If it's true that the entire health care reform effort since January has been one large exercise in blame-shifting, then Paul Ryan and House Republicans have successfully — for now — shifted blame for the failure to repeal and replace Obamacare over to the Senate. With 20 Republican defections, but with many Republicans in tough districts still having to cast tough "yes" votes, the House passed the American Health Care Act bill by the razor thin margin of 217 to 213.
The bill as passed is, as the kids say, a hot mess, and it sure doesn't seem to have many enthusiastic supporters. They did manage to separately pass a bill to keep their bill from protecting members of Congress and their staff members from what they are doing. But they rushed it to the floor before getting a score from the Congressional Budget Office. That's not just about how it would affect the federal budget deficit; they also passed this thing without any careful analysis of what the bill-as-amended would actually do.
The original version, pulled from the House floor back in March, would have reduced the number of insured Americans by an estimated 24 million; we don't know whether this version will do better or worse. Nor do we have any neutral estimates on how it would affect premiums or anything else.
We do know that the bill polls very badly, and it's unlikely that individual provisions poll well — there's not a lot of support out there for cutting off funding for special education, for example. Or ending the ban on lifetime caps or protections for those with pre-existing conditions — including for those with employer-linked insurance. This really differs from Obamacare, where most of the individual provisions were popular, but not the overall law. And recently, the Affordable Care Act itself has become popular, anyway, making the Republican repeal effort even more risky for them.
The biggest questions now are about what will happen in the Senate. This is a "reconciliation" bill, which means it will be protected against filibusters and will need only a simple majority to pass. But it also means that only certain provisions (those that affect the federal budget) can be included. It's entirely unclear what the Senate parliamentarian — an unelected official who singlehandedly makes major decisions on the reconciliation process — will allow, and what Mitch McConnell and Senate Republicans will do if the parliamentarian turns what the House has done into Swiss cheese by stripping various provisions from it.
Sen. Susan Collins, R-Maine (Photo: Collins)
