Politics & Policy

GOP Health-Care Bill Will Only Get Worse without Emergency Surgery

Senator Ted Cruz speaks at CPAC 2017 (Reuters photo: Joshua Roberts)
The Cruz move to use ‘reconciliation’ right now may be just what Republicans need.

House Republicans are being herded and whipped into voting for a controversial health-care plan this Thursday. Moderates and conservatives in the GOP may disagree on the problems with the bill, but an increasing number fear that they will be asked to cast a risky vote for a measure that can’t possibly pass the Senate as is and that can’t deliver on the promise to “repeal and replace” Obamacare. “We don’t have a realistic plan to get from point A to what we can sell the public, and if we don’t get one, the Democrats in the Senate will eat our lunch,” one GOP House moderate told me.

The bill before the House this week is supposed to be the first of three phases in replacing Obamacare. The bill — phase one — repeals the taxes and revamps the subsidies created by Obamacare. The second phase is meant to involve Health and Human Services Secretary Tom Price, using his administrative power to repeal Obamacare directives.

Speaking about this second phase, Senator Ted Cruz of Texas told CBS’s Face the Nation on Sunday: “That ain’t going to happen.”

Cruz went on to cast doubt on the third phase of the process as well, which is supposed to entail passing a package of insurance reforms that would bring down the soaring cost of insurance premiums for Americans. But the third phase is highly problematic. “Bucket three takes eight Democrats” to get to 60, he said. “Right now, Senate Democrats are opposing everything. You can’t get eight Democrats on agreeing to say, ‘Good morning.’”

“At the rate we’re going, this bill is moving in key ways to the left and is likely to go more that way in the Senate,” Representative Raul Labrador of Idaho told me. Indeed, Speaker Paul Ryan is already wooing moderate Republicans in the House with more generous health-care tax credits for the elderly. Requests from GOP conservatives to further expand health savings accounts are being brushed aside. Politico reports that “from the White House to the Hill, top GOP officials by-and-large ‘feel talks with the far right are just about done.’” In other words, if something does indeed pass Congress this year, it will be a pale shadow of the “repeal and replace” promise that Republicans have been making for the past seven years.

Senator Cruz believes it doesn’t have to be that way. “If it can be passed with reconciliation, it can be repealed with reconciliation,” Cruz told CNSNews in early February. “And we need to use every procedural means possible to fight to stop the train wreck that is Obamacare.”

Speaking of the 1974 Budget Act that created reconciliation, Cruz told CBS’s John Dickerson on Sunday: “It lays out a test for what is permissible on reconciliation. . . . The central part of the test is, it is budgetary in nature? If it is budgetary in nature, you can do it. If it’s not, you can’t.”

If Republicans let Senate Democrats water down health-care reform even further, they will be making it likely that a full government takeover of the system is only a political turn of the wheel away.

Last week, Cruz told reporters, “Under the Budget Act of 1974, . . .  it is the presiding officer, the vice president of the United States, who rules on what’s permissible on reconciliation and what is not.” The role of the parliamentarian, he said, was simply to advise, not rule.

If the current parliamentarian, Elizabeth MacDonough, were to rule that GOP-favored reforms (such as allowing insurance companies to sell across state lines or instituting medical-malpractice reform) had only an “incidental” impact on the budget and would therefore be outside reconciliation, the vice president could simply overrule her. “All of these reforms clearly have a major impact on federal health-care expenditures — it’s pure common sense,” Cruz told me.

Of course, Senate Democrats would howl that bypassing the Senate’s parliamentarian would represent a coup against Senate traditions. That ignores the fact that Democrats have often manipulated the process in the past, sometimes by ignoring reconciliation rules to pass President Bill Clinton’s welfare-reform proposals.

Richard Arenberg, a former aide to several Senate Democrats, calls the Cruz move toward reconciliation “a partisan power grab.” Sadly, the Senate’s behavior has deteriorated in that direction over the last several years, especially when then–majority leader Harry Reid did away with a 60-vote requirement to confirm Cabinet officers and all federal judges below the Supreme Court.

If Republicans blink and allow Senate Democrats to water down health-care reform even further, they should know they will be sabotaging true health-care reform and making it likely that a full government takeover of the system is only a political turn of the wheel away.

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