Even as the Republicans’ bill to replace the Affordable Care Act cleared its first committee in the House of Representatives and gained the support of the Trump administration, its chances of passing either chamber of Congress, and particularly the Senate, looked increasingly slim.
Both the House Ways and Means and Energy and Commerce Committees worked through the night on the American Health Care Act. Ways and Means chairman Kevin Brady (R-TX) announced after 4 a.m. on Thursday that his committee had finally wrapped up its work.
“Ways and Means Republicans just passed legislation that will help Americans finally have access to affordable health care,” he said in a statement. “We voted repeatedly to end Obamacare’s crushing taxes and mandates and ensure patients have more power over their own health care.”
The Energy and Commerce Committee, which convened at 10:30 Wednesday morning to consider the bill, passed the legislation after 27 hours of deliberation.
But the work seemed to many to be almost certainly in vain. Within the House itself, the bill is facing united opposition from Democrats, who say it will deprive millions of people of access to affordable health care. That wouldn’t normally be a problem, given that the Republicans have a majority in the House.
However, many of the most conservative Republicans in the body have come out against it as well, insisting that a system of tax credits that the bill would use to replace the ACA’s complicated set of subsidies, amounts to a new entitlement program.
Others are incensed at House leadership for rushing to pass the bill before the Congressional Budget Office has the time to provide an official budget score, which would details both the costs of the new plan and an estimate of the impact it would have on the number of Americans who have health insurance.
On Wednesday, the White House took the extraordinary step of preemptively attacking the credibility of the CBO, which is widely respected in Washington for delivering non-partisan analysis of legislation. “If you’re looking at the CBO for accuracy, you’re looking in the wrong place,” White House Press Secretary Spicer said during a briefing.
And if the AHCA’s chances in the House look iffy, it looks doomed in the Senate. The bill would be packaged as part of a budget reconciliation package, and therefore would not be subject to the filibuster and could be passed with a bare majority. But the GOP has only a 52-48 majority in the chamber, meaning that if they lost two votes they would need Vice President Mike Pence to break a tie (as both Al Gore did in a 1993 budget reconciliation bill and Dick Cheney did in 2003.) If they were to lose three senators, the bill would die in the Senate.
The problem is that so far more than half a dozen Republicans have expressed opposition to the bill. Four were concerned about the expectation that it would throw millions of people off of Medicaid rolls, which were greatly expanded under the ACA. Others, like Utah Sen. Mike Lee and Kentucky Sen. Rand Paul, said the bill, which retains some features of Obamacare, did not live up to conservatives’ promises to replace the law.
On Thursday morning, Arkansas Sen. Tom Cotton took his colleagues in the House to task on Twitter, blasting them for ramming through a piece of legislation in the same way that Republicans criticized Democrats for passing the ACA in 2010.
“House health-care bill can't pass Senate w/o major changes,” he wrote. “To my friends in House: pause, start over. Get it right, don't get it fast. GOP shouldn't act like Dems did in O'care. No excuse to release bill Mon night, start voting Wed. With no budget estimate! What matters in long run is better, more affordable healthcare for Americans, NOT House leaders' arbitrary legislative calendar.”
The White House, meanwhile, has thrown its weight behind the bill. President Trump, after earlier in the week warning Congressional Republicans that they would face an electoral “bloodbath” if they failed to pass the bill, called conservative House leaders into the Oval Office and reportedly berated them for “helping the other side” by calling the bill “Obamacare lite.”
During the meeting, CNN reported, White House staff expressed openness to moving up the proposed changes to Medicaid to 2018 rather than 2020, as the bill currently would. While that might bring along a few House conservatives, though, it would likely only harden opposition to the bill in the Senate.
He promised to hold football stadium rallies in states where Democrats are facing tough reelection battles, and reportedly said that his fallback position, should the bill not survive, would be to stop supporting the ACA, let the insurance markets collapse, and try to force the blame on Democrats.