Ian Tuttle of National Review and Greg Corombos of Radio America are cautiously optimistic as an amendment to the GOP health care bill gives more power to the states and brings more conservatives on board. They also discuss President Trump’s willingness to renegotiate NAFTA, and Ian explains why he’s concerned about Trump’s approach. And they dive into the effort by Democrats in California to bar businesses from future state contracts if they help to build a border wall.
Jim Geraghty of National Review and Greg Corombos of Radio America shake their heads as infighting among congressional Republicans and even White House staffers clouds the push for a vote. They also cast suspicion on President Trump’s vow to just let Obamacare continue if Congress failed to pass the bill. And they have some much needed fun by examining the push to rename the airport in Las Vegas for former Sen. Harry Reid.
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.
http://dateline.radioamerica.org/podcast/3-22-jacobs-blog.mp3 [ 11:34 ] Play Now | Play in Popup | DownloadJim Geraghty of National Review and Greg Corombos of Radio America shake their heads as Republicans fight over health care reform after telling Americans it would be easy to repeal and replace. They’re also disgusted as school officials in Maryland seem far more concerned about protecting the reputation of illegal immigrants than condemning the rape of a 14-year-old girl, allegedly by two teens in the U.S. illegally. And they get a kick out of Susan Rice lecturing the Trump administration about the importance of being honest and factual with the public and our allies.
Republican leaders are hoping to pass their health care replacement plan on Thursday, but the conservative sponsor of legislation to fully repeal the Affordable Care Act says the current GOP preserves far too much of the current system and must be rejected.
Rep. Jim Jordan, R-Ohio, is also a co-founder and former chairman of the House Freedom Caucus and has introduced legislation to fully repeal the Affordable Care Act, also known as the ACA or Obamacare. Jordan is vigorously opposed to the current version of American Health Care Act, arguing this is not what Republicans promised voters since 2010.
“We’re not repealing Obamacare. Even people who are for it, like Charles Krauthammer, has said it’s Obamacare-lite. It keeps the Obamacare structure and that’s not what we told the voters. If you don’t repeal Obamacare, you’re never going to bring down the cost of insurance for middle class and working class families,” said Jordan.
“So it is really that basic. Let’s do what we said. That’s what they sent us here to do. Let’s actually repeal Obamacare. A clean and complete repeal is what we’re after. This doesn’t do it,” said Jordan.
The American Health Care Act, or AHCA, is vigorously endorsed by President Trump and House Speaker Paul Ryan, R-Wisc. Ryan argues the plan does fulfill the promise to repeal and replace Obamacare.
Jordan laid out several areas he insists are key differences between a complete repeal and what the GOP plan does.
“We didn’t tell voters we were going to repeal Obamacare but we were going to keep some of the taxes in place, which the speaker’s plan does. We didn’t say we were going to repeal Obamacare but take the Medicaid expansion and extend it for several years, which the speaker’s plan does,” said Jordan.
“We certainly didn’t say we’re going to repeal Obamacare and start this new program of refundable tax credits and repeal Obamacare and get rid of the mandate but keep this 30 percent surcharge that we tell insurance companies you have to levy on people who don’t maintain continuous coverage,” said Jordan.
The most disturbing issue for Jordan is Republicans getting ready to own a massive health care reform that he believes will not lower the cost of health insurance.
“This is just Obamacare in a different format, and because of that it will not bring down the cost of insurance. It will not bring down premiums. Therefore, middle class families are still going to see the ridiculous high levels they’ve seen over the last several years,” said Jordan.
Jordan and several other members of the House Freedom Caucus are demanding a full repeal of Obamacare, just as the GOP-controlled Congress did in 2015 before the legislation was vetoed by President Obama.
“The one thing we know about our plan is it’s passed before,” said Jordan.
So why won’t leaders bring up that same bill?
“They’re saying some people may not vote for that, which is amazing to me. During election time you can do one thing, but once you get in office and it actually counts you can’t? That’s what drives voters crazy,” said Jordan.
