In addition to the huge tax cut for the wealthy that passed the House yesterday, I suspect that one of the reasons Paul Ryan was so giddy is that the whole headache of repealing Obamacare is at least temporarily off his plate. It has been passed on to Senate Majority Leader Mitch McConnell, who has been pretty much hiding in the shadows on this one for the last couple of months.
As I mentioned yesterday, the Senate plans to toss out the Republican bill and start from scratch to craft their own legislation. In addition to having to deal with the fallout created by the upcoming CBO score on the House bill, Julie Rover outlined the five things to watch that will be major hurdles for them to overcome.
- Medicaid
- Increase in the number of uninsured
- Tax credits
- Planned Parenthood
- Procedural problems
Because the Senate plans to use the budget reconciliation process, they will need at least 50 of their 52 members to vote for whatever bill might emerge (with the potential for VP Pence to break a tie). That means that the margins are extremely close.
Medicaid will be a huge issue for Senators who represent swing states and/or those that expanded it under Obamacare. The House bill slashes Medicaid spending by $880 billion over the next 10 years, primarily by changing it from an entitlement to a funding formula based on the needs of a state’s population.
In writing about how this will affect the fact that Medicaid currently pays the bills for over 60 percent of nursing home residents, Jon Schwarz tells an interesting story about the shenanigans that were used to get this passed in the House.
[Daniel] Webster (R-FL) explained he was only willing to vote yes because President Donald Trump, Vice President Mike Pence and the House of Representatives’ GOP leadership promised that they would find some way to deal with the potential disaster created by the bill.
So Trump, Pence and GOP leadership promised Webster that this would be fixed. Apparently he believed them and voted for the House bill despite his concerns over how it would affect seniors in his district who depend on Medicaid to pay for their care in a nursing home.
It would be interesting to know how many other promises were made like that in order to secure enough votes in the House. That is a pretty good example of how the administration and House Republican leadership were more concerned about putting a couple of points on the board than they were in actually crafting a bill that could become law. But regardless of their motivation, all of that is in McConnell’s lap right now.
The increase in the number of people uninsured is endemic to pretty much any approach the Republicans take to repealing Obamacare, as is the issue of tax credits. No matter what they do in those areas, Americans will lose coverage and pay more.
Senators like Susan Collins and Lisa Murkowski are going to have trouble voting for any bill that defunds Planned Parenthood (which the House bill did)—just as a lot of extremists will have trouble voting for a bill that doesn’t.
In much the same way that the House set up Senators to fix problems they created in order to put a couple of points on the board, they also set up their bill in a way that is likely to face procedural problems with the reconciliation rules of the Senate. Rover identifies three items from the House bill that aren’t likely to pass muster:
- the Meadows amendment that allows states to waive Obamacare’s regulation of insurers (i.e., pre-existing conditions)
- the 30% premium penalty (paid to insurers) for those who allow coverage to lapse
- the provision allowing insurers to charge older adults 5 times more than younger adults, as opposed to the 3:1 ratio in Obamacare
While any one of those could begin to unravel the bill, taken together, they pretty much gut what House Republicans just passed.
As you can see, what happened yesterday in the House was a completely cynical process that has everything to do with political games and not much to do with actual governing. Perhaps now it makes sense why Trump and House Republicans chose to do their pre-mature end-zone dance at the White House. That is very likely to be the only celebrating they are going to get the chance to do on this issue. Meanwhile, Martin is right, Mitch McConnell is probably gritting his teeth in anguish right about now.
