Washington DC Policy Update 3/10/17

Republican Health Bill Clears Hurdle as House Panels Approve

The second of two key congressional committees cleared a Republican health care bill, moving the legislation to repeal and change many key parts of Obamacare a step closer to a full vote in the House of Representatives.

The House Energy and Commerce Committee, after a 27-hour session that saw tempers flare as Democrats tried to delay the legislation, approved the bill by a 31-23 vote with only minor changes. The vote came after the Ways and Means Committee wrapped up 18 hours of debate on its piece of the proposal, which it passed without any changes. The two measures will be combined and sent to the Budget Committee before heading to the floor.

The bill, the American Health Care Act, would repeal Obamacare’s requirement that individuals have, and employers offer, health coverage and would eliminate many taxes on the wealthy, insurers and drugmakers used to fund Obamacare. The proposal includes a refundable, age-based tax credit to help people buy insurance and a wind-down of an expansion of Medicaid over a period of years.

Critics of the plan are worried people will forgo insurance without a mandate and that only the sickest will sign up. The Republican bill attempts to address that by allowing insurers to charge people as much as a 30 percent surcharge if they don’t maintain continuous coverage, though that may not be enough to entice younger, healthier people to buy insurance.

The AHCA still has major hurdles to overcome as conservatives, doctor and hospital groups, the main lobbying group for seniors and insurers have all expressed concerns or gone as far as to oppose the measure outright. Conservatives have panned the proposal because, while it repeals many parts of Obamacare, it also provides what they still see as large entitlements. Groups that lobby for doctors, hospitals, and insurance companies say the AHCA would not adequately fund Medicaid, the government program for the poor, and that the tax credits would not be high enough.

Conservative Opposition

Conservatives have opposed the bill’s same provisions — but because they say they go too far. Representative Joe Barton, a Texas Republican, proposed an amendment to try to address those concerns and potentially help bridge a divide within the GOP that has threatened the party’s health-reform efforts.

He withdrew the amendment at the request of Greg Walden, chair of the Energy and Commerce Committee, so lawmakers could continue to work on it for possible reintroduction, Barton said after the final vote.

“I’m not going to embarrass my chairman,” said Barton, a former chair himself.

The amendment would have frozen the Medicaid expansion next year instead of in 2020, after the mid-term elections. Thirty-one states have expanded Medicaid under Obamacare.

“There are probably some Republicans from the Medicaid expansion states that had problems with my amendment, and I respect that, but there are a lot of conservative groups, including the Republican Study Committee and the Freedom Caucus, that were very supportive,” Barton said.

His proposal may be a tough sell in the Senate, where Republicans have only a 52-48 margin and some lawmakers, including Republicans from states that expanded Medicaid, do not want to strictly limit the program.

Defense Bill Stalled as Senate Awaits Supplemental, Obamacare Repeal

A $580 billion Department of Defense spending plan will probably remain on hold while the Senate tackles other priorities like repealing the Affordable Care Act and resolving unfinished appropriations measures, lawmakers said.

Senate Republicans said Majority Leader Mitch McConnell (R-Ky.) hasn’t laid out plans detailing when he will try to take up the House-passed Defense bill, they said, and the outlook for wrapping up work on the fiscal year 2017 spending bills is also being complicated by the late arrival of President Donald Trump’s request for supplemental monies for the Pentagon and a border wall.

The developments suggest it is increasingly likely that the 2017 bills won’t get wrapped up until much closer to the April 28 deadline, when federal funds are due to expire, Republicans said.

House and Senate leaders put off finishing the bills late last year in order to give President Donald Trump more say in federal spending decisions. However, the continuing resolution Congress passed in December to fund the federal government is due to expire in April. Money for the federal agencies will lapse unless new legislation is passed.

Senate Republican Conference Chairman John Thune (R-S.D.) said March 9 that the Republican Party’s priorities are now to reserve floor time for the ACA replacement legislation the House is moving and the nomination of Neil Gorsuch to serve on the Supreme Court. Action on other items before lawmakers depart April 6 for a two-week recess are possible, but a large spending package is an item likely to wait in the wings until after the break, he said.

“[I]f there’s a window somewhere to wedge in [something] dealing with these undone appropriations bills from last year, then I’m sure Mitch will try to find a way to do that, but I think right now those are the two top priorities,” Thune told reporters after a closed-door meeting of Republicans.

Details of Bills

The House passed by a large margin the previous day the massive Defense bill (H.R. 1301) and sent it to the Senate for follow-up action. House Speaker Paul Ryan (R-Wis.) said he does not plan to bring up any of the other 10 unfinished appropriations bills but instead will let McConnell develop and execute a strategy for finishing the measures.

Under discussion, lawmakers said, is a scenario in which many of the non-defense appropriations bills are added to the Defense measure and then put to a vote. Such an omnibus then would be sent back to the House for final action, they said.

However, appropriators said they still are fighting against calls for lawmakers to simply pass Defense and then provide another CR for non-defense programs. The only FY 2017 measure passed by both chambers is the Military Construction and Veterans Affairs bill.

Lawmakers acknowledged there might be a middle ground where some bills are attached to Defense and other programs are funded by a new CR. Such a “cromnibus” was used in prior years to wrap up appropriations work.

However, both Democrats and Republicans on the Senate Appropriations Committee said they continue to negotiate the final details of all 10 outstanding bills. Among those that are said close to completion are the bills for Legislative Branch, Agriculture, and Transportation, Housing, and Urban Development priorities.

Sen. Jerry Moran (R-Kan.), who chaired the Agriculture Subcommittee in the previous Congress, said the agriculture bill is close to completion but issues related to the regulation of cigarettes and cigars remain unsettled. In the House, appropriators are trying to preserve language to keep the Food and Drug Administration from applying retroactively rules affecting e-cigarettes. However, such issues again are likely to be settled by leadership, he said.

“I’d expect again in the ’17 bill it will be determined by higher authority,” Moran said.

Similarly, regulation of the trucking industry is said to be a holdup in resolving the final version of the THUD bill. THUD Subcommittee Chairman Susan Collins (R-Maine) declined to discuss specifics but said progress is being made in talks with the House.

Sen. Roy Blunt (R-Mo.), chair of the Labor, Health and Human Services Subcommittee, said he and ranking member Sen. Patty Murray (D-Wash.) also are close to a deal on what is typically one of the most difficult measures to pass.

“Sen. Murray and I are largely in agreement and we’ll be ready to get an agreement if we are given the opportunity to move forward,” Blunt said. “I think it would be a real mistake not to do that.”

Waiting on Trump

However, Republicans acknowledged that McConnell’s next moves in part reflect the timing of Trump’s FY 2017 supplemental, which is said to be likely to seek another $30 billion for Defense and border security.

Senate Appropriations Committee Chairman Thad Cochran (R-Miss.), who met with White House budget chief Mick Mulvaney on March 9, and other lawmakers said they are uncertain about whether the president’s request will land on Capitol Hill the week of March 13.

Republican leaders could package the supplemental along with Defense and other regular spending bills, they said. However, the exercise could become even more problematic if Trump proposes cuts to the non-defense spending bills in order to pay for the border wall and other items, they said.

Collins, however, said she does not think that item, health-care legislation or any other matter will prevent Congress from dealing with the spending bills.

“I don’t think so,” Collins said. “We have to do it, and the deadline is looming at the end of April and the sooner we get it done the better. We have to start on next year’s budget and there may be many changes proposed by the administration.

“If I were the administration, I would want to get this year’s [bills] behind us,” she said. “We should have done them in December when many of us wanted to do them.”


John Zang Contributed To This Report




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