Senators returned from the Fourth of July break to continue the now six year slog to repeal the Affordable Care Act (ACA – Obamacare) having left town with at least nine Republican Senators unable to vote on the Senate repeal and replace bill as is. You will recall that some Senators in opposition think the bill doesn’t cut deeply enough into Medicaid while others think it cuts too deeply into that healthcare program for the low income, disabled, and aged populations.
Senate Majority Leader Mitch McConnell (R-KY) likened the process of getting 50 Senators on board as a Rubik’s Cube but is giving it one last try.
In the real world the problem with the House bill, HR 1628, The American Healthcare Act and McConnell’s version the Better Care Reconciliation Act is that the provisions in the bills and the time it has taken to bring them to the floor and the dissent among Republicans on the bills’ content is destabilizing the health insurance marketplace where insurers are trying to make actuarial decisions for 2018 against a very uncertain legislative future. And, of course, those covered under the ACA along with hospitals, physicians, and all involved in the healthcare market live with the uncertainty of whether or not the coverage will continue.
In the legislative world it is about correcting procedural hurdles; The House bill, The American Healthcare Act cannot be brought to the Senate floor as a reconciliation bill requiring only 51 votes to pass because it violates Senate rules for a reconciliation bill. The House is now tweaking that bill so it can be received by the Senate. The Senate bill as is seeking revisions regarding deficit reduction. McConnell has introduced the next version of his bill that, among other things keeps two Obamacare taxes; that on investments and payroll taxes on wealthy individuals. McConnell’s bill is now sent to the Congressional Budget Office for scoring to see if it meets deficit reductions under the Budget Control Act allowing it to be handled as a reconciliation bill. The CBO response is expected Monday, July 17th. If it passes CBO muster the Senate will accept the House bill and then amend it. . A likely amendment comes from Sen. Ted Cruz (R-TX) that would revise the ACA requirement that insurers offer plans that include the ten essential coverage requirements that include maternity and mental health coverage. Cruz’s amendment would allow insurers to offer plans with limited coverage. The thinking is the will cost less and inspire healthier adults to enroll thereby increasing revenues for insurers and then stabilize the market.
It is the wicked web woven making it likely, although the words are never uttered as such, that the Republican Congress will have to fix elements of the ACA which should stabilize the market, give those covered under the ACA some comfort, but will cause political backlash in their states and districts.
McConnell decided to stay in session after the August 1st break to take care of the healthcare matter and, perhaps consider the debt limit, the Defense Authorization, and other pressing matters It is not certain if the House will stay in session to respond to any passage of any Senate healthcare bill or will take it up after the August break. The now August adjournment dates are either August 7th or the 13th.
Big items, short time frame –
Adding insult to legislative injury Congress is back for three weeks before the five week August break and has, perhaps, more than it can handle before the October 31st end of the fiscal year. The big ticket items include raising the debt limit that faces either a clean debt limit increase as requested by Treasury Secretary Steve Mnuchin or a band of Republicans who want to add other provisions to the bill that are likely to be unacceptable to Democrats and even some Republicans risking once again a government shutdown and the further risk of the US credit rating being lowered as was the case when such an agreement couldn’t be made in 2013.
Budget Resolution –
While an acceptable budget resolution has been nearly impossible to accomplish since the Republicans took power in Congress in 2010 it is a necessary bill setting the spending guidelines for FY 2018 rather than continuing spending at the previous year levels with some tweaking usually in defense, homeland security and major issues as the Zika virus and perhaps the opioid epidemic currently upon us. The House Budget Committee has announced it is buckling down to produce a budget resolution but the spending process only begins there and must be followed by 12 authorization bills and 12 appropriation bills that define program priorities actually cut the check for the departments and agencies programs, respectively. A last minute omnibus spending bill always hovers as an option but past efforts resulted in continuing resolutions that continue spending at current levels with some tweaking as mentioned above.
Tax Reform –
Tax reform, that has sat on the bench until the repeal and replace effort freed up around $800 billion in taxes and fees from investors, insurers and medical device manufacturers that funded the ACA, is likely to remain a non-starter.
Worth noting that Trump’s budget, the southern border wall, and the proposed trillion dollar infrastructure plan will get no attention this year if at all.
Those investigations –
The four Senate and House committees investigating the Russian hacking of the 2016 elections and the possibility of collusion between the Trump campaign and the Russians over the hacking seem to have taken a back seat to the investigation under Special Counsel Robert Mueller. Recent news reports that Donald Trump Jr. met during the campaign with a Russian lawyer who promised some dirt on Hillary Clinton is certain to be investigated by Special Counsel Taking advantage of such a meeting invitation would be tempting to any party but, apparently Trump Jr at first denied meeting with the Russians but then said last week that he did.
The Senate bill, S 722, that passed 98 – 2 and would impose significant sanctions on Iran and on Russia for the election hacking is languishing with no real attention in the House. The legislation would allow Congress to block Trump from easing or ending penalties against Vladimir Putin’s government but the bill violated the rule that bills involving revenue start in the House. Reports are that the House prefers legislation that would allow Trump to go his own way on Russian sanctions but with no broad oversight from the House proper but only from Party leaders. Under current law the House can pass a resolution of disapproval if the White House changes the status of sanctions. Senate leadership has signaled a revised bill that would meet procedural rules. Once done the House will take up the matter that seems headed for a Senate / House conference to iron out differences.