Editor's Note: The piece below was written last night by Hedgeye Health Policy Managing Director Emily Evans.
"The AHCA is like a kidney stone — the House doesn't care what happens to it, as long as they can pass it." - Rep. Thomas Massie
The House is set to consider the American Health Care Act of 2017 tomorrow morning.
The House will must pass the AHCA for the following reasons:
- Denying a newly elected President a legislative victory especially when it fulfills a campaign promise AND when the president is the leader of your party is bad form and detrimental to your shared agenda.
- Repeal of certain provisions of the ACA like the taxes and Medicaid expansion lower the revenue baseline against which a tax reform bill will be scored. No repeal, no lowered baseline and tax reform – already a daunting task – gets more difficult.
- Right or wrong, most people blame the ACA for higher premiums and deductibles regardless of where they get their insurance. If Congress doesn’t do something, the public will not address their ire to Republicans or Democrats, they will target incumbents. There are, of course, more Republican incumbents than there are Democrat incumbents.
- The disproportionate amount of attention directed to the condition of the non-group market while changes to the Medicaid program remain un-scrutinized presents Republicans with a once in a lifetime opportunity to reform the program.
As of this writing, House leadership has schedule a Rules Committee meeting at 8:30 am with a vote on the AHCA at 12:30-1:00 pm tomorrow. Majority Leader Kevin McCarthy said this evening that they have the votes. We do not think they are stupid enough to schedule a vote without the necessary 216 “AYEs” so passage seems likely unless someone gets stuck in an elevator or their car breaks down.
For those of you in the “Senate will not pass this bill” camp: you are right. They probably won’t. But they are likely to pass something for the reasons listed above. You may have noticed that since March 24th when House leadership had to suspend proceedings on the AHCA due to a lack of votes, the Senate naysayers have really toned it down. Gone are the “dead on arrival” declarations. Instead Senators are saying they have a lot of work to do. They too need to get it done.
Changes I would expect out of the Senate:
- Focus will be on Medicaid. Senators will want to give their Governors a long ramp and time to adjust to a new system but reform is inevitable
- Something akin to the Cassidy Collins bill that permits states to maintain the status quo in the individual market, at the option of states.
Things are obviously fluid, so please call with questions, comments, thoughts.
