Another Day, Another Take on Repeal and Replace
Every day, DC comes up with a new plot twist when it comes to Affordable Care Act repeal and replace efforts. Two days ago, I wrote a blog post that was accurate when I started writing it, and completely inaccurate by the time I finished it an hour later. That afternoon I wrote another post which was accurate when it got published. Now it’s time to write this one – I wonder if it’ll be correct by happy hour?
In the last 24 hours, a lot has happened in the whole repeal and replace drama. First, President Trump held a lunch meeting with Republican Senators urging them to continue working on the healthcare reform front – and reminding them it would be better to do repeal and replace vs. repeal then replace. That led to an agreement for a group of those Senators to meet for dinner to see if there’s a way to work out their differences, at least enough so the Senate could agree to start the process of voting on their repeal and replace bill. Importantly, two senators – Rand Paul and Susan Collins – didn’t attend that dinner. Presuming that means they’re still “no” votes, Majority Leader Mitch McConnell can’t afford to lose any further votes and still get this passed.
While it’s unclear whether progress was actually made – early reports indicate the meeting was a good start, but nothing substantive came out of it, yet. One additional major event happened that will affect the proceedings, which was the announcement that Senator John McCain has been diagnosed with brain cancer. That awful news obviously had to have a sobering effect on his colleagues – even political enemies still work together on a lot of the more mundane day-to-day activities of the government, and despite public rhetoric they tend to become good friends (if you have any doubts this can happen, go look up friends Bill Clinton and George W. Bush). It also has a practical effect on the repeal and replace timeline – McCain’s vote is needed if there’s any hope of moving forward, but it’s not known yet when he’ll be able to return to DC to begin working again.
Finally, we got not one but two CBO scores analyzing the effects of two different Senate proposals. The first one out was on the “Obamacare Reconciliation Repeal Act” which is the “straight repeal” that was the Plan B once it became clear the Senate’s version of repeal and replace lacked votes for passage. The ORRA would simply repeal much of the ACA, and not provide any replacement plan. The score was great when it came to deficit reduction (more than $470 billion) but not so great when it came to the number of additional uninsured people (32 million – the highest of any proposal so far) or premium cost (up 100% by 2026).
The second CBO score is on the version of the Better Care Reconciliation Act that was released last week, but which appeared to die on Monday of this week. This score is more favorable – reducing the deficit by $420 billion, and only increasing the number of uninsured by 22 million. Premiums would rise in the short term, but in 2020 would start actually going down.
So, what’s next? It’s hard to say. The Senate is still scheduled to have a vote next week, which would be to adopt the House’s repeal and replace bill, then dump its content and insert their own. They would then debate and offer amendments to various pieces of it before calling yet another vote on whether to actually pass it. Here’s where McCain’s vote is so important – in order to begin that process, there needs to be 50 "yes" votes, and McConnell will need his to get to that number.
Of course, it’s only mid-day Thursday – at the rate things are going, everything will change by lunch tomorrow. We’ll keep you up to date!
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