reconciliation

President Trump and GOP leaders are furiously trying to find the votes necessary to pass the American Health Care Act, and while some news ‘yes’ votes are trickling in, the conservative pushback is also intensifying.

By most vote counts, Republicans are still a handful of votes away from being able to send the AHCA on to the Senate.  With all Democrats expected to oppose the bill, GOP leaders can only afford to lose 21 members on the final tally.  Unofficial whip counts in recent hours show 25-26 Republicans as firm or likely ‘no’ votes.  Sen. Rand Paul expects at least 35 Republicans to oppose it and predicts leaders will scratch the vote.

But Trump and GOP leaders have been able to sway a few more Republican votes to the ‘yes’ column, including Rep. Tom McClintock, R-Calif.

“We have to ask ourselves, if that’s all we get, does that give us a better system than the one we have right now?” said McClintock.  “It’s far, far from perfect, but it does move us in the right direction.  I am satisfied that, overall, it does give us a better system than the one we’ve got right now.”

McClintock believes Republican leaders made a mistake in insisting on moving a bill that does not address all needed solutions through the reconciliation process.

“The biggest problem is they’re using this convoluted process called reconciliation that doesn’t allow them to repeal the entire act, doesn’t allow them to replace the entire act and requires a lot of additional administrative regulations, which are going to be restricted by what the most liberal court in the country allows them to do, and by follow-up legislation whose future in the Senate is highly dubious,” said McClintock.

McClintock says Republicans and Democrats are responsible for the “convoluted” approach.

“Leadership chose that path precisely because of Democratic obstruction in the Senate.  The reconciliation process allows us to bypass that 60-vote cloture threshold and pass the bill with a simple 51 votes,” said McClintock.

However, he believes that a full repeal with all the market based reforms could pass the House and Senate if GOP leaders were willing to play hardball.

“I think the pressure on those eight Democratic holdouts would have been irresistible, particularly if (Senate Majority Leader) Mitch McConnell said, ‘If you want to filibuster this one, you’re going to have to actually go down there and filibuster it.  You’re going to have to stand by your desks and talk until you drop.  The record is 58 days.  Good luck breaking that.  When you’re done, we’re all going to vote,'” said McClintock.

However, McClintock says that option is off the table and he’s comfortable voting for the current bill.

“Those were arguments I made months ago and lost months ago.  We now have this bill in front of us and I think it more than merits an ‘aye’ vote,” he said.

McClintock wishes there were provisions in the bill allowing purchase of health insurance across state lines and that yanked out the Obamacare insurance regulations that are considered key drivers of premium and deductible increases.

But he says there is a lot to like in the bill as well.

“It ends the individual mandate that forces people to buy products they don’t want.  It ens the employer mandate that’s trapped a lot of low-income workers in part-time jobs.  It begins to restore consumers’ freedom of choice, which I think is the best guarantee of quality and value in any market,” said McClintock.

“It allows people to meet more of their health care needs with pre-tax dollars.  It relieves the premium base of the enormous cost of pre-existing conditions by moving those expenses to a block-granted assigned risk pool,” he added.

But while there are some notable improvements in the AHCA, for conservatives who have pushed “repeal and replace” since Obamacare became law seven years ago, the House bill simply fails to deliver on that promise.

“It’s good entitlement reforms in terms of some of the Medicaid reforms that are in the bill,” said Chris Jacobs, a former aide to Mike Pence and former Louisiana Gov. Bobby Jindal, who is now senior health policy analyst at the Texas Public Policy Foundation and CEO of the Juniper Research Group.

“But I think it’s far short of a full repeal.  It leaves Obamacare’s architecture in place when it comes to all the mandates and the insurance regulations that are driving up premiums.  We need to repeal those mandates and go back to respecting state sovereignty and the states’ role in regulating health care and health insurance,” said Jacobs.

GOP leaders have characterized the AHCA as a binary choice for their colleagues: either support the bill or support the existing health care system by default.  Jacobs is not buying that argument.

“That’s a false choice, the idea that we must do something, that this is something therefore we must do this has a flaw in that logic,” said Jacobs.

Sponsors of the AHCA say getting rid of the insurance regulations or “Obamacare architecture” is outside the bounds of what can be moved through reconciliation.  Jacobs says the handling of this very bill proves that is not true.

“I understand the limitations of the reconciliation process, but you have to at least try to repeal the major insurance regulations that are in there.  The bill amends some of them, repeals some of them and leaves others in place.  It’s an ideologically inconsistent position,” said Jacobs.

“If your position is we can’t do any of this because of Senate procedures, then why are we repealing some of them and modifying some of them.  If you can modify them, you can repeal them,” he said.

McClintock finally got on board with the AHCA after successfully sponsoring an amendment in the House Budget Committee that would provide an additional $75 billion  to help people afford health insurance as they transition from Obamacare subsidies to tax credits if the new bill becomes law.  He is also confident that within a few years, Americans will start to see noticeable price decreases in health coverage.

But that same manager’s amendment that satisfied McClintock also contains language that could threaten benefits for up to seven million veterans.  Jacobs says the technical glitch in the language shows the need to slow down the rush to pass the legislation and avoid ugly surprises after it becomes law, similar to what occurred with Obamacare.

As the furious battle for votes plays out, Jacobs hopes leaders pull back and rework the bill to honor the original campaign promises.

“There are folks negotiating now as we speak in the Freedom Caucus to repeal some of the insurance regulations and the mandates.  Hopefully that succeeds and we get to a better bill that conservatives can support,” said Jacobs.

McClintock says Republicans should not let the perfect be the enemy of the good.

“When you pull together a group of people to benefit from their combined wisdom, unfortunately you’re also going to get their combined follies, prejudices and misjudgments.  You can never get a perfect product out of this process.  What you can get is the product that is the most acceptable and moves us forward,” said McClintock.

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