AHCA– what’s next?

The Senate, of course.  And how to make sense of that?  Still haven’t come across anything better than Jonathan Bernstein’s take from right after the House passed it:

The biggest questions now are about what will happen in the Senate. This is a “reconciliation” bill, which means it will be protected against filibusters and will need only a simple majority to pass. But it also means that only certain provisions (those that affect the federal budget) can be included. It’s entirely unclear what the Senate parliamentarian — an unelected official who singlehandedly makes major decisions on the reconciliation process — will allow, and what Mitch McConnell and Senate Republicans will do if the parliamentarian turns what the House has done into Swiss cheese by stripping various provisions from it.

Nor is it clear that 52 Senate Republicans (with the support of Vice President Mike Pence to break ties) are enough to pass anything. To begin with, it seems likely Maine’s Susan Collins and Alaska’s Lisa Murkowski will oppose anything that retains the House bill’s hit on Planned Parenthood. Another half dozen or more Republican Senators have spoken against the measure’s cuts to Medicaid. And then Kentucky’s Rand Paul wanted a full Obamacare repeal, and it’s possible a handful of others (Ted Cruz of Texas? Mike Lee of Utah?) might join him in opposing the House bill (let alone anything modified to get the votes of Collins and Murkowski) as too weak.

It’s absolutely possible that Senate Republicans can figure out a way forward, but it should be at least as hard for them to get their version of the bill over the finish line than it was for House Republicans to do so. [emphases mine] It may be even harder at this stage of the process: Several members of the House said that they were counting on the Senate to modify things, but senators have less leeway to pass the buck in the same way.

Harder, but not impossible. If the Senate does pass something, and assuming the House isn’t willing to just rubber-stamp that version, then the two chambers would have to hammer things out in a conference committee. And the math is still extremely daunting: House Freedom Conference radicals simply want a bill that doesn’t appear to have 50 votes in the Senate…

My guess is that it’s still fairly unlikely that any version of this makes it into law. President Donald Trump is hosting a victory party at the White House for House Republicans today, and I still think their best strategy is to just pretend that they’ve killed off Obamacare for good, and then go on administering it.

But make no mistake about it: Something could very well pass. Even if very few House or Senate Republicans are excited by their bill and are fully aware of the electoral risk some of them are taking, politicians like to do what they promised, and they — as a group — promised to repeal and replace Obamacare. Many of them also remain individually more worried about being defeated in primaries if they take the blame for failure than they are about being defeated in general elections because they are blamed for voting for something unpopular. Only the latter can cost Republicans their congressional majorities. 

Also, Perry Bacon with a very nice analysis in 538 looking at the various competing concerns which will make this so difficult to get through the Senate.  Again, something certainly can, but it is far from a given.

Also, I’ll re-quote Bernstein:

And the math is still extremely daunting: House Freedom Conference radicals simply want a bill that doesn’t appear to have 50 votes in the Senate

So, first can 50 Senators actually agree on something?  And, if they can, will the Freedom Caucus vote for it?  Both are possible, but far, from an easy yes.

In fact, I think there’s a non-trivial possibility we could end up with something like we did on a health care bill from long ago– the 2001 Patients Bill of Rights.  The House passed a version.  The Senate passed a version.  But they could never pass a reconciled version that they both agreed upon.  Those, actual patients rights had to wait for the ACA.

About Steve Greene
Professor of Political Science at NC State http://faculty.chass.ncsu.edu/shgreene

One Response to AHCA– what’s next?

  1. Nicole K says:

    The only way this can be a reconciliation bill is if it doesn’t increase the deficit. We need the CBO scoring that the House could not wait for.

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