summary for the week ending July 28, 2017
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Maneuverings – The Long and Winding Road
Senate Majority Leader Mitch McConnell (R-KY) began an effort last week that shows itself to be a strategic retreat from what he would prefer; one version of the Senate idea of healthcare for Americans, to repeal the Affordable Care Act (Obamacare-ACA). The goal of McConnell’s efforts was to get something passed and sent to the House where the House would just approve the Senate bill and send it to the White House where it would be signed. His efforts were driven by politics in that he must have believed Senators would not have a pleasant August break when constituents realized that with control of Congress and the White House they have not made good on their promise to repeal the ACA.
That is the goal and because of that goal McConnell has tried to move legislation with significant impact without hearings or committee review thereby ignoring regular order.
This week’s effort to send the Senate and House home for the August break having completed at least something regarding healthcare began with Senators voting to proceed to debating HR 1628, the House-passed American Healthcare Act that, when passed by the House, was determined by McConnell to be dead on arrival in the Senate. But McConnell’s efforts to get the Senate bill, The Better Care Reconciliation Act (BCRA) in motion stalled at least twice over the past two weeks as various Republican Senators found those bills unacceptable; some because of the severe cuts to Medicaid and the potential to knock more Americans off the healthcare insurance roles and cause premiums to increase significantly for those age 55 to 65 and others who opposed the bills because they did not cut enough or did not completely repeal the Affordable Care Act. In the end there was another reason to oppose McConnell’s bills; the absence of regular order where committees meet and debate and stakeholders are heard.
Senate Democrats were rankled because the first McConnell bill was crafted by only 13 Republican Senators behind closed doors and received an unfavorable report from the Congressional Budget Office such that it violated Senate rules governing what kind of bill could be considered under reconciliation and such allowing passage by only 51 votes. McConnell then began to work off the nearly $200 billion the bill would make available by making offers to resistant Senators. Still the tweaked bill did not draw the Republican support it needed to pass.
McConnell set up a vote this week to simply repeal the ACA and set a two-year timeline to come up with a replacement. That effort, too, met with resistance, especially from Senator Susan Collins (R-ME) who lamented that McConnell’s efforts meant reforming a significant benefit program the outcome of which could be disastrous on many levels and particularly causing instability in the healthcare insurance market that would cause premiums to rise across the board.
McConnell abandoned that approach and brought HR 1628 to the floor for amendment and a vote. He faced a 50 – 50 vote to proceed that got the tie-breaking vote from Vice President Mike Pence.
McConnell’s first 178 page amendment that he then modified with another amendment essentially repealed the ACA and installed a Senate version the details of which remained unclear to Senators voting. Senators rejected the McConnell amendments and then rejected another amendment that would just repeal the ACA.
McConnell then came out with what has been called the ‘skinny’ repeal bill of which he did not at first disclose the contents. Various reports on some of the bill’s content suggest that premium support under Medicaid would remain unchanged and would allow ACA taxes to remain in place with the exception of the ACA tax on Medical device manufacturers. The bill would repeal both the individual and employer mandates and the fines imposed if those mandates were not met. It was reported that the ‘Skinny’ would Defund Planned Parenthood (which would lead to a standoff with the House Parliamentarian that the provision violates procedural rules), would repeal the Prevention and Public Health Fund, and Repeal Community Health Center Fund.
The Congressional Budget Office (CBO) weighed in on the “Skinny’ showing it, like the other McConnell bills would decrease the deficit over ten years but would cause some 15 million to lose their healthcare insurance.
As support for the ‘Skinny’ seemed to grow among Republicans McConnell again took the bill behind closed door and brought latest incarnation back to the floor for a vote.
When McConnell returned to the floor he had renamed the Better Care Reconciliation Act to the Healthcare Freedom Act. The amendment to substitute the Healthcare Freedom Act by McConnell contained provisions to repeal the individual and employer mandates to buy and provide insurance, respectively; deductibles on healthcare savings accounts were increased; organizations such as Planned Parenthood would be defunded and $422 million would be provided to community health centers; states are given more flexibility when determining the use of federal funds (implement reforms); and the medical device tax is suspended for three years.
The House then signaled it may not need to go to conference but rather would have a floor vote and send the bill to the White House where signature is expected.
The Healthcare Freedom Act failed on a 48 to 51 vote with Senators Murkowski (R-AK), Collins (R-ME), and McCain (R-AZ).
The House moved quickly to approve many appropriation bills to send to the Senate before the August break. HR 3219 titled the Defense Appropriations bill also contained spending guidelines for Legislative Branch appropriations, Military Construction and Veterans Affairs, and Energy and Water and provided $1.6 billion for southern border wall construction
Called a Minibus rather than an omnibus the bill faced extensive amendments and finally passed …
The House also passed HR 3364 that increases sanctions on Iran for missile activities and human rights violations, increases sanctions on Russia for its involvement in Ukraine and US election meddling, and increases sanctions on North Korea. The bill requires approval from Congress if Trump tries to lessen sanctions on Russia. The bill was supported by the Senate that passed a similar bill recently. If Trump vetoes the bill its support in Congress is certain to provide enough votes to override the veto.
Trump’s son-in-law, Jared Kushner, appeared before two congressional committees behind closed doors but a Republican Senator attending one meeting told reporters that for those who go to bed dreaming of impeachment (of Trump), Kushner is not going to get them there. He said Kushner was a cooperative and credible witness.
While the investigation by Special Counsel Robert Mueller III continues it does so under the speculation that Trump might attempt to get Mueller fired. That effort seems to be combined with Trump’s complaints about attorney General Jeff Session and consideration replacing him, a move not supported by Senators.
Trump could fire Sessions and appoint a replacement during the August recess that would not require the replacement to go through Senate approval procedures until 2018. Senate Majority Leader McConnell could prevent such an end run by Trump by staying in session pro-forma until Congress returns in September.