Even the Best Laid Plans

Health Care

Repealing Obamacare continues to be a challenge for the Trump Administration. As of press time, a new plan and legislation have not been introduced.

The results of the 2016 elections gave Republicans control of both chambers of Congress, the Executive Branch, and, as a result of the previous two, the tie-breaking vote on the Supreme Court. While Democrats were reeling in bewilderment of what the election meant, Republicans in Congress were salivating about all they could do with full control of the government.

What became obvious in January shortly after Inauguration was that Republicans had a game plan, or so they thought. First, Congress would repeal Obamacare. Second, they would rescind Obama-era regulations through the use of the Congressional Review Act (CRA). Repealing Obamacare would allow the rolling back of a bevy of taxes, that would form the basis for lowering the individual, corporate and international tax rates in a grandiose Tax Reform plan. Tax Reform would change the way the government collects revenue, of which some would be siphoned off into a pot that would be a part of the $1 trillion infrastructure package President Trump has promised.

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No timeframe was given for these plans, but we are nearly through President Trump’s first 100 days and it is clear that these best laid plans have been nearly entirely blown up.

It started with healthcare. Republicans, who have been banging the “Repeal Obamacare” drum since 2010, struggled internally with how to actually do it. Some Republicans in the House simply wanted to repeal the law. Others wanted to repeal parts of the law, mainly the exchanges, business requirements and taxes, and keep many of the popular elements such as pre-existing condition protections and remaining on parents’ healthcare until age 26. Democrats, unsurprisingly, were against any of it. When House Speaker Paul Ryan introduced the plan that would replace Obamacare, the Republican infighting intensified and the measure was pulled from the floor because they didn’t have the votes on March 24. As of press time, a new plan and legislation have not been introduced.

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There are two culprits for the implosion of the Republican Healthcare repeal efforts: infighting and process.

The Freedom Caucus, the group of Tea Party Republicans in the House, are largely responsible for the Republican infighting. Freedom Caucus membership, which is somewhere between 30 and 40, is large enough to block any and every piece of legislation they don’t like. Practically, however, anything that the Freedom Caucus supports is dead on arrival in the Senate where the majority and ideology are unsympathetic to Freedom Caucus priorities.

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The Freedom Caucus wanted the Republicans to go substantially further than it did, which became problematic for the process.
As mentioned previously, Democrats have made it clear they will not support repeal or replacement of Obamacare. In order to avoid the 60-vote requirement in the Senate (Republicans only control 52 seats), Republicans planned to use a process called “reconciliation.” Reconciliation is a product of the Congressional Budget and Impoundment Control Act of 1974 which stipulates how budget-related legislation may be passed by simple majority, or 51 votes in the Senate. In order to qualify for reconciliation, however, nothing “extraneous,” or unrelated to the budgetary nature of the bill, may be included. This means items that the Freedom Caucus demands, like rolling back Obamacare’s mandated plan requirements, which are unrelated to the budgetary elements, cannot be added to the House version. If they were to be included in the House version and the Senate Parliamentarian were to declare those elements extraneous, the whole bill would be sunk because it would then be subject to the 60-vote threshold. Conversely, if these provisions are not included in the House version that goes to the Senate, an amendment could be offered to the bill dealing with the “extraneous” provisions that would not sink the entire bill if struck by the Parliamentarian. If the Parliamentarian doesn’t declare the provisions extraneous as an amendment (which is unlikely), then Republicans win twice.

This reconciliation plan requires the Freedom Caucus to put faith in the Republican leadership. This is a tall order for the group responsible for the ousting of former Speaker John Boehner. As of press time, the Freedom Caucus hadn’t agreed to an altered plan to move healthcare reform forward.

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As a result, the domino effect Republicans hoped for hasn’t even started. Obamacare’s tax provisions remain intact, which were to be recouped as tax savings allowing Congress to lower individual and corporate rates in a broader tax reform plan. Lowering the rates and streamlining the tax code was supposed to provide investment for infrastructure. Unfortunately, without a willingness from Congress to reinvent its plan, none of the dominoes will fall.

Compounding and further delaying the plan is the federal budget, which due to a short-term extension at the end of 2016, expired on April 28, 2017, on President Trump’s 99th day in office.

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Will Brown is NUCA’s director of Government Affairs.

Read more articles by Will Brown here.

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