Senate Prepares to Negotiate American Health Care Act

The GOP-backed American Health Care Act narrowly cleared the House last week with a vote of 217-213. From there, it moves on to the Senate. 

As I wrote in a previous article, the bill must pass through the Senate before landing on the president’s desk. If the Senate makes any changes (which they certainly will), the House must approve those changes before sending the bill to Trump. 

Many are viewing the upcoming fight as a test of Trump’s fragile relationship with Senate Majority Leader Mitch McConnell (R-KY). “Whether or not they are able to forge a positive, personal, and working relationship will be one of the early tests of this,” said former RNC chairman Michael Steele. 

No matter what happens, the healthcare bill will likely be unrecognizable when it gets back to the House. 

“I’ve already made clear that I don’t support the House bill as currently constructed,” said Ohio Senator Rob Portman. He mentioned the bill’s vast Medicaid cuts, including treatment for drug addicts, and said he would make sure that “those who are impacted by this [opioid] epidemic can continue to receive treatment.”

Arkansas Senator Tom Cotton says the House is “moving too fast” and has promised that Senate Republicans are “going to write our own bill.” Cotton agrees we should repeal ObamaCare, but wants to insure that Arkansas Governor Asa Hutchinson has “the flexibility he needs to help Arkansas adapt to any change in Medicaid.”

The Affordable Care Act caused a 12% drop in Arkansas’ uninsured rate between 2013 and 2016 (this is more than any other state except Kentucky). Many of Cotton’s colleagues, especially those who represent states that took advantage of the ACA’s Medicaid expansion, are unsure how to proceed. 

Texas Senator Ted Cruz, whose state did not accept the expansion, says Medicaid reform could mark “the first meaningful entitlement reform in the modern decade.” 

But he admits the situation is tricky. “There are not only ideological differences, but parochial differences. You have some of the states that have expanded Medicaid, other states have not, and no senator wants to see their state get the short end of the stick,” said Cruz. 

According to Cruz, the main priorities are to find a way to lower insurance premiums and to allow the purchase of insurance across state lines. He calls the ACA the “single biggest jobs killer in this country,” and insists changes to the law will boost the nation’s economy. 

The healthcare bill has “the potential of having a huge impact on the fiscal strength of our country,” said Cruz, adding that it would be “catastrophic” if the Senate fails to return a bill to the House.  

There are 52 Republicans in the Senate. By taking advantage of special rules, they could pass the bill with just 50 votes (and rely on Vice President Mike Pence to break a tie).

Cruz says the matter is a “deliberative process” that could take as long as a “couple of months.” 

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As it stands, the House bill ends the ACA’s fines on people who choose not to purchase insurance. It removes taxes on higher-earning people and on health industry businesses. The bill also allows insurers to charge higher premiums for people with pre-existing conditions and replaces federal subsidies for lower-income Americans with tax credits associated with a consumer’s age. 

The bill includes over $800 billion in Medicaid cuts and suspends Planned Parenthood funding for one year.