Why the GOP Health Care Plan Could Still Go Down in Flames
Policy + Politics

Why the GOP Health Care Plan Could Still Go Down in Flames

Reuters/GraphicStock/The Fiscal Times

After a month of fits and starts, the Republicans in the House of Representatives finally passed legislation meant to replace the Affordable Care Act. They marked the achievement by immediately boarding buses to the White House to celebrate the achievement in the Rose Garden at a press conference hosted by President Trump and Vice President Pence.

It was an odd sight, at least to anybody familiar with basic civics or the current composition of the United States Congress. It felt almost as though a baseball team was staging a ticker tape parade during the All-Star break. That’s because what House Republicans achieved on Thursday -- despite the weeks and weeks of drama and hand-wringing -- was actually the EASY part of eliminating the Affordable Care Act.

Related: Think the GOP Health Care Plan Doesn’t Affect Your Insurance? Think Again

Here’s what comes next.

Now It’s the Senate’s Turn

As most of us learn in middle school, for a bill to become law, both houses of Congress have to pass it and the president needs to sign it. That’s where we see the first problem for the American Health Care Act. Because not only is the Senate not going to pass it in its current form, it isn’t even going to consider it.

From a legislative perspective, the smoothest path for a bill is always when one house of Congress passes a bill and the other house adopts it as written. The next smoothest is when the bill passed by one house is taken up by the other, amended, and then passed. In the latter case the new version has to be approved by the body where it originated before it can go to the president.

But neither of those is going to happen with the AHCA. Senior members of the Republican Senate Majority have signaled that they have absolutely no intention of taking up AHCA and are drafting their own bill. The Senate bill might contain some elements of the House-passed legislation, but because it will face a very different political reality in the Senate, the similarities will be limited.

Related: The GOP’s Bizarre Gamble on Health Care Reform

The AHCA barely passed the House with 217 votes, one more than the minimum necessary, despite the fact that the GOP has its largest majority in that body since the late 1920s. The Senate Republicans, by contrast, have a slim 52-48 majority, and many of them have already expressed opposition to some of the more draconian elements of the AHCA. (The Senate can pass health care bill with only 51 votes because Senate leaders plan to use the budget reconciliation process to avoid the filibuster. If the Democrats could filibuster the bill, all bets would be off.)

That means that whatever legislation eventually comes out of the Senate -- assuming they manage to pass something at all -- is going to look very different from what the House passed, and there is virtually zero chance that the House GOP will meekly accept the Senate’s offering and agree to pass it.

That leads us to: Conference Committee.

When the two houses of Congress have passed bills that have some similarities but don’t match precisely, the next step is for the leaders of both houses to appoint “conferees” to serve on what’s known as a conference committee. The object of the committee is to hammer out a compromise between the two bills that the members believe can pass both chambers.

In the past, conference committees were often bipartisan affairs, but there is no reason to expect that to be the case here. The Democratic Party is not expected to provide any votes for a legislative effort to undo the last Democratic president’s signature domestic program. So the conference committee will be Republicans talking to other Republicans.

Related: Ten Things You Need to Know About the House GOP Health Care Bill

The committee will face a difficult balancing act. The House managed to pass AHCA by a tiny margin only by finding a balancing point between the two groups, the ultra-conservative Freedom Caucus and the more moderate Tuesday Group. Original versions of the bill failed because the Freedom Caucus didn’t feel it was conservative enough and threatened to jump ship. Some refused to vote for the bill even after changes meant to mollify them were made.

On balance, whatever comes out of the Senate is likely to do less to peel away elements of the Affordable Care Act than the House bill. That means that any compromise in the conference committee would result in a final bill that is less to House conservatives’ liking than the bill that passed Thursday, meaning leadership would have to worry about the bill failing to pass the House.

And all this will be going on in the face of what is likely to be a large and coordinated campaign by Democrats and activists to paint the House Republicans’ vote as a betrayal of their constituents.


The final votes hadn’t even been cast before Democratic lawmakers and activist groups were promising massive blowback for any Republicans supporting AHCA. Republican House members hadn’t even made it to the Rose Garden celebration on Thursday before the Democratic National Committee was using the AHCA vote in fundraising pitches.

And even as the bill was being debated on the floor of the House, new analyses from health care researchers and industry consulting groups were revealing possible unintended consequences from the bill.

Related: GOP Health Bill Would Fund Just 5 Percent of People with Pre-Existing Conditions

Ben Wikler, Washington director for the liberal activist group MoveOn, pressed for protesters to call Republican House members who voted for the bill to complain and to show up at their offices and town halls. The object, he said, was to convince Senate Republicans that if they propose legislation like AHCA, “They’re walking into a political buzz saw.”

At this point, House Republican celebrations aside, it’s far from clear that the effort to replace the Affordable Care Act is actually going to bear fruit in the end. There is a very real chance that in the end, all the Rose Garden ceremony with President Trump will have done is supply B-roll for Democratic attack ads in 2018.