House Postpones ACA Repeal Vote As Support Dwindles
By Harris Meyer Modern Healthcare March 23, 2017
House Republican leaders fell short of rounding up enough GOP votes to pass a bill in their race to repeal and replace the Affordable Care Act, and have indefinitely postponed a House floor vote scheduled for Thursday.
The U.S. House of Representatives' ultra-conservatives reportedly rejected an offer from President Donald Trump Thursday morning to include a repeal the ACA's minimum essential benefits requirement in the proposed American Health Care Act. Members of the House Freedom Caucus said they needed more changes in the bill to reduce health plan premiums, or else they would vote against it.
All House Republicans are scheduled to meet Thursday night to discuss their options.
Chris Condeluci, a Republican healthcare lobbyist and former Senate staffer, predicted House Speaker Paul Ryan of Wisconsin would give members the option of either giving up on repealing the ACA or supporting a different revised version of the bill. Opponents likely will be warned that they will bear the political blame if their party fails to fulfill its seven-year-old promise to kill Obamacare.
“It's not over until the fat lady sings,” said Condeluci, who said he's growing increasingly pessimistic about the odds of passing a repeal bill. “She's warming up her vocal chords right now. Maybe tonight we'll hear something different.”
Any changes agreed to in the conference would go to the House Rules Committee, whose Republican majority has promised to quickly approve any revisions and move them on to the full House for a vote.
As of Thursday afternoon, 37 House Republicans, mostly Freedom Caucus members, had declared their opposition to the bill, the Washington Post reported. A handful of more moderate GOP members, including Rep. Charlie Dent of Pennsylvania, announced their opposition, spurred by proposed revisions that likely would further reduce Medicaid spending and coverage.
White House spokesman Sean Spicer continued to say he anticipated a House vote on the bill by the end of the day. But most other observers said a vote would not happen Thursday because there was no final bill and no deal that would win enough conservatives and moderates to pass the bill with no expected Democratic votes.
Any delay in the House vote would set back GOP plans to pass the bill in both the House and Senate before the Easter recess begins April 7. GOP leaders fear that their members will come under strong pressure to oppose the bill when they return to their districts and face constituents upset about the prospect of losing their ACA coverage.
At least a dozen Senate Republicans have expressed doubts about whether they could support the House bill in its current form. There are big uncertainties about whether provisions to change the ACA's insurance market regulations would comply with the Senate's budget reconciliation rules allowing legislation to pass with 51 votes.
Condeluci said there are ways Republicans could revise the bill to satisfy both conservatives and moderates and comply with Senate rules. For example, the language on changing the ACA's benefit requirements could be written in a way that the Senate parliamentarian would determine had a budgetary impact and therefore was permitted.
But House ultra-conservatives would have to compromise, which currently is the major GOP obstacle.
“If conservatives continue to say no, they'll never achieve Obamacare repeal,” Condeluci said. “Maybe, sadly, they're OK with that, and they just want to continue to be opposition party because they're in the news and they're getting attention.”
But other observers say whatever bill comes out of the House will face shaky odds in the Senate due to the bill's large Medicaid spending cuts and coverage losses projected last week by the nonpartisan Congressional Budget Office.
Jim Manley, a Democratic lobbyist and ex-aide to former Senate Democratic leader Harry Reid, said repealing the minimum benefits requirement is one more feature that would doom the bill. He said many Republican senators, such as Ohio's Rob Portman, will worry that it would hurt access to substance abuse treatment in their addiction-wracked states.
“This is destined to failure,” he said. “It would die a quick, painful death in the Senate.”