If you're tracking health care this week, there are some key things to keep in mind
Don't necessarily listen to what the White House is saying; watch Congress
This is a huge week for the future of health care. Period.
Here’s what you need to know:
- Let’s all do ourselves a favor and ignore the White House predictions (or outright declarations) on when a vote might take place. They don’t exactly have a great track record on this front the past 102 days. It’s the House leaders who should (and will) guide the way on when, or if, a vote happens this week.
- That said, House Republican leaders desperately want to get this done this week. There are a number of reasons – momentum, sheer terror about members going home for recess next week and getting killed again on this, the budget window closing – that make it a really big moment for them.
- Leaders really do think they can get there this week. The combination of members who just want to do something, anything, to get this off their plate, along with what they believe is a workable product, has them closer than they’ve ever been.
- How close are they? Whip counts are dangerous and always very fluid, but we have 15 “public,” on the record NOs. That means for the remaining few dozen either undecided or undeclared, Republicans can lose around six more. That’s not much space to work with, unless they make changes/give something to the NO votes to bring them on board
- Same dynamic remains: moderates have to make a choice – walk the plank on a bill that in a bad political environment could end up ending their political careers, or reject leadership and/or a GOP President and take all of the blame for a catastrophic legislative failure for the new administration.
- They blitzed the undecided, and some outright NOs, over the weekend, both from the White House side (Vice President Mike Pence and Health and Human Services secretary Tom Price) and the Hill side (House Speaker Paul Ryan, House Majority Leader Kevin McCarthy and Rep. Patrick McHenry), aides say, but it was less arm twisting, more “education.” There’s a sense members didn’t have the time to fully understand the provisions in place in the amendment to keep those with pre-existing conditions protected from price increases even if their states opt-out, and they’re trying to get their members comfortable with that. They’re also trying to make a point to many of the northeastern moderates: there’s no way your governor would opt out, so you shouldn’t worry about it.
- Still, even those protections (pre-existing with current plans would be grandfathered in at their current prices primarily/opt-out states would have to represent fully functioning high risk pools to handle anyone who falls out of this bucket), the proposal is unquestionably filled with holes. There is a sizable churn for those with pre-existing conditions – a natural, and historical, record of a large percentage falling off plans, then getting back on. Or even just moving to a new state. So for those individuals, the grandfathering provision would do all of zero to help them. On top of that, critics say the risk pool funding in the bill – $130 billion – is likely woefully insufficient to adequately finance functioning high risk pools on a national level.
- One possible change that could occur is an attempt to address that very issue – funding for the risk pools. There is space to add significant new cash to the bill’s existing State Stability Fund as the most likely change that could be made to try and increase the comfort of moderates. But remember, the bill has to include *at least* $2 billion in deficit savings in a order to comply with reconciliation instructions. So that reasonably gives them about $100-$115 billion, give or take, to work with. There’s a lot of risk in blowing your cash cushion in the House, when you’ll almost certainly need it for changes in the Senate, so if House leaders start heading in this direction, it’s not a good sign about where things stand. In an ideal world, they don’t want to significantly change the MacArthur amendment.
- Bottom line: House GOP members and aides have quietly been making clear they think the White House hindered this process the last week or so by pushing so hard for a vote before the conference was comfortable with the proposal, but this week the urgency is real. The window is seriously closing and, as one aide told me, “going back to the drawing board would be death to repeal and replace.” Expect them to do everything they can to get this done this week. But they have a lot of work to do. A lot. As of now, they still don’t have the votes. They’ll get the first real sense of where they are Monday at the 6:30 p.m. ET unrelated vote. They’ll map out their path forward Tuesday morning at their conference meeting. *If they have the votes, or are within striking distance at any point this week, this will likely move very fast.