The Problem with Hoping for ‘Phase Three’ of Obamacare Repeal

by Jim Geraghty

President Trump and Health and Human Services Secretary Tom Price assure disgruntled conservatives that the bill currently trying to win enough votes in the House of Representatives is only “phase one” of their health care reform plan. Phase Two is the HHS Department repealing and changing the regulations enacted under Obamacare, and Phase Three, which would include concepts like selling insurance across state lines, would come later . . . when there are 60 votes in the Senate willing to vote in support of them.

As Price wrote:

Achieving all of the President’s goals to reform healthcare will require more than what is possible in a budget reconciliation bill, as procedural rules on this type of legislation prevent inclusion of key policies such as selling insurance across state lines, lowering drug costs for patients, providing additional flexibility in Medicaid for states to manage their programs in a way that best serves their most vulnerable citizens, or medical legal reforms.

When do Republicans envision having 60 votes in favor of these ideas? Assume the American Health Care Act passes the House, at least 50 Republicans in the Senate vote for it and Trump signs it into law. For “Phase Three, “ will eight Senate Democrats be eager to vote with Republicans to make further reforms?

If you’re a Democrat, after AHCA passes, Republicans “own” the status quo on the health care system. You can blame AHCA for anything any constituent doesn’t like about their insurance, their premiums, their co-pays, their deductibles, or their quality of care. It may or may not be accurate, but let’s face it, accuracy has never mattered much in attack ads.

Could some red-state Democrats up for reelection in 2018 feel some pressure? Eh, maybe, but right now Senate Democrats look pretty unified in opposition to just about all of the GOP repeal-and-replace ideas. It’s just about impossible to imagine eight Democrats joining with 52 Republicans to enact Trump’s health care reform agenda.

Is the plan to wait until after the midterms? We have no idea what to expect in the midterms; in 2006, 2010 and 2014, the president’s party got wiped out in the midterm elections. Even in a good year, winning an additional eight Senate seats is a tall order.

Sen. Tom Cotton’s been emphasizing this point in the past few days, scoffing to Hugh Hewitt about the idea of “some mythical legislation in the future that is going to garner Democratic support and help us get over 60 votes in the Senate. If we had those Democratic votes, we wouldn’t need three steps. We would just be doing that right now on this legislation altogether. That’s why it’s so important that we get this legislation right, because there is no step three.”

Nuking the filibuster appears to be off the table, at least for now. So what’s the roadmap to get to 60 votes? And if there is no viable path to get 60 votes . . . how do the ideas in “Phase Three” ever get enacted?

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