This Week on the Hill: McConnell Aims for Health Care Vote This Week; CBO, Parliamentarian, Opposition Hurdles Remain

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.

Five Republican senators have announced their opposition to the bill so far, split between a group of four senators — Sens. Rand Paul (R-KY), Mike Lee (R-UT), Ron Johnson (R-WI), and Ted Cruz (R-TX) — who want to move the bill in a conservative direction, and electorally-vulnerable Sen. Dean Heller (R-NV), whose concerns center on the bill’s sharp cuts to the Medicaid program. Others have offered serious reservations, including moderate Sen. Susan Collins (R-ME), who said this weekend  that “it’s hard for me to see the bill passing this week.” Nevertheless, reports suggest that Leader McConnell is confident that he can ameliorate the holdouts’ concerns and move the bill before the end of the week. The path to 50 votes remains very narrow, but it is difficult to predict how senators will react to changes made to the bill once it hits the Senate floor.

The House, on the other hand, will wade into the immigration debate this week with a pair of measures designed to help fulfill President Trump’s campaign promise of stricter immigration rules. One bill (H.R. 3003) — dubbed “Kate’s Law” in honor of a victim of a crime perpetrated by an undocumented immigrant — would enhance the punishment for immigrants that try to re-enter the United States after being deported. Another bill (H.R. 3004) would target sanctuary cities by requiring local officials to comply with federal orders and bar Homeland Security and Justice Department grants from cities that hesitate to cooperate with federal immigration officials. Both bills are highly partisan and were brought to the House floor without consideration in the House Judiciary Committee.  

Today’s floor action will be relatively muted. The Senate will finalize its confirmation of Kristine Svinicki to the Nuclear Regulatory Commission after she passed cloture last week on a 89-10 vote. Meanwhile, the House has four suspension bills to consider, namely:

• H.R. 2547 – The Veterans Expanded Trucking Opportunities Act would allow for more Department of Veterans affairs medical professionals to be qualified to issue medical certificates to veterans seeking approval to operate commercial motor vehicles.
• H.R. 1684 – The Disaster Assistance Support for Communities and Homeowners Act would direct the Administrator of the Federal Emergency Management Agency to provide technical assistance to common interest communities regarding eligibility for disaster assistance.
• H.R. 2258 – The Active Duty Voluntary Acquisition of Necessary Credentials for Employment (ADVANCE) Act would require that certain standards for commercial driver’s licenses applicable to former members of the armed services or reserves also apply to current members of the armed services or reserves.
• H.R. 1726 – The Coast Guard Improvement and Reform Act would make technical changes to the U.S. Code affecting the Coast Guard, including moving it from the Department of Homeland Security to the Department of Defense. Notably, Coast Guard Commandant Adm. Paul Zukunft has spoken out against the move, saying that while the service needs more robust funding, Homeland Security is a good fit for the Coast Guard, given its missions.