If, as is now widely anticipated, the American Health Care Act bill goes down to defeat in the House on Friday — or for that matter, dies later in the Senate, in a House-Senate conference committee, or in votes on a conference report in the House or Senate — the consequences are not limited to health-care policy. And by that I am not simply talking about the political consequences of the GOP failing to redeem a long-standing promise, or of the White House and the congressional GOP leadership pointing fingers at each other in a postmortem blame game.
There will be some more immediate and pungent fish to fry in terms of provisions in this year’s budget-reconciliation bill that have little or nothing to do with the health-care benefits bestowed by the Affordable Care Act.
First of all, the taxes repealed in the AHCA (a year earlier in the latest version) didn’t simply represent a nice reward for the wealthy Americans mostly affected. They were also intended to lower the revenue baseline against which the tax cuts in the next big Republican legislative measure, the so-called “tax reform bill,” would be measured, making it easier to permanently cut taxes under budget rules requiring revenue neutrality within ten years. Thus, as House Ways and Means Committee Chairman Kevin Brady admitted today, his job in designing the tax plan that was supposed to consume Washington once Obamacare was repealed and replaced has suddenly become more difficult.
Second, the AHCA included a piece of legislation considered must-pass by many, many conservatives: the defunding of Planned Parenthood (indeed, this very morning the president jabbed his House Freedom Caucus tormenters on Twitter for letting Planned Parenthood funding continue by blocking AHCA). If the health-care bill is no longer available as a vehicle for meeting this demand, congressional Republicans must find another quickly, or run the risk of anti-abortion advocates forcing an appropriations battle with Democrats over Planned Parenthood that could culminate in the last thing the GOP needs: a government shutdown. Unfortunately, defunding Planned Parenthood is not a popular cause among the public generally, so nestling it in some larger legislation was a good idea that so far hasn’t worked out.
Third and finally, AHCA sneaked into place a Medicaid “reform” that was not necessary to the repeal and replacement of Obamacare: a per capita limitation on federal funding for Medicaid beneficiaries. This provision was actually broadened in the final version the House is voting on today into an option for states to turn Medicaid into a block grant that caps overall federal spending on the program. With both the White House and congressional Republicans taking a pass so far on the perilous project of fundamental changes in Social Security and Medicare, these Medicaid provisions are about the only entitlement reforms on the table this year. And now they may fall through the cracks unless they are pursued in some other bill, like perhaps the tax reform measure that could always use some more offsetting budget savings.
All these orphans of the failed AHCA will represent hungry mouths that will still need to be fed by the GOP. There will be little time for regrouping and a lot of pressure to get everything right going forward.