The Path to Passing the GOP's American Health Care Act

The American Health Care Act (ACHA), the House Republicans’ bill to replace the Affordable Care Act (ACA), has been announced to strong opposition from not only Democrats, but also members within the party. This dissatisfaction stems from the reconciliation process Republicans are relying on to get the Obamacare repeal bill through the Senate, which limits the number of changes the GOP can make.

During a speech at America’s Health Insurance Plans’ National Health Policy Conference, held March 8-9 in Washington, DC, Newt Gingrich, former House speaker, ran through the hurdles Republicans will have to jump through in order to get the ACHA passed.

The GOP had campaigned on repeal and replace for years, which meant it was required to pass some kind of repeal in order to “appease the Republican base,” Gingrich said. However, the reconciliation process mandates that anything changed must closely relate to spending money, and there is a parliamentarian who chooses how strictly to interpret that rule. As a result, since the Republicans must work within the confines of reconciliation, conservatives are unable to deal with other parts of the ACA that they would like to address.

“So you end up with a bill that is, in some ways, a little bit deformed by the legislative requirements of putting stupidly something you would like to do intelligently, but you can’t do it intelligently because then you can’t pass it,” Gingrich said. “So if you send over the bill you would like to send over, it would die; but to send over the bill that can survive, you’re going to send over a bill you don’t like.”

Now, the very conservative House Freedom Caucus is unhappy with the bill that has been released because it does not go far enough to repeal the ACA. The House Freedom Caucus currently holds 32 seats in Congress, and if they all vote against ACHA, House Speaker Paul Ryan, R-Wisconsin, will not have enough votes to pass the bill.

So now, Gingrich says, the party whip has to go out and find out how many votes the party can convert from “no” to “yes.” However, he believes that with President Donald Trump and HHS Secretary Tom Price, the caucus’ members might be willing to vote for the bill with the promise that it will be tweaked later on.

The real challenge is in the Senate. Even if the bill gets out of the House with few amendments, Senate Majority Leader Mitch McConnell, R-Kentucky, can only afford to lose 2 votes because this is expected to be a completely partisan vote.

“Legitimately, no Democrat is going to vote to repeal Obamacare,” Gingrich said. “It guarantees they’ll have an extraordinarily tough primary. And they have no vested interest. Why would they do that?”

He estimates that McConnell has 10 Republican senators who don’t like ACHA and could vote against it: 2 moderates with concerns about Medicaid; at least 4 conservatives opposed to the bill on general principle; and another 4 who are opposed on policy grounds.

In the process of converting some of those votes, McConnell has to be wary of making changes to the bill.

“As you put [the votes] back together, you also have to be concerned about the notion: do you accept amendments in the Senate which now makes it impossible for Ryan to get it through the House?” Gingrich asked. “And if you bring it out of the Senate, do you bring it to conference and try to match the bills up?”

Conference has its own challenges depending on timing. The plan for the ACA had been to bring the House and Senate bills to conference to work out the differences. However, Ted Kennedy, who had been the Democratic senator from Massachusetts, passed away, which meant the ACA couldn’t be sent back to the Senate, because Democrats didn’t have enough votes to pass a new bill.

Ultimately, Gingrich believes that Trump will not want to lose his first big bill. There are a few aspects of GOP healthcare reform that will likely stay intact:

· Get the power out of Washington

· Try to be economically rational

· Move toward a system that is more open and oriented to innovation and change

· Maximize competition

“I will stipulate right now that something will get signed into law,” Gingrich said. “I don’t have a clue what it will look like. And I actually don’t think they do either, because they have to wait and see how the pressure cooker works.”