Now that there is again at least a fighting chance the House passes the revised American Health Care Act, a.k.a. Zombie Trumpcare, it may be time to review the well-founded but hardly infallible conventional wisdom that the bill is doomed in the Senate.
Everyone would concede that no matter how many obstacles there are to Senate passage of a bill that can eventually produce a compromise that can pass the House, the odds of running this gauntlet are a lot better than enactment of any major health-care legislation if the GOP bill fails a second time in the House. Some progress is better than no progress.
The sobering reality for senators is that if the House passes anything, those in the upper chamber will soon be shooting with live ammo. This may help explain why senators aren’t loudly deriding the House effort this time around, as Politico reports:
Compared with the Senate GOP’s open attempts to sink the previous effort by House Republicans, senators have been relatively muted this time. There’ve been no blistering statements from conservative Sens. Ted Cruz of Texas, Mike Lee of Utah and Rand Paul of Kentucky, nor has Sen. Tom Cotton of Arkansas done a media tour warning that House members could lose their seats for supporting the legislation …
“People are coming to a conclusion that it’s pretty important at some point we legislate on this. We’ve got to deliver,” said Sen. John Thune (R-S.D.). “People are starting to calm down a little bit and tone down some of the rhetoric. … If we’re going to get a solution, all of us are going to have to figure out a constructive way to make that happen.”
To put it another way, while the House is just trying to avoid a self-inflicted defeat, Senate Republicans know they need to produce a victory, or the entire party may suffer in 2018. That alone may make the Senate GOP’s various factions more flexible.
Substantively, Republican senators can add some nips and tucks to address various needs, including more tax-credit money for low-income individuals, more money for people with preexisting conditions, a slower death for the Medicaid expansion, and less stringent rules for Medicaid funding going forward. Keeping conservatives in both houses aboard may require more of the “state flexibility” magic that secured the endorsement of the House Freedom Caucus — basically allowing states to implement conservative policies that Senate moderates oppose for the whole country. Indeed, an even broader “state option” approach has been kicking around the Senate for months in the form of the Cassidy-Collins legislation that lets states decide whether to keep or abandon the basic structure of Obamacare.
A key question that cannot be answered yet is whether the state-option provisions in Zombie Trumpcare can survive a “Byrd Bath” — the review of legislation by the Senate parliamentarian to determine whether provisions reasonably belong in a budget bill. If the parliamentarian plays ball, the Senate’s job gets easier in the sense that it can manipulate health-care regulations in the manner needed to get to 50 votes (versus 60 for a standard piece of legislation).
And therein lies one big Senate problem: whereas House Republicans can afford to lose 22 votes and still pass legislation without Democratic support, the Senate GOP can only lose two senators. Both Susan Collins and Lisa Murkowski have strongly opposed provisions “defunding” Planned Parenthood — without which no budget reconciliation bill can get to the starting gate with most other Republicans. Murkowski has separate concerns involving Alaska’s unusual health-care needs. If Mitch McConnell is not careful, his conference could devolve into a long line of senators with their hands out wanting some special inducement in exchange for becoming the 50th vote for health-care legislation.
Still another problem is optics: If the House does pass Zombie Trumpcare this week, it will dodge what will probably be a quite negative Congressional Budget Office “scoring” of the final bill in terms of its cost and coverage impact. The Senate will not have that luxury.
All these concerns help illustrate why most observers are skeptical that the Senate can come up with a health-care bill that gets to 50 votes but that is still compatible with the unwieldy House alliance put together with baling wire and chewing gum to pass Zombie Trumpcare. For the many millions of Americans who will be adversely affected by any GOP health-care bill, though, betting on failure could be a costly gamble.