If it’s true that the health care reform effort since January has been an exercise in blame-shifting, then Paul Ryan and House Republicans have successfully shifted blame for the failure to repeal and replace Obamacare over to the Senate. With 20 Republican defections, but with many Republicans in tough districts still having to cast tough “yes” votes, the House passed the American Health Care Act by the razor-thin margin of 217 to 213.
The bill as passed is a hot mess, and it doesn’t have many enthusiastic supporters. They rushed it to the floor before getting a score from the Congressional Budget Office. They also passed this thing without any careful analysis of what it would actually do.
The original version, pulled from the House floor back in March, would have reduced the number of insured Americans by an estimated 24 million; we don’t know whether this version will do better or worse. Nor do we have any neutral estimates on how it would affect premiums or anything else.
We do know that the bill polls very badly, and it’s unlikely that individual provisions poll well — there’s not a lot of support out there for cutting off funding for special education, for example. Or ending the ban on lifetime caps or protections for those with pre-existing conditions, including for those with employer-linked insurance. This really differs from Obamacare, where most of the individual provisions were popular, but not the overall law.
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.
No consensus in the Senate
It’s not clear that the 52 Senate Republicans (with the support of Vice President Mike Pence to break ties) can pass it. It’s likely Maine’s Susan Collins and Alaska’s Lisa Murkowski will oppose anything that retains the House bill’s hit on Planned Parenthood. A half-dozen or more Republican senators have spoken against the measure’s cuts to Medicaid.
That’s not to say it’s impossible for Senate Republicans to figure out a way forward, but only to say that 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.
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 Caucus radicals simply want a bill that doesn’t appear to have 50 votes in the Senate.
That said: It is true that the Freedom Caucus showed some ability to compromise on this. They did an impressive job of moving the bill toward their position, but what almost all of them voted for Thursday was still considerably short of what their ideal bill would have been.
My guess is that it’s still unlikely that any version of this makes it into law. President Donald Trump hosted a victory party at the White House for House Republicans on Thursday, 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.
Jonathan Bernstein is a Bloomberg View columnist. Email: jbernstein62@bloomberg.net.
