As far as health policy goes, this week could be one of the most eventful in years.
Sen. John McCain, about whom we joked last week would be returning for the vote if his staff had to put him on Air Force One with a doctor, is, in fact, on his way back to Washington.
We think it is safe to conclude, then, that Majority Leader McConnell has the votes to pass a motion to proceed to the bill.
What happens next is anyone’s guess but we are pretty sure it won’t be nothing. We don’t buy the whole “McConnell is just putting a bill up so it can fail and we can all move on” conventional wisdom. Like most people in politics, McConnell plays to win and is usually successful.
Here are some educated guesses on what happens after the bill survives a motion to proceed:
Repeal without replace a la the 2015 bill – In a nod to Sen. Rand Paul who wants to see his colleagues – especially those that voted “Aye” in Dec 2015 – on the record, this bill will serve as the starting point. It contains repeal of all the operative sections of the ACA such as the individual and employer mandates, the taxes and the Medicaid expansion.
Debate on the repeal bill - For 20 hours the Senate will debate that version of the BRCA.
Vote -a-rama - For hours and likely days after debate ends, the Senators will offer amendments like provisions in the BRCA, point of order on provisions in the bill and amendments, and appeals to decisions related thereto. This is the point at which things get dicey.
ANYTHING CAN HAPPEN.
Where we think we end up is with a bill that that repeals the individual and employer mandate and a few taxes but especially the medical device tax. Of course, that result will leave insurers required to sell only benefit rich plans that no one has to buy and only the otherwise uninsurable want to buy. The hope is that contradiction will be resolved in conference committee.
We are out of consensus on the chances for repeal or repeal and replace at 54-46 right now. We land there because doing nothing has grave consequences for the individual and small group health insurance markets (not to mention the political future of Congressional Republicans and to the legislative agenda of President Trump.).
In short, the stakes are very high.
If, however, consensus is right and the whole effort does not produce a bill that can be sent to conference with the House, then the question of ACA repeal and replace gets put down for the foreseeable future. The happy talk about bi-partisan solutions to stabilize the individual and small group markets ignores the deep and irreconcilable flaws of the ACA and the lack of consensus about a solution within each party and across the aisle. In other words, a bipartisan bill will never happen.
Lacking hope for a bi-partisan agreement on fixing the flaws in the ACA, the goal right now is to just keep the bill moving as it is the only possibility for bringing relief to about 20 million Americans.
Call with questions. We will be glued to C-Span watching sleepless octogenarians and flipping through our dog-eared copy of Robert’s Rules of Order.
Emily Evans
Managing Director
Health Policy
@HedgeyeEEvans
