WASHINGTON ― Without a single Democrat voting in support, the House narrowly advanced a budget blueprint on Friday intended to be the eventual vehicle for gutting Obamacare.
After conservatives and GOP moderates spent a week signaling that they might vote against the repeal vehicle, most Republicans fell in line, with the House voting 227-198 in support of the resolution. Only nine Republicans ultimately voted against it, joining 189 Democrats in opposition to a budget that deems it “appropriate” for U.S. debt to rise by more than $9 trillion over the next decade. (Republicans say they won’t go along with debt increases at those levels, and that they intend to write another budget this year more in line with their values.)
Among the Republicans who did vote against the resolution, most cited concerns over endorsing that amount of new debt. Three moderates also voted against the resolution, seemingly as a signal to GOP leadership that their votes shouldn’t be taken for granted in an eventual repeal or replacement.
Conservatives and moderates alike have been pushing House leaders for more specifics on what the eventual repeal would look like ― how long it would take to enact, how much of Obamacare it would revoke, how soon afterward a replacement would follow. But even without answers to most of their questions, Republicans feared voting against the budget would send a conflicted message to their constituents. Most Republicans in Congress spent years vigorously campaigning against Obamacare for years, and President-elect Donald Trump has left no mystery about his support for the resolution.
Now that the House has agreed to the reconciliation instructions, the Energy and Commerce Committee and the Ways and Means Committee in the House ― and the Finance and Health Committees on the Senate side ― will write bills to repeal Obamacare. Those bills would then go to the respective Budget Committees in both chambers, and the two chambers would either pass the same bill or go to a conference committee to work out the differences in the two versions. The resulting legislation would then only require simple majorities in the House and Senate before going to the president for his signature.
The whole point of the reconciliation exercise is to subvert the filibuster in the Senate with a 50-vote threshold for passage, in theory making this the easy part of the GOP plan to end the Affordable Care Act.
Most Republicans, though not everyone, agree they will need to replace Obamacare with something once it’s gone ― which is why Republicans are planning to delay the date of enactment on a repeal for a good long time.
While Democrats have been focused on the immediate effects of ending the health care law, Republicans claim they can mitigate those effects ― or even improve coverage ― with a new alternative, albeit one that might not have as many protections for the sick or the poor. Trump has promised to replace Obamacare with something “far less expensive and far better,” without offering specifics.
The policies the GOP favors would not be able to replicate what the Affordable Care Act offers, because Republicans don’t actually want to devote enough funding to help people afford insurance. They also don’t want to provide the same level of consumer protections the law includes, especially when it comes to guaranteed coverage for people with pre-existing conditions.
Those policy deficiencies make it difficult to believe Republicans could find 60 votes in the Senate for a broad alternative. And if Democrats remain united against a Republican alternative, it’s anyone’s guess which side would break first in negotiations. Republicans are betting that once the health care law is gone, Democrats would have no choice but to help push a replacement across the finish line. Democrats are betting that Republicans might just extend Obamacare indefinitely, or else risk the political ramifications associated with changing people’s coverage, their costs and, indeed, the entire health care system.
The problem with the delayed enactment gambit is that as soon as Republicans repeal the law, health insurers would have little incentive to offer plans in the upcoming year, particularly if they’re losing money on the health insurance exchanges.
That would lead to higher prices and limited plan options, which would in turn limit the customer base for Obamacare to those who truly need health coverage. This would be the proverbial “death spiral” that politicians from both sides talk about.
The issue with a quick, or even immediate, enactment is that people already on their health care plans rely on that insurance, and the process for offering Obamacare exchange plans in future years begins well before open enrollment in the fall. Offering just a short delay could further exacerbate the death spiral, with insurers deciding to sit out the upcoming year and wait for the new health care system.
House Speaker Paul Ryan (R-Wis.) has taken to saying in recent weeks that Republicans don’t want to “pull the rug out” from people using Obamacare, which is why House Republicans say leaders are leaning toward a three-year delay for repeal enactment.
That’s a point of contention for conservatives, who want no more than a two-year delay.
But those questions are nothing compared to the onslaught of issues Republicans face in coming up with an Obamacare alternative. And those issues are just the beginning of their problems. There is that pesky procedural complication of a 60-vote requirement in the Senate, and Republicans in the House who are certain to be upset with the final compromise.
It’s part of the reason Trump has insisted this week that a replacement follow a repeal within a few days ― a timeline that Ryan has repeatedly endorsed despite the difficulty in Republicans coming up with an alternative so hastily.
During debate for the bill, Ryan seemed to reaffirm the idea of a quick timeline when he said that “in the weeks ahead,” Republicans would take “several steps” to address Obamacare.
“This experiment has failed,” Ryan said. “This law is collapsing as we speak.”
Ryan then read some data on possible premium increases in states, and said Republicans were on “a rescue mission” for people on Obamacare.
Once Ryan finished his speech, House Minority Leader Nancy Pelosi (D-Calif.) rose to slam Republicans for essentially cutting taxes for the richest Americans by repealing Obamacare.
“Show me your values,” Pelosi said. “Show me your budget.”
Before Pelosi was given the floor, however, the Democratic manager of the debate, top Budget Committee Democrat John Yarmuth of Kentucky, had to yield her time. And before he did that, Yarmuth continued a strategy he had adopted for every Republican speaker that day: reading off data from the Department of Health and Human Services and the Commonwealth Fund on the impact of repealing Obamacare in that Republican’s state.
“I remind the speaker that his vote today to repeal the Affordable Care Act will result in 211,000 people from his state of Wisconsin losing their health care coverage, 46,000 workers losing their jobs and an economic loss of $25.7 billion in gross state product in the state of Wisconsin,” Yarmuth said.