Republicans Pass Obamacare Replacement Bill; Let The Senate Bickering Begin


After a stunning defeat on March 24th, followed by over a month of back and forth bickering, Paul Ryan & Co. has finally passed an Obamacare replacement bill after just securing the required 216 votes.



And Republicans launched into song to celebrate:

"Na na na na, hey hey hey, goodbye!"


Per the Washington Post, here is what happens next:

Bill must pass Senate

Because Republicans hope to pass this legislation under the less-onerous budget reconciliation process, which would allow it to pass the Senate with only 51 votes, House leaders must make the bill comply with the Senate’s “Byrd Rule.” Generally, the rule says a reconciliation bill must relate to the budget, which means some of the Affordable Care Act’s provisions cannot be addressed via this process because they do not deal with taxes or spending. It also stipulates that the law cannot add to the deficit in the long term (10 years after it is implemented).


It will be up to the Senate parliamentarian to decide whether the legislation meets the Byrd Rule standards. Democrats have said that the bill does not meet the standard, something Republicans sacrificed in favor of a more complete repeal.


It’s likely that the Senate will do a significant rewrite of the legislation, modifying it but also setting up a showdown with House Republicans aiming for a more conservative approach.


If the House and Senate bills differ, a conference committee is formed

It’s almost certain that the Senate version of the legislation will look nothing like the conservative bill the House hoped to pass Thursday. If and when this happens, it’s common for a group of lawmakers from the two chambers to come together to iron out the differences between the bills. The result is then presented to both chambers for a final up-or-down vote.


President signs the bill into law

If Trump sours on the bill, he could decide to veto — effectively killing the legislation. Or he could sign it, kicking off the next phases of the Republican effort to dismantle Obamacare: further regulatory actions and additional legislation.


Last year, an Obamacare repeal bill cleared both houses but was promptly vetoed by President Barack Obama in defense of his signature policy accomplishment.


Administrative actions

 Beyond the AHCA, Republicans have outlined two other phases of health-care overhaul. The first of those is an easing of regulations, begun by Trump’s Jan. 20 executive order telling federal agencies to “minimize the unwarranted economic and regulatory burdens” of Obamacare. Regulatory reforms could include narrowing the list of benefits that Obamacare requires insurers to cover.


Additional legislation

 Because only budget-related items are allowed in a reconciliation bill, Republicans also plan to address other aspects of the replacement with at least one other piece of legislation. This bill would be subject to the filibuster, requiring 60 votes — and at least eight Democrats — to get to a Senate floor vote. It could include allowing people to buy insurance across state lines.

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On March 24th, President Trump and Republicans suffered an embarrassing defeat, at the hands of their own party no less, when they failed to rally the Freedom Caucus around their Obamacare replacement bill.  Today, after nearly a month of back and forth bickering, Paul Ryan & Co. is ready to give it another try. 

Tune in below for what will be President Trump's first major legislative victory or second embarrassing defeat.


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For those who missed it, below a preview of today's vote that we posted earlier this morning:

It's a big day for Paul Ryan and Republicans in the House.  With the stage set for another Obamacare repeal and replace vote later today, all eyes will be anxiously watching to see whether the day will end in another miserable, embarrassing defeat or whether a new healthcare bill will finally be sent to the Senate.

Republicans have become increasingly confident throughout he week that they have the votes after several moderate Republicans switched from 'no' to 'yes' after changes were made to allow for more funding to cover patients with pre-existing conditions.  According to Bloomberg, the Trump administration projected confidence about the outcome at a White House dinner last night after an aide joined the dinner late, saying the count had reached 218, two more than needed to guarantee passage. The aide added that he thought the final tally would top 220 votes, according to two people who attended.

Of course, no Democrats are expected to back the bill so Republicans can only lose 22 votes from their own party if everyone in the House casts a vote.

Meanwhile, Kevin McCarthy seemed somewhat confident as well after leaving Paul Ryan's office last night.

“Would you have confidence? We’re going to pass it."


"We will be voting on the health care votes tomorrow. Because we have enough votes. It'll pass. It's a good bill."


That said, and to our great 'shock', House Minority Leader, Nancy Pelosi, continued to trash the new healthcare legislation, per CNN...

House Minority Leader Nancy Pelosi blasted the bill and decision to vote Thursday.


"Forcing a vote without a CBO score shows that Republicans are terrified of the public learning the full consequences of their plan to push Americans with pre-existing conditions into the cold," Pelosi said in a statement. "But tomorrow, House Republicans are going to tattoo this moral monstrosity to their foreheads, and the American people will hold them accountable."

... even though, as we pointed out yesterday, Obamacare exchanges around the country continue fail in epic fashion with the latest casualty coming in Iowa where the last large insurer, Medica, just announced they'll abandon the Iowa exchange in 2018 leaving pretty much the entire state without a single option for purchasing health insurance.  Per the Des Moines Register:

Medica, a Minnesota based health insurer, released a statement suggesting it was close to following two larger carriers in deciding not to sell such policies in Iowa for 2018, due to instability in the market.


“Without swift action by the state or Congress to provide stability to Iowa’s individual insurance market, Medica will not be able to serve the citizens of Iowa in the manner and breadth that we do today. We are examining the potential of limited offerings, but our ability to stay in the Iowa insurance market in any capacity is in question at this point,” the company’s statement said.

Of course, all of this should come as little surprise to our readers as we've been writing for years that the entire Obamacare system was on the "verge of collapse" as premiums were soaring, risk pools were deteriorating and insurers were pulling out of exchanges all around the country leaving many Americans with just a single 'option' for health insurance (see "Obamacare On "Verge Of Collapse" As Premiums Set To Soar Again In 2017").  In fact, the following charts provide a stunning illustration of that collapse (charts per Bloomberg):



So, if the bill manages to pass the House, the real question becomes what happens in the Senate?

Assuming Republicans can pass the bill via the reconciliation process they'll only need a simple majority and they control 52 seats.  That said, at least eight Senate Republicans are strongly opposed to different elements of the bill which means modifications will be required to flip at least 7 Republican votes.

But, even if they're able to flip the votes required, Schumer has already threatened to throw up a procedural roadblock known as the "Byrd Rule."  The rule governs legislation passed under the special budget rules Republicans are using to pass the healthcare legislation. To pass muster, legislation must be primarily focused on addressing the deficit, which is why only provisions that have a budgetary impact can be included.  That said, Senate Democrats will argue that changes like an amendment that allows states to opt out of certain elements of the bill would violate the Byrd Rule. Per The Hill:

"To my moderate Republican colleagues in the House, I ask, 'Why would you risk a yes vote for a bill that is devastating to your constituents and has virtually a minuscule chance, virtually no chance of becoming law?' " Schumer asked on Wednesday.


He added that "the reality is TrumpCare cannot pass the Senate."


"The amendment to allow states to drop pre-existing condition requirements, for instance, very possibly violates the Byrd rule. If the moderate group in the House gets an additional amendment to the deal with the very same issue, that may violate the Byrd rule as well," Schumer said.

So what say you?  Does the Trump administration score it's first major legislative victory today or will Republicans deliver themselves another embarrassing defeat?