Two months into the President’s term, and Speaker of the House Paul Ryan has finally revealed the American Health Care Act, claiming the legislation will satisfy the promise of Obamacare repeal.
However, it is already clear that conservatives feel their promises have been far from met, as Ryan’s plan appears retains some of the most expensive elements of Obamacare, such as insurance subsidies and extends Medicaid expansion until 2020, when existing beneficiaries of the expansion will get to keep their coverage if it does not lapse.
As this flows into committee, Republicans like Ryan must be willing to listen to the conservative perspective; if they do not, the guarantee of repeal and replace could be lost altogether.
The key is that Republicans cannot afford to lose the assistance of their own base conservative network. Despite having a majority, Republicans cannot afford to lose the votes of more than 20 Republican Representatives and more than two Republican Senators if they intend to pass their healthcare bill, based on the realistic assumption that not a single Democrat will vote to repeal any part of Obamacare.
The conservative House Freedom Caucus has already made it clear that level of support will not exist for this legislation unless changes are made; with three senators, Rand Paul (R-Ky.), Ted Cruz (R-Texas), and Mike Lee (R-Utah) already threatening to oppose the bill.
Sen. Paul has defended Republicans’ promise of a full repeal. In a joint op-ed with U.S. Rep. Mark Meadows (R-N.C.), the two referred to Ryan’s proposal as “Obamacare Lite” and explain, “We own repeal. We ran on it. It is our idea. We have to pass it cleanly, now.”
The two continue that this can only be done through “a real-old fashioned period of allowing all ideas to be debated and voted on to produce the best product possible.” And that is exactly what should occur now in committee.
Such a repeal was already passed by Republicans in the House and Senate in 2015 and was vetoed by former President Barack Obama last year, and conservatives argue this should be the minimal base for repeal and replacement should occur after to ensure it is not rushed.
Senator Mike Lee explained in a statement that, “We don’t know how many people would use this new tax credit, we don’t know how much it will cost, and we don’t know if this bill will make health care more affordable for Americans…This is exactly the type of back-room dealing and rushed process that we criticized Democrats for… Let’s pass the 2015 repeal bill that Republicans in both houses of Congress voted for and sent to the White House just 15 months ago. Once Obamacare has been properly sent to the dustbin of history then we can begin a deliberative, open, and honest process to reform our nation’s health care system.”
Ryan has pushed for a single bill because of the truth that Obamacare is “rapidly collapsing,” but without the conservative support his own bill will assuredly collapse all on its own.
Even after offering strong support on Tuesday for the legislation, President Donald Trump is realizing negotiations must occur to keep the idea of healthcare reform alive. On Twitter on March 7 Trump said the bill was open for “negotiation.”
Mick Mulvaney, director of the Office of Management and Budget, met with the Freedom Caucus on behalf of the Trump administration to discuss a path for negotiations.
Meadows noted after the meeting that, “The White House is willing to negotiate … and look at things we can coalesce around. I don’t know that there is a bill at this point that has the necessary 218 votes to coalesce around, and so we got more work to do as the Freedom Caucus to come up with a solution.”
In a statement to Breitbart.com, Americans for Limited Government President Rick Manning urged Republicans to get the legislation right: “This legislation must be retooled to rip all of Obamacare out by the roots, followed by a replacement bill that respects the American people and the Constitution by returning authority over health care to the states.”
Meaning, this cannot be a bill written behind closed doors by House leadership. Committees now must focus on the ultimate promise to the American people; first, to fully repeal Obamacare. To that end, they must work with House conservatives. There is no other way.
After that, then a potential replacement that empowers the consumer and the private sector can be considered.
But before this legislation even hits the floor for a failed vote, committees must fix the problems within replacement and offer a plan for a real repeal.