Jordan also doesn’t buy the GOP leadership’s three-step approach to reform, which includes this bill, letting Health and Human Services Secretary Tom Price roll back many of the regulations in the current law and then passing market-based reforms in a separate bill that will likely require 60 votes to clear the Senate.
“That’s a joke,” said Jordan.
“We know phase two is going to get tied up in court. You saw what the courts have done on President Trump’s executive order on the travel ban. You’ve seen how he reworked it and came back with something we know is consistent with the law. And where is that right now? It’s tied up in court. So to think the left is not going to take Obamacare and tie it up in court is just ridiculous,” said Jordan.
As frustrating as it has been for full repeal proponents to plead their case with leadership, Jordan says the difference between conservatives and Democrats on the issue is like night and day.
“They view success as signing people up for government, Medicaid or Obamacare. We define success as let’s put in place the policies that make insurance affordable so that people can pick the plan that meets their needs. That’s what we’re trying to get accomplished,” said Jordan.
While Trump is vociferously supporting the GOP plan, Jordan is hopeful the president will be able to broker changes to the legislation that will rid the law of crippling insurance regulations dictating what has to be in all policies, allow for market based reforms that will drive competition and lower costs and repeal other burdensome regulations by statute.
Jordan, who met with Trump along with other Freedom Caucus members, says the White House has been far more accommodating than Republican leaders in Congress.
“We appreciate the outreach the White House did being willing to work with us. Our leadership initially talked about this binary choice, take-it-or-leave-it approach, which I don’t think is helpful. Since then I think they’ve been more open to talk with us, probably driven by the fact they don’t have the votes,” said Jordan.
With a vote planned for Thursday, Jordan suspects a scramble is underway to find more support for the AHCA.
“One thing I learned a long time ago is when leadership is out there saying they have the votes, that means they probably don’t have the votes. Based on what I know from our members of the Freedom Caucus and some other people, I believe they do not have the votes, so we’ll see how negotiations go this week,” said Jordan.
The House Republican health care bill cleared another hurdle on Thursday, but one of the most fiscally conservative GOP lawmakers says the bill will never pass unless it acts to immediately reduce the cost of coverage and includes repeal of Obamacare’s burdensome regulations.
The House Budget Committee approved the American Health Care Act, 19-17. Three Republicans voted against it, including Rep. Dave Brat, R-Va.
“The budget committee went forward with it, but some of the guys are getting promises that we’re going to have some fixes and some fairly significant fixes going forward,” said Brat, who believes the Republicans are heading toward disaster on their present course, largely because they don’t address health care costs effectively.
“Both conservative and liberal think tanks and health experts agreed that the current House bill maintains the current structure of Obamacare,” said Brat. “You keep the individual exchanges. You keep the individual market and you keep the insurance regulations, so I don’t know how anyone expects the price of health care to go down.”
And without lower costs, Brat says Republicans are walking into a political buzz saw with no upside.
“That’s the big thing we have to fix and we all want Trump to be successful. For him to be successful, we have to make those changes or in a few years we’ll be in another death spiral,” said Brat. “It’s fairly simple. Either you lower the price of this thing so people can afford it or else you’re going to pay the price politically.”
He says the key to driving costs down is to address insurance regulations, a priority President Trump has been pushing for months.
“Our leadership bill has prices going down 10 percent after three years. So we’ve got price increases coming. We’ve got to make sure that does not happen. The biggest way you can prevent that is to get at the insurance regulations,” said Brat.
There’s also the issue of choosing what’s in a plan. For example, Brat notes that because of the many requirements Obamacare mandates in every approved health plan, it’s impossible for young, healthy people to buy low-cost, high-deductible catastrophic plans.
GOP leaders currently argue that market-based reforms would be included in separate legislation from the first bill which deals mainly with taxation and mandates. That’s the third phase of replacing Obamacare. They also say regulatory repeal is not in the bill because Health and Human Services Secretary Tom Price can roll those back unilaterally. That is phase two.
Brat is not impressed.
