It seems that few, if any, Americans – let alone Republicans – are happy about the GOP health care plan. The plan is being panned by radio callers, medical trade groups and the Freedom Caucus, which plans to offer its own bill with a simple and straightforward Obamacare repeal. Republicans promised to repeal and replace Obamacare, so why not just repeal it immediately? The answer is simple: They can’t.
In the last Congress, the Republicans had a 54-46 majority in the Senate. This fell short of the 60 votes needed to end debate on legislation and the 67 votes needed to override President Obama’s veto. Republicans were effectively blocked by Democratic filibusters even though they had a majority.
In the 2016 elections, Republicans managed to keep control of the Senate, but lost two seats to the Democrats. Republicans now also hold a 59 seat majority in the House of Representatives. With a Republican president who won’t veto a repeal of Obamacare, everything should be easy, right?
Not exactly. Republicans are eight votes short of the 60 needed to bring a bill to a vote. Without at least eight Democrats breaking ranks to vote for cloture, the Senate cannot consider Republican bills. Filibusters and cloture votes are a long tradition in the Senate that have been utilized by both parties. Right now the ball is in the Democrat court.
An exception to the cloture rule is the annual budget reconciliation. The budget reconciliation was created by the Congressional Budget Act of 1974. It requires only a simple majority vote to pass and is not subject to filibusters. The Democrats passed Obamacare into law as part of a budget reconciliation in 2010 and Republicans intend to use the maneuver to pass their own health plan.
So why not use the budget reconciliation to simply repeal Obamacare? Four Republican senators have pledged to join the Democrats in voting against any repeal bill that does not allow a period to phase out Obamacare’s Medicaid expansion. The four, Lisa Murkowski of Alaska, Cory Gardner of Colorado, Rob Portman of Ohio and Shelly Moore Capito of West Virginia, are all from states that chose to adopt the Medicaid expansion. If the four cling to their pledge, a budget reconciliation with a simple repeal would be defeated in the Senate. Given the opposition of the Medicaid Four, Republicans had no choice, but start tinkering with a replacement that would garner their votes.
Republicans are also losing the battle of public opinion on repeal. While repeal – like The Wall – is popular among Republicans, that isn’t the case with the public at large. A spate of recent polls show that Obamacare is actually gaining in popularity. Several polls show that a majority want Republicans to keep Obamacare and change the law to fix it.
So that was what Republicans did. Their American Health Care Plan amends the Affordable Care Act, keeping some of Obamacare’s more popular provisions and replacing other parts with a Republican prescription for change. The result was a bill that seems to have pleased no one except President Trump.
Now the Republican TrumpCare bill seems as unlikely to pass as a straight repeal would have been. Members of the Freedom Caucus are coming out against the bill in the House. In the Senate, Rand Paul (R-Ky.), Mike Lee (R-Utah) and Tom Cotton (R-Ark.) have lined up against the bill and Ted Cruz (R-Texas) seems likely to join them in voting no.
That Republicans could have written a better health care bill is not a question. Speaker Ryan presented his own health care plan based on conservative principles last summer. Several other plans have been floated as well, including one by Tom Price, the new Secretary of Health and Human Services. Any one of them would have been more popular than the current bill.
Nevertheless, it isn’t the whole GOP that is preventing the repeal of Obamacare. It is the Medicaid Four.
At this point, repeal of Obamacare seems as unlikely as it did when Barack Obama was president. As under Obama, the reason is simple. Even with a congressional majority and a friendly president, Republicans don’t have the votes to kill Obamacare. The best idea for the GOP right now would be to scrap the current bill and go back to the drawing boards for a bill that will win the support of the Medicaid Four as well as the Freedom Caucus.