An avalanche of criticism cascaded onto Republican leadership this week with the release of the American Health Care Act (AHCA), but none so potentially damaging as that from the Republican Study Committee (RSC). The conservative group of House Republicans dismissed the AHCA plan as “in principle, ObamaCare,” and scoffed at the notion that a future Congress would roll back the Medicaid expansion as planned. “It is unlikely,” their report argued, “that any future Congress will have a stronger political will in terms of reforming Obamacare than the sitting Congress,” suggesting that conservatives would staunchly oppose the AHCA.
Today, though, the RSC offered a significant step toward compromise. Dispensing with their usual hands-off approach on amendments, the group offered its support for two efforts to accelerate the rollback and to impose work requirements for recipients, Politico reported late this morning:
The group, which rarely takes positions on amendments in committee, supports a proposal from Reps. Joe Barton (R-Texas) and Marsha Blackburn (R-Tenn.) that would freeze Medicaid enrollment under enhanced Obamacare rates at the end of 2017, two years sooner than the GOP repeal bill allows.
The group is also backing an amendment from Rep. Morgan Griffith (R-Va.) to institute work requirements in Medicaid for able-bodied, childless adults.
The changes could go a long way in winning over conservatives who say the repeal bill put forward by House leaders is nothing more than “Obamacare Lite.” The endorsements underscore the bill’s high profile and the need for Republicans to come together to get it through the House.
That certainly looks like a signal from House conservatives that they’re willing to work on the AHCA rather than oppose it out of hand. Perhaps Trump’s warning yesterday really did make an impact, or perhaps it’s more of the obvious political reality that voters expect them to do something about ObamaCare, and soon.
The problem is that their range of action is limited, in part by Trump himself. As I write in my column for The Fiscal Times today, Republicans on Capitol Hill and the White House are stuck between the rock of Trump’s pledge to keep Americans covered and the hard place of reconciliation:
One challenge facing Republican leadership is the reconciliation process in the Senate. Harry Reid famously used that budgetary exception to pass Obamacare on a majority vote, eliminating the use of the filibuster. However, only legislation with a specific impact on the federal budget can cite reconciliation to avoid the filibuster. That limits what the repeal bill can do and still be passed on a majority vote. The AHCA necessarily only addresses those portions which qualify under Senate rules.
The next complicating factor is Donald Trump’s promise to ensure that Americans don’t get abandoned in the process. That’s almost certainly why the AHCA does not eliminate the Medicaid expansion immediately, as House conservatives had hoped, and why this plan continues the practice of subsidies for health-insurance purchases. The need to extend both of those for the next few years stems from the difficulty of getting a full replacement program through the Senate; Republicans clearly hope to have a filibuster-proof majority after the 2018 midterms, but need to leave some measures in place before then.
That doesn’t necessarily make the AHCA the best bill that can pass under these circumstances, but it does explain why Republican leadership may have refrained from producing a final, full-scale repeal-and-replace bill in favor of a transition plan. And the White House has responded to criticism of the plan by offering to negotiate amendments through the legislative process. Tom Price, former chair of the RSC and now Secretary of Health and Human Services, made that explicit on Tuesday.
That means that this bill is only the first step in the process. The Washington Post’s Amber Phillips gives a solid rundown on the limits of reconciliation and comes to the same conclusion:
The alternative is to pass some Obamacare reforms that affect the nation’s budget now using the simple majority vote afforded by reconciliation, and worry about the rest later. That’s actually how Democrats passed major parts of the ACA in 2010, and it’s how Republicans passed some of the Bush-era tax cuts a decade earlier.
Listen closely and you’ll noticed that supporters of this bill — like House Speaker Paul D. Ryan (R-Wis.) — are championing it even while cautioning that many big changes to health care are yet to come. That’s code for reconciliation.
The ability to buy insurance across state lines, an attempt to lower drug prices and malpractice liability protections for health care givers “can’t be done through this current bill,” acknowledged Trump press secretary Sean Spicer this week.
Phillips notes that Paul Ryan has explicitly made this argument. He’s talked about the need for a three-phase rollout, the first of which is getting as much done through reconciliation as possible. Tom Price can then rewrite the regulatory side of ObamaCare largely untouched, and then finally Republicans can implement the third phase of ObamaCare replacement after the 2018 midterms, assuming they can pick up enough Senate seats to make that happen. The AHCA is in this model just step one — not the step one we want, to paraphrase The Dark Knight, but the step one we need … for now.
The big question will be whether rank-and-file Republicans trust leadership to follow through on these promises.The RSC analysis makes it clear that they don’t want this structure for the final replacement of ObamaCare, but their support of these amendments suggests that they’re willing to be patient with the process. House conservatives may need more guarantees on the end game to go along with the AHCA, but this looks like they may be open for the wheeling and dealing that the White House offered.
Addendum: Salena Zito discusses the context for these developments, which is that Trump voters want action, even if it doesn’t get them everything they want immediately:
Many people living in this town of used-to-be’s don’t expect their community will ever return to its glory days.
They don’t anticipate the return to a downtown of bustling businesses patronized by a well-paid middle class working at the Wheeling-Pittsburgh Steel plant. They want a little fresh paint on the vacant buildings, to cover up the sorrows lining the main business district’s ironically named Commerce Street.
And they’re not expecting magic from President Trump.
They don’t necessarily think all their dreams will come true tomorrow, but they expect to see Trump and Republicans making progress on them. That’s the risk of failure on the AHCA, and Trump’s trying to make sure everyone knows it.