“The problem there is it’s not permanent. We’ll have this kind of bumper pool every four years, when you switch administrations you’ll change health care for the whole country. We want that that bucket number two, that Price is going to take care of, to be put into the bill itself,” said Brat.
He says allowing greater competition for coverage and including regulatory reform in the bill could salvage the legislation for many conservatives.
“I think if leadership goes forward with that and pushes it over to the Senate, that’ll get a lot of people to ‘yes.’ That could be the sweet spot,” said Brat.
How will this play out in the coming weeks? Brat says Trump is the key.
“I don’t think we’re even close to having the votes, so Trump will come in and negotiate and put his foot down on a system that he wants. He wants to increase competition across state lines and to reduce the costs for everybody so it’s affordable. If we can get it done in a month or two, it can be signed, sealed and delivered if we can zap these insurance regulations,” said Brat.
He says those components would also allow Republicans, who ran on repealing and replacing Obamacare, to make good on their promises to the American people.
“We can put [a bill] together brick by brick but the key is you’ve got to start out with the glue. Repeal, that was the promise. Then move forward from that and build a scaffolding up from there,” said Brat.
“You want to start with free markets and then add a safety net. You don’t want to start with socialism and then promise free markets later. That never happens,” said Brat.
So why haven’t these ideas been in the bill from the start? Brat suspects quite a few GOP senators are looking to dodge controversial votes.
“The Senate has become kind of a high noon tea society over there. They’re not taking tough votes. They don’t want this bill to come over in the first place. I think they’re using that as a way to duck. Even our side uses that as a way to duck from pushing through what we have to get through,” said Brat.
Brat also rejects the leadership’s argument that market reforms and regulatory repeal can’t be included in a reconciliation process. He says that’s just not true. He says the Senate can simply vote to determine if a provision is tax or budget-related.
He says getting this major overhaul done and done right is a matter of political will, and adds that not is the time to demonstrate that will.
“Let’s roll the TV cameras in there. Let’s put that live in front of the American people so they can see the process of their own government at work for them, and I think we’ll have a big win,” said Brat.
The first man to sue the federal government over the Affordable Care Act says Republicans are breaking their campaign promises to repeal the health care law and are instead abandoning free market principles with legislation that will make health care even worse and let the Democrats off the hook for the blame.
Former Virginia Attorney General Ken Cuccinelli III launched the first constitutional challenge to the law, widely known as Obamacare, in 2010. His efforts, along with others, ultimately ended in a 5-4 U.S. Supreme Court decision that saved President Obama’s most significant domestic policy.
Late Monday, House Republicans unveiled the text of the American Health Care Act and promoted as a means of getting Washington out of health care, reducing costs and regulations and setting the stage for market-based reforms.
But Cuccinelli says the bill is nothing more than a GOP version of Obamacare.
“This is a sloppy Democrat bill. The people who call this Obamacare-lite are wrong. It’s not lite. It’s just a Republican form. This is a really terrible piece of legislation on its own merits. It’s even worse when you realize this is what’s supposed to pass for keeping their promise to actually repeal Obamacare,” said Cuccinelli.
He says any members trying to keep their promise to repeal the law have to vote against it.
“The problem for conservatives is if it doesn’t really mean actually getting rid of Obamacare and all of the worst features of it, then it should be voted against,” he said.
“Otherwise, it’s an adoption by the Republicans of all the worst elements of Obamacare. They’re going to own the consequences. They’re going to own those price increases and health insurance increases, which will keep happening,” said Cuccinelli.
Cuccinelli says it will be up to congressional Republicans to get this right because President Trump has yet to wade into many specifics.
“Whatever bill gets to the president’s desk, he’s going to sign it. He was very unspecific in the campaign. They’ve been very unspecific in the last week or two. Clearly, they just want to check this box and ‘get it done,’ whatever that means,” said Cuccinelli.
Republicans ran on repealing Obamacare in the past four election cycles. The issue was largely responsible for the GOP takeover of the House of Representatives in 2010 and the Senate in 2014. Cuccinelli says the promise resonated with voters, so it makes no sense to abandon that mission now.
