Who’s up for bailing out the House over ObamaCare repeal? Not Senate Republicans, according to The Hill, who watched the American Health Care Act (AHCA) bill pass, on a 217-213 vote, with decidedly mixed feelings. Not only do they see the AHCA as a mess in its current condition, they don’t see many prospects for reorganizing it into a bill that can pass — or even qualify for reconciliation:
Republican senators say they don’t see a way to get healthcare reform over the finish line, even if the House passes a bill this week.
A senior GOP senator said the chances of getting 51 votes for legislation based on the House healthcare bill are less than 1 in 5.
The senator also put the chances that the House bill will meet Senate budgetary rules preventing a filibuster at less than 1 in 5, meaning portions of the legislation would have to be removed.
They’ll have plenty of time to test out those odds. Thanks to parliamentary issues — and the need for a CBO score for reconciliation — the earliest the Senate can act would be late June, and perhaps much longer than that:
So, we're either up against a July 4th recess deadline or an August recess deadline. => https://t.co/XWIJMH4FkE
— David M. Drucker (@DavidMDrucker) May 4, 2017
That assumes that the Senate will debate the House version of the AHCA. That’s almost certainly not the case, as Senate Republicans have made clear for weeks. Susan Ferrecchio reported that they made it clear again today:
Senate Republicans said Thursday they won’t vote on the House-passed bill to repeal and replace Obamacare, but will write their own legislation instead.
A Senate proposal is now being developed by a 12-member working group. It will attempt to incorporate elements of the House bill, senators said, but will not take up the House bill as a starting point and change it through the amendment process.
“The safest thing to say is there will be a Senate bill, but it will look at what the House has done and see how much of that we can incorporate in a product that works for us in reconciliation,” said Sen. Roy Blunt, R-Mo.
They will likely use the bill’s parliamentary framework but gut the legislation in favor of a completely different proposal, a process that will take weeks, or likely months. In fact, that probability emerged as a selling point in the House this week, with Rep. Peter King (R-NY) telling Bloomberg, “I would hope it gets changed over there.”
As I write in my column for The Fiscal Times, the Senate needs to act soon, though. The insurance markets are melting down, and inaction is simply no longer a valid choice:
All of this might make for a fine absurdist comedy about Washington DC if it weren’t for the ongoing collapse of Obamacare exchanges and the destruction of the individual insurance market. This week alone, the retreat from that market has grown even more serious. Aetna, one of the largest insurers in these markets, announced Tuesday that it would “significantly reduc[e] its exposure” further in 2018, after dropping from 15 states to four in 2017. A month earlier, Aetna had announced that it would drop out of the Iowa market; on Wednesday, they also announced a withdrawal from Virginia citing “an uncertain outlook for the individual marketplace.”
Iowa may well wind up with no insurers at all for most of its consumers. Aetna’s withdrawal left Minnesota-based Medica as the last statewide provider, but they sounded the retreat on Wednesday as well. “Without swift action by the state or Congress to provide stability to Iowa’s individual insurance market,” the company announced, “Medica will not be able to serve the citizens of Iowa in the manner and breadth that we do today.”
This collapse began well before Donald Trump won the election. Insurers began pulling out of the individual markets in earnest two years ago. Minnesota had to resort to rationing enrollments to keep insurers from fleeing the state last year, and Governor Mark Dayton warned that the rationing would not work for long. The federally subsidized co-ops have almost all collapsed, again well ahead of Republican control of the White House, thanks to the impossible contradictions of Obamacare mandates. The crisis started long before the first stirrings of the AHCA, and a states-rights version of the ACA isn’t likely to solve the main problems of contradictory mandates and impossible risk allocations.
Unfortunately for Republicans, all that is prolog. The crisis may not have originated with them, but they’re in charge now, and voters expect them to govern. Republicans and the White House must put a new plan in place to avoid a complete collapse while insurers can still retool for a free-market system. Time is running out, and the stakes run much higher than the momentary optics of just passing something to kick the can to the other side of the Capitol. If the AHCA can’t deliver those free-market reforms, then the Senate needs to start from scratch, and immediately.
Can the Senate Republican caucus execute on that necessity? That may largely come down to two men, Roll Call reports. Orrin Hatch and Lamar Alexander have not tipped their hands as of yet, but when they speak on health care reform, the whole GOP caucus listens:
The legislation being considered in the House is widely expected to change significantly in the Senate, and coordination between Hatch and Alexander will be critical. The two wield enormous influence over any health care legislation — Hatch as chairman of the Senate Finance Committee and Alexander as leader of the Health, Education, Labor and Pensions panel. And while members do not expect the measure to go through the formal committee process, the opinions of Hatch and Alexander carry significant weight.
“If they oppose something, it’s not going to happen, that’s the respect they command in the conference. On the other hand, if they are behind it, people will take a second look even if initially they were not sure,” Louisiana GOP Sen. Bill Cassidy said. …
And some GOP senators point to Alexander, not Hatch, as the main driver behind any health care overhaul.
“Once Lamar is able to step in and work some of his magic, I think you’re going to see things start to move,” South Dakota Sen. Mike Rounds said. “Sen. Hatch is going to have a lot say about the finances. … But before you can do that, you’ve got to know what you want for your end result and I think that’s where Lamar Alexander will have a real opportunity.”
Regardless of whether they want this hot potato, it’s in their lap now. And given the seven years of Republican promises to repeal ObamaCare and deliver a better free-market-based system, they’d better start having those conversations tout suite.