The release of the House Republican leadership's repeal and replace legislation has focused all attention on health care reform and will keep it there until the Senate turns to the nomination of Judge Gorsuch to the Supreme Court.
The reaction to the proposal in the Republican ranks is not a new debate. For years there has been a difference of opinion on whether to use tax credits or tax deductions to provide support for a new market oriented health care system. Part of this debate is also the typical, my strategy is better than your strategy discussion, familiar to many over the past five years.
For many reasons the House wants to pass this legislation so that the Senate can take it up before the April recess. Thus they are moving with all due speed right now. One has to take into account that the core of these ideas has been discussed over the last seven years by House Republicans and was the subject of serious discussion last year when the House developed its Better Way agenda. These ideas are not a shock to anyone.
The reconciliation bills reported out of the Ways and Means Committee and the Energy and Commerce Committee this past week will be compiled by the House Budget Committee and reported out next week for floor action the week of March 20th. During this period, President Trump and the House leadership will be working with members to put together the 216 (there are only 431 sitting members of the House right now) votes needed to pass the reconciliation legislation.
Some people have asked why the House can't just repeal the ACA in one reconciliation bill. The reason is two-fold:
First, and foremost, the ACA was passed as two bills in 2010. One was a reconciliation bill and the other was passed under regular order in the Senate and then that Senate bill was passed by the House. This was not a reconciliation bill and contained the legislative language that had little or no direct budgetary effect.
Second, some language proposed to be repealed produces a change in outlays or revenues which is merely incidental to the non-budgetary components of the provision which violates the Byrd rule.
It is clear that House Republicans opposed to the reported reconciliation bill hope to find a way to help pass the legislation. Whether there is a path to success remains to be seen.
This is President Trump's "Reagan" moment. In 1981 President Reagan was the critical person in gathering the votes to pass the Reconciliation legislation and the tax reform bill. Now President Trump is presented with the same sort of challenge that President Reagan faced in 1981.
The next three weeks could well determine if the Trump Administration and their Republican partners in the House and the Senate will be building on success or trying to crawl out from the debris of legislative failure.