“They’re all running around, at least leadership is, afraid that they’ll upset somebody. Well, I’ve got news for you. People are already upset, and it isn’t a question of whether people are upset after you do whatever you’re going to do. If that’s all you care about, what will they be more upset about: doing what you said you would or going in another direction?” said Cuccinelli.
“If you go in another direction to appease a constituency you didn’t rely on to get elected, what you’ve succeeded in doing is ticking everyone off. That’s the direction Republicans are headed right now,” Cuccinelli.
But Cuccinelli goes a step farther. He says Republicans are really abandoning a full repeal because they do not actually want a market-based health care system.
“They don’t want the regulations to go away. That’s their dirty little secret. They don’t want market-based health care. They want big government control, even though someday it’s all going to come crashing down just because of how bankrupt it will all be,” said Cuccinelli.
He says GOP leaders have gotten comfortable turning to government to address problems.
“Let’s take (House Speaker) Paul Ryan for instance. Paul Ryan has never done anything in his adult life except be in government. It’s his solution to every perceived problem. He doesn’t rely on the market. He doesn’t trust the one force in the history of the world that has raised more people up out of poverty than any other, and that’s free market capitalism,” said Cuccinelli.
So what does Cuccinelli specifically see s the biggest problems with the GOP bill?
“There were 24 major regulations with Obamacare. Under Ryancare, 22 and a half of those stay in place. And of course we get blessed with a brand new entitlement. I don’t know if anybody in the Republican leadership noticed, but we are bankrupt. They do nothing really to resolve that problem,” said Cuccinelli.
“They make no move toward a market-based approach to health care. There’s no expansion of freedom and there’s no reason for people to want to become a doctor any more than under Obamacare,” he added
Supporters of the GOP point out that this legislation needs to start the reform process because it can pass through reconciliation, meaning a simple majority in both chambers can get the job done. They also suggest Health and Human Services Secretary Tom Price can tackle most of the regulations unilaterally. Then, they say market-based ideas can come in later legislation.
Cuccinelli isn’t buying it.
“I could swallow [all of that] a whole lot more easily if the first bill was a repeal bill. So if you want us to trust you, then you do what you said you were going to do. Is that really too much to ask? Just do what you’ve been promising for seven years,” said Cuccinelli.
“Don’t put it on Tom Price to get rid of the regulations. You do it in the legislation. You do it as part of the vote. It’s what repealing means,” said Cuccinelli.
Cuccinelli says Republicans had no problem passing a full repeal in 2015 so there’s no good reason not to pass it again.
“All of them have voted on that bill. Were they lying then when they voted on it? It sure seems like it now. Why not just pass a true repeal again?” he said.
“They were loudly speechifying back then. Now they’re using scare tactics to say, ‘Those of you people who want to hold us up for this repeal bill are for Obamacare,” said Cuccinelli.
“That is the worst kind of ducking of a debate on the substance of an important, important issue to every family in America. And it’s a dodge on their campaign promises. They’re all breaking their promises and making liars out of themselves,” said Cuccinelli.
Jim Geraghty of National Review and Greg Corombos of Radio America react to Howard Dean saying pro-life people have no home in the Democratic Party. They also wince as Republicans are divided about how to overhaul Obamacare and leaders suggest any opposition to the current bill is tantamount to supporting Obamacare. And they discuss how ESPN’s political agenda had led to a subscriptions free fall and the need to eliminate $100 million in on-air personnel.
Conservatives and liberals are savaging the House Republican health care plan, but one of the leading advocates for a market-driven approach says the bill is a good start to imploding Obamacare and setting the stage for additional conservative reforms.
The plan is getting hammered by conservatives for not fully repealing the 2010 Affordable Care Act, failing to allow the purchase of coverage across state lines, and for allegedly replacing one entitlement program with another. Liberal critics say the plan would knock millions of Americans off health insurance and leave them one illness from bankruptcy again.
So what about those claims?
