The House Ways and Means Committee followed by the House Commerce and Energy Committee moved their parts of Speaker Paul Ryan (R-WS) health plan on Thursday, March 9.  The Ways and Means Committee gave final approval to their part of the bill on Thursday morning around 2:00 AM.  Later that early afternoon the Energy and Commerce Committee acted.  Technically the two committees reported their bills to the House Budget Committee which combines the legislative product into a reconciliation bill for a final debate and vote on the House floor.  That bill will be called the American Health Care Act.

The plan is for the House to approve the bill by late March with the Senate approving it before they leave for their Spring break on April 7.  The two pieces that were approved will likely be changed by Ryan and House leaders as they negotiate to get enough votes.  House leaders feel they will get the 216 to 218 votes (depending on House vacancies due to cabinet appointments) but it will take negotiating. The bill is likely to become more conservative.  Opposing groups that have sway over dozens of House Republicans include the Heritage Foundation, FreedomWorks and Club for Growth. One compromise that might draw votes is to cut back in Medicaid expanded coverage sooner than the bill’s 2020 target date. President Trump has sent mixed signals on whether he supports cutting back Medicaid further or whether he supports the 2020 date.

While conservative groups were opposing the bill some significant health care groups were opposing it because they feel it goes too far—particularly in its Medicaid cuts.  The American Medical Association, the American Academy of Pediatrics, AARP, Families USA, the American Hospital Association, and the Children’s Hospital Association have all formally come out against the bill although their sway with conservative members may be more limited.  Still there are a core group of less conservative members who may not be as comfortable especially with the cutbacks in Medicaid coverage.

When they clear a House bill, Senate Majority Leader Mitch McConnell (R-KY) wants to move the bill very quickly.  If he can get to 50 he could do that because the bill cannot be filibustered under reconciliation.  He has been involved in the House action and is working with the White House to try and get the President a bill by April 7. Some Republican Senators have asked for a slowdown and have expressed broad concerns but it is unclear if that would mean an actual no vote. The Majority Leader wants a vote on whatever the House sends over because a Senate-amended bill would require a second House vote.

Congressional leaders have described a three-part strategy in repealing the ACA with three “buckets” of action: the reconciliation bill, regulatory and administrative changes by HHS Secretary Tom Price and side legislation that would do away with some of the health insurance requirements that cannot be included into the reconciliation bill due to the rules.

The next hurdle is this week’s expected release of an analysis and budget score or calculation on the cost and effect of the bill by the Congressional Budget Office (CBO). Those numbers will tell whether the bill is paid for and whether it continues to cover 21 million as the current ACA.