The last week of head-spinning on health care was best represented by the various positions of the President throughout the week. By week’s end the path forward is still uncertain with the Senate parliamentarian delivering the biggest blow Friday night but Senator McConnell (R-KY) determined to vote on Tuesday.
The effort to move forward on the Better Care Reconciliation Act or a revised version was dealt a body-blow late Tuesday when two members Senator Jerry Moran (R-KS), and Senator Mike Lee (R-UT), both announced that they would not vote to proceed with the actual reconciliation process until they had a better bill to vote on. Majority Leader McConnell was seeking the vote to start reconciliation so he could push his members to vote yes on a final bill.
That effectively stopped the debate and the President then proceeded to go in several different directions: repeal and replace, just repeal, let the law “collapse” back to a Wednesday Senate luncheon to once again repeal and replace.
Senator McConnell’s proposal after the Tuesday announcement is that the Senate should vote on immediate repeal but that received another blow when the CBO confirmed an analysis from last year that if you simply repeal the ACA you will cause 32 million people to lose health insurance in 10 years, with an immediate 17 million people losing their health insurance coverage just next year. CBO then released another analysis of the modification to the modified Senate bill but that analysis still indicated that 22 million Americans would lose coverage in the long run. It did not include an assessment of the Cruz amendment that would allow insurers to sell cheaper policies below standards.
A President’s luncheon was held on Wednesday but it doesn’t seem that the President’s style of public threats against member of his own party and the singling out of several members, is paying dividends. It did result in several members of the Senate caucus to meet again Wednesday evening to find a path forward. The meeting may have been at a disadvantage since two of the holdouts senators, Senator Rand Paul (R-KY), and Senator Susan Collins (R-ME) were not part of the session.
All of this became more complicated when Washington was rocked by the upsetting news that Senator John McCain (R-AZ), longtime Senate iconic and respected leader is facing a battle with brain cancer. The news was almost a repeat of Senator Ted Kennedy’s battle with cancer that came at the height of that 2009-10 debate on health care.
HHS Secretary Tom Price and the head of Centers on Medicare and Medicaid (CMS) Seema Verma have been working on new ways and funding to craft a Medicaid alternative to what is in the package however those discussions seem to revolve around simply giving states more money without any significant changes to the per capita cap or block grant proposal conservatives have been fighting for.
The biggest blow may have come late on Friday evening. The Senate Parliamentarian’s ruling on what parts of the bill violate the Senate’s “Byrd rule” was released. There are nearly a dozen provisions in violation of the rule. As a result, those provisions could be struck from the bill if 60 senators do not support them. This could be done collectively or individually.
The provisions in violation include: De-funding Planned Parenthood, abortion restrictions on tax credits, weakening the essential benefits package through Medicaid, funding for cost sharing subsidies, striking the ACA’s loss-ratio insurance standards, a provision that effects New York State Medicaid contributions, and allowing states to roll-over Medicaid block grant funds for non-health. There are other provisions still under review including the optional Medicaid block grant.
That rule crafted by the late Senator Robert Byrd (D-WV) prohibits provisions in a reconciliation that are not relevant to revenue raising or deficit reduction. It is a very technical provision—thus the need for leaders to get an official judgement each reconciliation. Striking the provisions may make the bill even less appealing.
Although the health care debate seems to change by the day the question is will there be an opportunity for a bipartisan level discussion to make improvements and corrections to the underlying ACA law. Some members are trying to make such efforts namely Senator Joe Manchin (D-WV) but whether there will be enough reciprocal interest in trying to find a bipartisan solution is unclear at least at this point.
To be certain at this point the President seems to have no interest in such an effort but he also seems to show little interest in the actual policy details of the health care beyond some of the catch phrases of repeal and replace, repeal, collapse or creating a “beautiful” proposal. All of which likely means he would support whatever bipartisan deal the Senate could come up with.