Galen Institute President Grace-Marie Turner is a veteran of Washington health care debates and was a fierce opponent of the Clinton health care reform effort in the 1990’s and Obamacare since 2009. She is encouraged by what she sees in the American Health Care Act and says the realities on Capitol Hill force this kind of legislation.
“It’s a first step. They’re pushing as far as they can with the process they have to go through. They do not expect any Democrats, in the House or the Senate, to vote for this. That means they have to do this through a particularly difficult process called reconciliation that limits the kinds of things you can repeal,” said Turner.
“They can’t repeal everything in the law through this process because it has to have direct spending and budget implications. They’re doing as much as they can and they have plans to go forward with other pieces of legislation, for example, that will allow people to purchase health insurance across state lines. That’s not possible through this particular pathway,” said Turner.
She says this legislation is needed to gut the worst parts of Obamacare.
“There will also be follow-on legislation going forward, but not if this [doesn’t pass]. You can’t build change on the crumbling infrastructure of Obamacare. You’ve got to begin with changes that lead us in a new direction,” said Turner.
“It’s like a battleship or an aircraft carrier. It takes a long time to turn this around ,” she added.
Turner also says a lot can be done to ease the burden on all Americans without involving Congress. She says Health and Human Services Secretary Tom Price can accomplish a lot through the powers granted him in the original Affordable Care Act.
“Sec. Price has control of the regulatory mechanism. There were 20 million words of regulation written to enforce Obamacare. He has the power to undo a lot of those and to rewrite them but also to provide new guidance to the marketplace to engender much more competition and consumer choice,” said Turner.
Sec. Price outlined the very same strategy Tuesday at the White House.
Turner says the GOP bill offers important provisions like eliminating a trillion dollars worth of taxes on the economy and protecting coverage while the system transitions from Obamacare. She also says the bill takes a smarter look at Medicaid dollars that should mean less burden on the taxpayers.
“It begins the pathway to reform the Medicaid program, arguably one of the worst health care programs in the country that is bankrupting the states. At the same time, millions of people (on Medicaid) can’t find a doctor to see them,” said Turner.
And how would it do that?
“This legislation would begin the process of giving states a per capita allocation. A per capita allocation is very different from a block grant. It basically says we are going to make a distinction between moms and babies who are healthy and people who have multiple disabilities,” said Turner.
She also likes that states will have much more say over health care while Washington backs off.
“It gives states more power and more authority, not only to figure out how to take care of their citizens that are on Medicaid, but also to provide their citizens with more choices from the kind of health insurance that they want to buy, rather than have the federal government tell them the health insurance they have to buy,” said Turner.
But will the plan ultimately lower premiums and deductibles? Turner says that hinges on getting people to stay on insurance for the year once they’ve purchased it and getting more, young healthy people into the system.
“You need young, healthy people in the system. What do you do? You try to give them more choices, more options of more affordable coverage. So attracting people, giving them incentive to want to stay covered, by giving states more options to provide them with choices for health insurance – not just Washington’s three or four cookie-cutter policies,” said Turner, who also advocated for multi-year policies so patients could lock in rates for years at a time.
While acknowledging the fierce opposition to the plan from the right and left, Turner says the bill not only makes key changes but looks at health care in a whole new way.
“It’s a really different philosophy of giving people the market incentive to respond to consumers who are newly empowered and want to make responsible, good choices,” said Turner. “People want insurance but they don’t want insurance that costs more than their mortgage.”
This is one of multiple perspectives we will be sharing on this legislation as the debate continues.
Conservatives in Congress are increasingly frustrated by what has been leaked about the Obamacare repeal legislation and by what they see as a lack of transparency, even as House Speaker Paul Ryan insists Republicans are all on the same page and predicts unity on a final vote.
For most congressional Republicans, what they know of the repeal is what they read in a leaked report on the purported bill last week. Sen. Rand Paul, R-Ky., made headlines by unsuccessfully trying to get a hard copy of the legislation.
Most Republicans don’t know what’s currently being put together.
