Repeal and Replace Passes the House
Last week the House of Representatives approved a bill to repeal and replace the Affordable Care Act, commonly known as Obamacare. The new measure is called the Affordable Health Care Act (AHCA) Example coverage: NY Times article, May 4 CNN.com article, May 4. The eight days since then seem like an eternity already thanks to the brouhaha over President Trump's firing of FBI Director James Comey, but I'd like share several observations about the AHCA for the record. Here are Five Things:
1) Doing it For Real was Hard
The Republican-led Congress passed 60+ measures to gut Obamacare between 2011 and 2016. None took effect because they were vetoed by President Obama, of course, or died in the Senate. With Republicans in control of both houses of Congress and the White House since January party leaders promised that a real repeal and replace would be ready on "Day One". Well, no vote was scheduled until about 3 months in, and the first few attempts were cancelled when party leaders saw they were going to be lose. Now this bill passed on Day 105. Why did it take so long?
The obvious fact is that doing it for real was tough. Those 60+ votes taken in the preceding several years were show votes. Political theater. Politicians could vote for repeal without concern for the consequences because they knew the bill wasn't going anywhere. But with majorities in both chambers and an ardent "repeal and replace!" president in the White House a vote to approve would have real consequences. It'll be on them if millions of people lose health insurance.
2) The AHCA Passed by a Razor-Thin Margin
The AHCA passed the House by a narrow margin, 217 to 213. Twenty Republican joined all House Democrats in voting against it.
3) They Passed it Without Knowing the Costs
The Congressional Budget Office (CBO) is a non-partisan organization created by Congress to advise it on the fiscal costs of legislation. The ACA/AHCA have enormous impact on federal budgets, and indeed reducing the federal government's costs is a big selling point of the AHCA. Yet the House passed the AHCA before the CBO completed its analysis.
Obviously the people who voted to "repeal and replace" Obamacare don't care what it costs. Their position is ideological. Facts be damned.
Well, we'll see what the CBO's projections are in their report due out later this month.
4) This Bill is More Extreme than Bills that Failed
With attempts to pass the AHCA having failed a few times earlier this year you might think the version passed last week was more moderate than its predecessors, to attract more centrist politicians. Actually it's more extreme!
The Republican Party painted itself into a corner with its pledge to "Repeal and replace". They repeated it so often as a rallying cry that it became an empty talking point. When it came time to draft actual legislation they found it extremely tough to satisfy both the ideologically extreme parts of the party as well as the moderates.
Members of the arch-conservative Freedom Caucus objected to versions of the AHCA proposed earlier this year because they would have left in place too many Obamacare regulations, for example, parts of federal subsidies (which cost the government money) and burdens on insurers such as covering preexisting conditions. Moderate Republicans opposed the bills, too, because they worried that even watering down key provisions of Obamacare could leave millions of people without adequate health insurance.
As it turns out, shifting the bill to the right was the way to bring both factions on board. The Freedom Caucus got what it wanted, so they joined on board. This left the moderates exposed as the sole holdouts, so for political survival many of them signed on.
5) It's Not Law Yet
Just because this legislation passed in the House does not mean it's the law of the land yet. Refresh your memory with this 1970's Schoolhouse Rock classic "I'm Just a Bill":
In particular, the bill still needs to pass the Senate, where it faces longer odds. Republicans hold a narrow majority there. The defection of just a few votes would doom passage. And senators are likely to scrutinize the bill more carefully, knowing that if they pass it it is much closer to being the law of the land. (To some extent the House's vote was another "show vote" because the Senate still needs to pass it.)
Then there's the filibuster. Democrats are almost certain to use it to block such legislation, requiring 60 votes for passage. That's why Republicans have been planning for months to use a legislative back door called Budget Reconciliation. That avoids the filibuster and can pass on a simple 51 vote majority. But the rules of budget reconciliation impose significant constraints, namely forbidding a bill that increases the federal deficit.
