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H.R. 1628: 3 ways House Rules warmed things up

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House Rules Committee Chairman Pete Sessions today may have paved the way for Republicans and Democrats to come up with some kind of health coverage access solution by holding a friendly, down-to-earth meeting on H.R. 1628.

H.R. 1628 is the American Health Care Act bill, a bill that’s supposed to de-fund and change major parts of the Affordable Care Act.

Related: H.R. 1628: 5 AHCA change highlights for agents

The Rules Committee is a powerful committee that determines the final shape of legislation before it reaches the House floor, and the terms of floor debate.

At press time, the Rules meeting on H.R. 1628 was still under way. Washington publications that follow Congress were full of breathless reports on whether supporters of H.R. 1628 have enough votes to get it through the House and on to the Senate. House leaders have been hoping to win final House approval for the bill Thursday.

The Rules Committee was streaming the video live on the web here (and will post a recording there when the hearing is over).

[Update: The committee ended its hearing on H.R. 1628 about 11 p.m. Wednesday, after voting to approve a rule that lets the committee operate under "martial law" and consider just about any rule proposed by the leadership up until Monday. Rep. Alcee Hastings, D-Fla., a Democratic member of the panel, interpreted the move as meaning bill supporters "need more time to buy votes" for the bill.]

But Sessions seemed to get both Republicans and Democrats to talk about H.R. 1628 in a calm, detailed way that might help lay the groundwork for further discussions, whether or not that particular bill becomes law.

Here’s a look at three ways House Rules seemed to thaw some of partisan hostility.

Rep. Jim McGovern asked why the House has to vote on H.R. 1628 tomorrow. (Photo: House Rules)

Rep. Jim McGovern asked why the House has to vote on H.R. 1628 tomorrow. (Photo: House Rules)

1. Greetings

The Democrats who appeared before the committee had many complaints about the process Republicans are using to get H.R. 1628 through the House.

Traditionally, when the House uses “regular order,” it’s supposed to provide time for debate on bills and amendments.

Because congressional Republicans are trying to use a special “budget reconciliation” process to get the ACA change bill through the Senate with just 51 votes, rather than the 60 normally required, House leaders have held that the normal bill consideration rules do not apply.

Rep. Frank Pallone, D-N.J., complained about the lack of hearings on H.R. 1628, as opposed to bill markups, or revision sessions. “Speaker [Paul] Ryan said there would be regular order,” Pallone said. “There was not regular order.”

Rep. Jim McGovern, D-Mass., noted that the sponsors themselves seem harried.

“This was such a good vetting process we have four managers’ amendments on the list, with each one correcting the other ones,” McGovern said.

At another point, McGovern asked why Republican leaders can’t give House members an extra week to read the bill and the proposed amendments.

“What’s the difference between today or next week?” McGovern asked.

But Sessions let Democrats talk, without rushing them, and he started the meeting by noting that Rep. Louise Slaughter, D-N.Y., was in the hospital with a chest cold. Sessions said he’d talked to her in the hospital.

“She can’t wait to get her hands on me,” Sessions said. “I mean, on the bill.”

During a break, Sessions worked to fuel bipartisanship by distributing extra-large chocolate chip cookies.

Rep. Greg Walden said he thinks existing benchmarking rules will keep mental health benefits in Medicaid plans. (Photo: Walden)

Rep. Greg Walden said he thinks existing benchmarking rules will keep mental health benefits in Medicaid plans. (Photo: Walden)

2. Details

The House Rules debate on H.R. 1628 seemed to focus more than earlier ACA change hearings on the actual provisions in the bill and the proposed amendments, and less on general attacks on the motives of the people on the other side.

Democrats on the committee said they had major concerns about Medicaid mental health benefits, commercial health coverage premiums for older consumers, and proposed commercial health insurance market stabilization funds for the states.

The Democrats noted that it appeared that the amended version of H.R. 1628 might eliminate the need for state Medicaid programs to meet ACA major medical essential health benefits requirements, including the ACA mental health benefits coverage requirements put in the EHB package by the U.S. Department of Health and Human Services.

Pallone said governors will see that change as invitation to cut expensive mental health, substance abuse and prescription drug benefits from their programs.

Rep. Greg Walden, R-Ore., an architect of the bill, said other Medicaid benchmarking rules, tied to state or federal employees’ health benefits, will keep mental health benefits in most states’ programs.

Democrats also suggested that changes could let insurers charge adult enrollees ages 50 to 64 as much as six times as much as they charge their youngest adults enrollees, up from the maximum ACA age band ratio of three to one.

Rep. Richard Neal, D-Mass., scoffed at the idea that states will use the stabilization grant money H.R. 1628 provides, as an alternative to ACA subsidy programs, to stabilize insurance markets.

“They’re going to use it to path highways,” Neal said.

But Rep. Kevin Brady, R-Texas, had stories of his own about problems with the current ACA benefits.

In rural areas, for example, the ACA push for commercial plans to shift to narrow networks means that many ordinary Americans in rural parts of Texas no longer can use local doctors or hospitals, Brady said.

3. Personal stories

Democrats talked about constituents who were helped by the ACA coverage expansion programs, and what they might lose if H.R. 1628 becomes law.

Sessions talked about his own experiences using the ACA coverage that members of Congress get through DC Health Link.

The premiums are twice as high as what his family had before the ACA came along, the deductible is twice as high, and the children’s hospital he would want to use in Dallas if his son were still young is not in the plan’s network, Sessions said.

Moreover, the ACA exchange plan reimbursement rate is so low in his area that providers would prefer to treat Medicaid patients than exchange plan enrollees, Sessions said.

The age-based tax credit in H.R. 1628 may have problems of its own, but it would give moderately high-income Americans who are now uninsured a way to pay for coverage, Sessions said.

Rep. Jared Polis, D-Colo., talked about his own frustration about an inability to get serious consideration for ACA improvement proposals. He said he hoped that Democrats and Republicans could eventually work together to talk about the many changes that members of both parties want to make.

“We’re spending all of our time on exactly what this insurance part looks like, without getting at the cost drivers,” Polis said.


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