Analysis: Are House Republicans Close to Passing an Obamacare Repeal Bill?

Posted: May 02, 2017 4:05 PM

Yes, says one GOP vote-whipper -- some of whose vote-counting colleagues remain, er, undecided on the bill -- with some additional colleagues telling reporters that the margin is looking razor thin. If they're to be believed, House Republican leaders are excruciatingly close to getting a bare majority to pass the amended American Health Care Act out of the lower chamber (see update). Speaker Ryan, hedging his bets, says a vote could be called later this week. One thing you can take to the bank, though: If they don't have the numbers, they won't schedule a vote. But they may be close to locking down the numbers:

House Speaker Paul Ryan told Republicans Tuesday to “pray” as they try to win over the remaining holdouts on the health-care bill with leaders pushing for a vote later this week. Representative Dennis Ross of Florida, a senior member of the House vote-counting team, described Republicans’ closed-door meeting and said they are about “five votes away” from the number needed to pass the bill. “Now is the time,” House Majority Leader Kevin McCarthy said to House Republicans, adding that they should be prepared to vote Wednesday or Thursday on the measure. But a significant number of moderates remain opposed. A Bloomberg News count found at least 21 members opposed to the latest version. Republicans can only afford to lose 22 votes and guarantee passage.

That's very little wiggle room, and certain defections look worrisome for leadership. Former Energy and Commerce Committee Chairman Fred Upton announced that he's currently a "no," flip-flopping on 'community rating' flexibility for insurers. And a rank-and-file member from a deep red Trump state who wasn't seen as a likely candidate to buck the party also said he couldn't support the legislation.  Unlike last time, when the conservative House Freedom Caucus was a significant culprit behind the March failure, it's primarily center-right moderates who are now threatening to torpedo the bill.  Many are citing the need to protect consumers with pre-existing conditions as the source of their trepidation.  We addressed that point in a post yesterday, quoting two analyses that explain why these fears are overstated.  Paul Ryan's office put out a memo designed to reassure concerned lawmakers that the AHCA does offer several layers of safeguards for at-risk patients:

The amendment is very clear: Under no circumstance can people be denied coverage because of a pre-existing condition. Current law prohibiting pricing customers based on health status remains in place and can only be waived by a state if that state has chosen to take care of the people through other risk-sharing or reinsurance mechanisms. Even if a state asks for and is granted a waiver, no person may be priced based on health status if they have maintained continuous coverage. In addition to these protections, the AHCA provides significant resources at the federal and state level for risk-sharing programs that lower premiums for all people. Although it gives states an option to tailor coverage limitations, the process is very strict. A state must explain how a waiver will reach the goals of lowering premiums, increasing enrollment, stabilizing the market/premiums, and/or increasing choice. States must lay out the benefits they would provide. And most importantly, states may only apply for a waiver if they have their own risk pool in place. Again, the coverage of people with pre-existing conditions will be protected.

Democrats have been beating the drums on pre-existing conditions as a rallying cry against the AHCA, even though the legislation doesn't gut those provisions of Obamacare. An emotional monologue by late-night comedian Jimmy Kimmel cited the example of his newborn infant who required immediate heart surgery, pleading with Congress not to harm patients with pre-existing conditions. Republicans are currently working to convince their own members that their bill would do no such thing. President Obama, whose central domestic accomplishment was the passage of his still-failing healthcare law, highlighted Kimmel's example as a reason to keep Obamacare in place:

But as Ryan and others keep explaining, the AHCA doesn't just cut consumers with pre-existing conditions loose.  They've included a host of elements to make sure that (quite small) segment of the population gets help, earmarking $115 billion for high risk pools and stability funds.  Meanwhile, some Senate Republicans are wondering aloud why their House colleagues can't get their act together to pass the first iteration of a bill that would inevitably undergo significant renovations down the hall.  In other words, the House bill won't become law as-is.  There would be a Senate version, then another bout of compromises hammered out in a potential bicameral conference committee.  But passage of a House bill is a crucial first step to finally repeal and replace Obamacare with something that will enable the marketplace to offer a more diverse array of coverage options, many at a lower cost, to the American people.  This is a pledge Republicans up and down the ballot have been making to voters for seven years.  There may be political implications for members who vote in favor of a controversial bill.  But make no mistake: There will also be political implications for a party that abandons its voters by choking on a core, clear promise.  

By the way, if House Republicans can somehow pull the AHCA across the finish line, how might the party's Senate majority alter it?  According to reporting from Axios, they're preparing a mix of more generous tax credits and related spending (plus a slower Medicaid expansion phase-out) to win over moderates, and increased autonomy for states to please conservatives. It would still be a treacherous balancing act, no doubt -- but it's one that the Senate GOP may never even grapple with if the House actively decides to fumble the ball on the first play of the drive.  Obamacare, incidentally, is still falling apart.  Next year will bring fewer options at higher costs for millions, as carriers flee unsustainable markets.  A majority of Americans want to see the law totally uprooted or partially dismantled, a number that could swell as the existing law's dysfunction continues to harm consumers:

Though it drastically reduced its involvement in Obamacare this year, Aetna continues to struggle with losses from the business. The health insurance giant announced Tuesday that enrollees in the individual market racked up bigger bills than expected in the first quarter, prompting Aetna (AET) to set aside $110 million to cover additional losses. In total, the company is expected to lose about half the $450 million it lost last year. Aetna also signaled that it might further reduce its Obamacare participation in 2018. The company announced last year it would pull out of 11 of its 15 markets in 2017 after suffering nearly $700 million in losses since the exchanges opened in 2014.

I'll leave you with today's press conference from House Republican leaders. The healthcare bits come from Steve Scalise (around 6:30) and Paul Ryan (around 11:30):

UPDATE - The WSJ reports that they may be losing votes at this point, which feels like deja vu.

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