And this is where the CBO (see Thing 3, above) comes in. Previous CBO estimates found that Obamacare actually lowered federal deficits. Hence undoing key provisions may increase the deficit. We'll see how it plays out. Grab your popcorn for some more political theater!
1) Doing it For Real was Hard
The Republican-led Congress passed 60+ measures to gut Obamacare between 2011 and 2016. None took effect because they were vetoed by President Obama, of course, or died in the Senate. With Republicans in control of both houses of Congress and the White House since January party leaders promised that a real repeal and replace would be ready on "Day One". Well, no vote was scheduled until about 3 months in, and the first few attempts were cancelled when party leaders saw they were going to be lose. Now this bill passed on Day 105. Why did it take so long?
The obvious fact is that doing it for real was tough. Those 60+ votes taken in the preceding several years were show votes. Political theater. Politicians could vote for repeal without concern for the consequences because they knew the bill wasn't going anywhere. But with majorities in both chambers and an ardent "repeal and replace!" president in the White House a vote to approve would have real consequences. It'll be on them if millions of people lose health insurance.
2) The AHCA Passed by a Razor-Thin Margin
The AHCA passed the House by a narrow margin, 217 to 213. Twenty Republican joined all House Democrats in voting against it.
3) They Passed it Without Knowing the Costs
The Congressional Budget Office (CBO) is a non-partisan organization created by Congress to advise it on the fiscal costs of legislation. The ACA/AHCA have enormous impact on federal budgets, and indeed reducing the federal government's costs is a big selling point of the AHCA. Yet the House passed the AHCA before the CBO completed its analysis.
Obviously the people who voted to "repeal and replace" Obamacare don't care what it costs. Their position is ideological. Facts be damned.
Well, we'll see what the CBO's projections are in their report due out later this month.
4) This Bill is More Extreme than Bills that Failed
With attempts to pass the AHCA having failed a few times earlier this year you might think the version passed last week was more moderate than its predecessors, to attract more centrist politicians. Actually it's more extreme!
The Republican Party painted itself into a corner with its pledge to "Repeal and replace". They repeated it so often as a rallying cry that it became an empty talking point. When it came time to draft actual legislation they found it extremely tough to satisfy both the ideologically extreme parts of the party as well as the moderates.
Members of the arch-conservative Freedom Caucus objected to versions of the AHCA proposed earlier this year because they would have left in place too many Obamacare regulations, for example, parts of federal subsidies (which cost the government money) and burdens on insurers such as covering preexisting conditions. Moderate Republicans opposed the bills, too, because they worried that even watering down key provisions of Obamacare could leave millions of people without adequate health insurance.
As it turns out, shifting the bill to the right was the way to bring both factions on board. The Freedom Caucus got what it wanted, so they joined on board. This left the moderates exposed as the sole holdouts, so for political survival many of them signed on.
5) It's Not Law Yet
Just because this legislation passed in the House does not mean it's the law of the land yet. Refresh your memory with this 1970's Schoolhouse Rock classic "I'm Just a Bill":
Click to viewIn particular, the bill still needs to pass the Senate, where it faces longer odds. Republicans hold a narrow majority there. The defection of just a few votes would doom passage. And senators are likely to scrutinize the bill more carefully, knowing that if they pass it it is much closer to being the law of the land. (To some extent the House's vote was another "show vote" because the Senate still needs to pass it.)
Then there's the filibuster. Democrats are almost certain to use it to block such legislation, requiring 60 votes for passage. That's why Republicans have been planning for months to use a legislative back door called Budget Reconciliation. That avoids the filibuster and can pass on a simple 51 vote majority. But the rules of budget reconciliation impose significant constraints, namely forbidding a bill that increases the federal deficit.
And this is where the CBO (see Thing 3, above) comes in. Previous CBO estimates found that Obamacare actually lowered federal deficits. Hence undoing key provisions may increase the deficit. We'll see how it plays out. Grab your popcorn for some more political theater!