As Republicans battled to get enough votes to bring the revised American Health Care Act to the House floor, I took a look ahead and the prospects for this legislation in the Senate. It was not a pretty sight, as I explained at New York.
Normally in a situation like this, where a party’s president is 100 percent invested in a piece of legislation, you would look for scattered signs of internal opposition among that party’s senators and speculate as to whether the White House could wear it down. But there is nothing scattered about Senate Republican misgivings over Trumpcare: It appears to be endemic, as Politico reports:
“The hurdles in the upper chamber were on vivid display Wednesday as House Republicans celebrated their breakthrough on the stalled repeal effort. The compromise cut with House Freedom Caucus members won over the right flank, but the changes will almost surely make it harder to pick up votes in the more moderate-minded Senate.
“Not to mention that some Senate conservatives still seem opposed to the emerging House deal.”
They sure are. Rand Paul and Ted Cruz, who helped derail the original “replace and delay” strategy that might have at least temporarily papered over GOP differences of opinion over health-care policy, are making discouraging noises about Zombie Trumpcare. Paul in particular seems determined to quash any happy-talk about consensus:
“The Freedom Caucus has done a good job of trying to make the bill less bad,” Sen. Rand Paul (R-Ky.), one of the lead Senate agitators against the House health care push, said Wednesday. “For me, it’s a big stumbling block still that there’s taxpayer money that’s being given to insurance companies, and I am just not in favor of taxpayer money going to insurance companies.”
The more any eventual bill has to shift in the direction of Senate conservatives, of course, the less support there will be from moderates. And lest we forget, the GOP can only lose two senators to pass health-care legislation, barring any support from Democrats — and there are zero signs of any Democrats even considering a defection so long as the bill is being pushed on a party-line basis via budget-reconciliation rules that prohibit filibusters.
The rules governing the reconciliation procedure present another potentially big problem for Senate Republicans. The House bill, and particularly the new version with its authorization of state waivers of existing Obamacare regulations, is very likely to run afoul of the Senate parliamentarian’s enforcement of the Byrd Rule prohibiting non-budget-germane provisions in budget bills. If such provisions have to be struck, the compromises that have made it possible for the House to revive Trumpcare could quickly unravel.
And then there is the strong possibility that the Congressional Budget Office will “score” the House bill in a manner that makes its negative impact on health-care coverage vivid. The House itself may be able to avoid terrible publicity on the “score” by racing to a vote before CBO’s analysis comes down. But that evasion will not be possible for senators.