great deal of fanfare last week as supporters and detractors quickly tried to establish their positions on the bill. Four conservative Republican senators — Sens. Rand Paul (R-KY), Ron Johnson (R-WI), Ted Cruz (R-TX), and Mike Lee (R-UT) — announced that they are opposed to the bill in its current form; although they were sure to add the caveat that they are “open to negotiation and obtaining more information before it is brought to the floor.” Moderates have yet to commit to either supporting or opposing the bill, but several said they had concerns with the discussion draft, primarily related to its cuts to Medicaid. Sen. Dean Heller (R-NV) was the first moderate Republican last week to say he would not vote for the bill in its current form. A full roundup of the health care debate is included below.
In an Inside Health Policy article published yesterday, Thorn Run Partner’s Senior Vice President Shea McCarthy offered his take on the role of conservatives in the House — namely the Republican Study Committee (RSC) and the House Freedom Caucus — in looming negotiations between the two chambers as lawmakers continue to digest the Senate’s healthcare reform bill. McCarthy noted that while it was expected that the Senate’s version was always expected to be more centrist than the House’s American Health Care Act (AHCA), key questions remain as to whether or not Senate conservatives — such as Senators Ted Cruz (R-TX) and Mike Lee (R-UT) — will support a more moderate package. “Cruz in particular still carries a lot of weight with the RSC and the Freedom Caucus,” said McCarthy in the interview prior to the Senators’ opposition of the current bill. “Assuming Cruz and Lee ultimately sign off on the Senate’s version, signaling that the bill goes ‘far enough,’ it’s hard to envision enough conservative House members casting votes to sink the package.”
The Senate’s version of a health care overhaul was released with a great deal of fanfare yesterday as supporters and detractors of the bill quickly tried to establish their positions on the bill. The most significant development came yesterday afternoon when four conservative Republican senators — Sens. Rand Paul (R-KY), Ron Johnson (R-WI), Ted Cruz (R-TX), and Mike Lee (R-AZ) — announced that they are opposed to the bill in its current form; although they were sure to add the caveat that they are “open to negotiation and obtaining more information before it is brought to the floor.” President Trump threw his support behind the Senate draft this morning in an interview on Fox & Friends and seemed open to placating the conservatives, saying “They’d like to get certain changes, and we’ll see if we can take care of that.”
The product of weeks of negotiation is set to be unveiled today when Senate Majority Leader Mitch McConnell (R-KY) releases a “discussion draft” of the Senate’s version of a health care overhaul to replace the Affordable Care Act (ACA). The Majority Leader is hosting an all-caucus meeting at 9:30am this morning to present the plan to Republicans, many of whom have said they hadn’t seen the text as of yesterday. Nevertheless, the overarching plan of the bill is understood to be similar to the House version, which included a significant cut to Medicaid funding, elimination of the ACA’s individual and employer mandates, and repeal of most of the ACA taxes, among other provisions. Key differences in the Senate version are expected to include linking insurance subsidies to income-level rather than age, curtailing the Medicaid expansion at a more gradual rate than proposed under the House’s American Health Care Act (AHCA), and linking federal spending under the Medicaid per-capita caps to a slower growth index than the one included in the AHCA (portending larger long-term cuts).
The horrific events of last week drew poignant remarks from leaders on both sides of the aisle, who along with others, not only condemned the violence but urged participants on all sides to tone down the vitriol of the current state of political discourse. Unfortunately, like all too many parents know, when petulant siblings are seen screaming that it was “the other one’s fault” and “they started it,” it is often impossible to adequately resolve the issue in the eyes of either aggrieved child. Perhaps, instead of contributing the “weighing and measuring” aspect of modern political analysis, Members of Congress and the Senate can become the profiles in courage that will lead the way to the political compromises that used to make this country great. Or…
President Trump and Republican leaders were able to breathe a sigh of relief last night as election returns came in from two special elections — in Georgia’s 6th district and South Carolina’s 5th district — showing GOP holds in both seats, albeit by relatively narrow margins. In the more prominent of the two races, Republican Karen Handel bested Democrat Jon Ossoff in the most expensive race ever run in the House of Representatives, where Democrats were hoping a win could demonstrate momentum in their efforts to block the Republican legislative agenda. Instead, the Republican wins could prove to be a boon for their legislative initiatives on health care and tax reform.
After weeks of negotiation, Senate Republicans appear to be closing on the legislative text for its version of a healthcare overhaul, with the aim of holding a vote before the end of next week. The components of the Senate bill have reportedly been sent to Congressional Budget Office (CBO), who will need to release a score of the bill before the Senate can vote on it. Similar to the process in the House, there is no firm vote count on the bill and the eventual floor vote is likely to be dramatic – and close. Republicans will need to avoid three defections from their ranks in order to pass the bill, although Leadership appears serious in its intent to hold a vote regardless of whether a victory is ensured. Defeat in the Senate would likely forestall health care reform for the foreseeable future as Republican lawmakers are reportedly eager to move on to tax reform.
As the summer churns along, Republican leaders are hoping to break the stalemate on their major priorities, namely health care legislation, tax reform, and the appropriations process for the 2018 fiscal year. All three appear to be deadlocked at the moment, with health care reform at the front of the queue. According to a report yesterday from Axios, Senate Majority Leader Mitch McConnell (R-KY) is hoping to force a vote on the Senate’s version of health care reform – which has yet to be publicly released – as early as next week. That move would require legislative text to be sent to the Congressional Budget Office (CBO) in order to be scored, meaning that negotiations would need to be finished this week. The remaining sticking points are well-known – Medicaid funding and the degree to which the bill will roll back restraints put on the insurance market by the Affordable Care Act (ACA) – but a formal whip count remains elusive as senators await legislative text.
The Week in Review
The week in Washington was marred by tragedy after a gunman opened fire at a baseball practice for Republican Members of Congress ahead of the annual Congressional Baseball Game, injuring four, including House Majority Whip Steve Scalise (R-LA). Members of Congress were shaken by the event, particularly after it was apparent that the gunman was targeting lawmakers, and legislative schedules were altered as Congress grappled with their response to the attack. That response took the shape of a remarkable show of unity at the Congressional Baseball Game, and an emotional floor speech from House Speaker Paul Ryan (R-WI), speaking for lawmakers of all partisan stripes, saying, “For all the noise and all the fury, we are one family.” All of the victims of the shooting are expected to recover.