“I think it’s mostly members of committees with jurisdiction. You’re talking about members on Energy & Commerce and members on Ways & Means. That’s probably as far as it goes,” said Jason Pye, director of public policy and legislative affairs at FreedomWorks, which has endorsed the replacement bill authored by Sen. Paul.
“Maybe the broader conference knows the general discussion of what’s going on,” said Pye. “The actual legislative text is what matters. That’s where the nuances come into play.”
FreedomWorks shares the frustrations of Sen. Paul and other lawmakers clamoring for details.
“I think Sen. Paul has a point that this entire process is being done largely in secret. Americans deserve to know what’s going on. Are we going to see Obamacare-lite or are we actually going to see a real patient-centered alternative,” said Pye.
What would real transparency look like?
“We should be having hearings as the bill is going through. Why not have debates on C-SPAN while it’s being discussed and being drafted?” asked Pye.
On Friday, Politico reported that GOP leaders hoped to vote on repeal later this month and they were prepared to “steamroll” conservatives into backing the plan.
“They say they have no problem steamrolling conservatives by daring them to vote against an Obamacare repeal that their constituents have demanded for years,” reported Politico.
“‘Conservatives are going to be in a box,” said one senior Republican lawmaker. Trump, the source predicted, eventually will “go out front and … tell the conservatives … they’re either for this or for keeping Obamacare,'” the report continued.
That’s a far cry from the assurance of unity Ryan offered at his weekly press conference on Thursday.
“We’re all working off the same piece of paper, the same plan. So we’re in sync – the House, the Senate, and the Trump administration – because this law is collapsing. You can’t just repeal it. You have to repeal it and replace it with a system that actually works. That’s exactly what we’re doing,” said Ryan.
“I am perfectly confident that when it’s all said and done we’re going to unify because we all, every Republican, ran on repealing and replacing and we’re going to keep our promises,” added Ryan.
Pye says FreedomWorks is just as eager to scrap Obamacare, but he says how it’s done is vital.
“The speaker said that the repeal and replacement of Obamacare is entitlement reform. That certainly should be the case but the problem is we’re repealing one entitlement and creating a new one. You don’t do that as conservatives, especially one who claims to be a fiscal conservative,” said Pye.
He says if the leaked version of the bill is accurate, there is a lot to oppose in there.
“We were surprised to see the Republican version of the individual mandate included in this bill. We were surprised to see $100 billion in new mandatory spending over the next ten years in this bill. We didn’t anticipate that. We didn’t anticipate the new Republican version of the Cadillac Tax in this bill. We weren’t old those thing,” said Pye.
In the end, will leaders twist enough conservative arms to pass the plan? Pye doesn’t think so.
“Leadership is really who’s in a box right now. If the 70 conservatives in Congress stick together, if you keep 41 of those guys and maybe a couple more, [leaders] don’t 218 votes to repeal and replace,” said Pye.
“They’re going to have to listen to conservatives in the conference. I’m sorry. That’s just the way it is. And right now, this Lee, Cruz, and Paul trifecta sticks together, [Republicans] only have 52 seats in the Senate. You’re going to get Democratic votes on either side. You have to listen to conservatives,” said Pye.
Conservatives are already explaining what they want, namely in bills offered by Sen. Paul and Rep. Mark Sanford, R-S.C.
“It puts individuals on the same playing field as employers. It gives states the option for flexibility through Medicaid, allowing them to seek waivers from the Department of Health and Human Services. It expands [Health Savings Accounts] to the point at which you can pay your health insurance premiums out of that,” said Pye
“Those are patient-center alternatives and consumer-friendly alternatives that improve the health system and truly empower Americans to make their health care choices,” said Pye.
If conservative ideas are now adopted into the replacement bill, Pye suspects Republicans may abandon the effort to pass a repeal and replacement together. He says passing a repeal similar to the one President Obama vetoed last year might be where the GOP factions find common ground.
“I know everybody wants to get this over with now and I do as well, but there is no difference, fundamentally, between what we did in 2015 and what we should be doing now, other than the disagreements over replace. If we can’t figure out replace, let’s come back another day, but let’s go ahead and start the process on repeal,” said Pye.