ACA Regulatory Update: Republicans Mount Opposition to Proposed Legislation

The eventual fate of the American Health Care Act remains uncertain one week after its release. Conservative and moderate Republicans alike have expressed opposition to the bill, indicating the eventual legislation passed into law will likely be significantly different from last week’s proposal. Members of Congress do not seem particularly concerned regarding the AHCA provisions on reporting requirements. Whether the Senate will maintain, modify, or remove those provisions is unclear at the moment.

Opposition to the Bill

Prominent Republicans in both the Senate and House have described the AHCA as “dead on arrival.” Conservative Republicans want the repeal to go even further, while moderate Republicans fear the legislation would pull the rug out from under millions of Americans who obtained insurance through the Affordable Care Act. The Congressional Budget Office validated those fears when it announced the AHCA would result in an additional 14 million uninsured people on top of the 10 million who currently do not have insurance, as well as a short-term increase in premiums. These revelations have strengthened the bill’s opposition on both sides within both parties. Republican Representatives Leonard Lance and Ileana Ros-Lehtinen have already made their intentions to vote against the AHCA clear. Rep. Lance is especially concerned the bill would fail in the Senate, with Senators Rand Paul and Lindsay Graham noting their opposition. Senator Bill Cassidy, who co-sponsors another version of ACA replacement referred to as the Collins-Cassidy plan, spoke out against the administration for reneging on its promises on health care reform. He also expressed deep concern with the CBO report and the coverage losses that would result from this law. The Collins-Cassidy plan would allow states to keep the ACA in its current form if they so choose, and other states would be allowed to craft their own health care laws based upon certain federal standards. Senators Collins and Cassidy will likely attempt to include some aspects of their plan if or when the AHCA reaches the Senate. Their bill would likely gain support from Republican governors — many of whom have declined to endorse the AHCA — in response to provisions that allow for greater flexibility at the state level. Cassidy was also apprehensive about increases in premiums outpacing the tax credits available for seniors under the ACHA. Rep. Charlie Dent, a member of the moderate Republican ‘Tuesday Group,’ expressed concern over the AHCA’s Medicare rollback. The current bill would roll back the Medicaid expansion before 2020. Rep. Dent explained, “Taking the date back from 2020 is a huge problem. It is a non-starter for many.” Many Republicans from Medicaid expansion states are looking forward to the 2018 midterms in their refusal to give their support to the AHCA. Other suggested changes from members of the Senate include lower costs and further relief for poorer and older Americans; increased funding to states with hard-to-insure populations; and larger transition grants to cover people with pre-existing conditions, subsidize insurance purchases, or for other interventions. Most Senators do not want to vote for any bill that would result in any, albeit a temporary, increase in premium costs.

Likelihood of Moving Forward

If the bill does indeed pass the in House, the Senate will likely make significant changes rather than passing it in its current form. At the same time, House leadership has indicated much — if not most — of the bill is not open to negotiation. They do expect the Senate to make modifications when it takes up the legislation. However, prospects in the Senate are not much better. Several Republicans have warned it would be nearly impossible to satisfy Senate conservatives and moderates with one piece of legislation – the ideological divide is too wide given the nearly universal Democratic opposition and the weak margin currently held by Republicans. To bridge the gap, the President met with Senate leaders to discuss possible changes to which both Congress and the White House would be amenable. Details from this meeting are not yet public. The bill may be in peril from a procedural standpoint as well. Senate aides have expressed concerns that some provisions of the House bill may violate the “Byrd Rule,” which requires any items considered during budget reconciliation to bear some relation to revenue generation. “Extraneous” items may then be subject to a two-thirds vote outside the reconciliation process, rather than a simple majority. At present, there are doubts as to whether Republicans can even get the 50 votes necessary to pass AHCA legislation during budget reconciliation. Senators can vote for the parliamentarian to sidestep procedure. However, it is unlikely that they will take this type of political risk for a bill they already view as fundamentally flawed. Bottom line: The eventual legislation passed into law will likely be significantly different from the bill introduced by the House last week. Members of the Senate will continue to note their proposed modifications in the weeks ahead. For further information regarding how the bill currently stands in Congress: http://www.npr.org/2017/03/10/519629973/new-health-care-bill-find-out-where-your-member-of-congress-stands

Further Reading

• CNN: White House, Senators Plot Major Changes to Obamacare Repeal Bill
• CNN: GOP Senator on Health Care Plan: ‘That’s Not What President Trump Promised’
• CNN: Rattled by CBO Report, Moderate Republicans Turn Against GOP Bill
• NPR: 5 Charts That Explain the CBO Report on the Republican Health Plan
• New York Times: G.O.P Senators Suggest Changes for Health Care Bill Offered by House