Fate of Republican Health Bill Teeters on New Financial Analysis

  • Congressional Budget Office to release analysis Wednesday
  • Bill could miss required targets, forcing House to redo vote

Trump Says Premiums Will Come Down Under New Health Bill

House Republicans are waiting anxiously for a new financial estimate Wednesday on their Obamacare repeal proposal that could force them into an embarrassing do-over on the bill they barely passed early this month.

Speaker Paul Ryan says he is uncertain about the nonpartisan Congressional Budget Office analysis of the measure’s budget impact -- critical for meeting Senate rules that would let the GOP pass it with a simple majority amid unanimous Democratic opposition.

"We have every reason to believe we are going to hit our mark," Ryan of Wisconsin told reporters Tuesday. Still he added, "CBO scores have been unpredictable in cases in the past."

For the health plan to comply with requirements for using a streamlined Senate process called reconciliation, the CBO will have to conclude that it reduces the deficit by at least $2 billion over 10 years. If not, the House will have to redo the bill to meet that standard and vote on it again. And that won’t be easy after the weeks of negotiations and revisions that led to the American Health Care Act’s May 4 passage by a narrow 217-213 House majority.

The CBO analysis may not be the final word on whether the GOP can push a health-care bill through the Senate without facing a Democratic filibuster. There are several other arcane budget rules that it must also satisfy, although the Senate parliamentarian could override some of those the rules and let the bill move ahead anyway.

A Quick Start

House Republicans had rushed to vote on the health bill -- without waiting for the CBO analysis of last-minute changes -- so the Senate could get a quick start on it. But Ryan then decided not to immediately send the bill to the Senate, as he normally would, in case the CBO analysis requires the House to revise parts of it.

This uncertainty is evidence "of the consequences for Republicans of trying to move as quickly as possible" to pass the Obamacare replacement, said Molly Reynolds, a congressional specialist at the Brookings Institution in Washington. "That choice did not come without costs."

Republicans have insisted for years they would repeal and replace former President Barack Obama’s health-care law if they gained power, and President Donald Trump also made it a top campaign promise. Many GOP lawmakers have been confronted at town-hall meetings by angry constituents who oppose a repeal, though, and a CBO analysis of an earlier version of the House bill said 24 million people would lose insurance in 10 years.

Edward Lorenzen, a senior adviser for the nonpartisan Committee for a Responsible Federal Budget, said he expects both sides to take their arguments to the Senate parliamentarian after the CBO report is released.

Pressure From Republicans

House Minority Whip Steny Hoyer of Maryland told reporters Tuesday that if the bill doesn’t meet Senate requirements, he hopes the chamber’s parliamentarian doesn’t face undue pressure from Republicans to let the bill go forward.

Steny Hoyer

Photographer: Joshua Roberts/Bloomberg

"I hope so," said Hoyer. "Am I confident? No."

Ryan said Tuesday that Republicans want to make sure the House bill is done correctly so it won’t have to be killed in the Senate.

That’s where the CBO comes in. Its report Wednesday is expected to dive deep into the measure to see if it meets the deficit-reduction requirements to avoid a Democratic filibuster. To qualify, the measure must reduce the deficit by at least $2 billion -- $1 billion each in the areas covered by the Senate Finance Committee and by the health panel.

State Waivers

Another question is whether a provision added by the GOP allowing states to waive certain Obamacare regulations may mean the bill doesn’t reduce the deficit. Lorenzen said that if the waiver is widely used, it could result in less generous benefits and lower premiums. That could lead more people to buy health insurance, making more of them eligible for the law’s tax credits. There are estimates that an increase of 1 million enrollments would cost about $30 billion over a decade.

The CBO is also expected address how many people would lose insurance under the new House plan.

Democrat Jim McGovern of Massachusetts, speaking on the House floor on Tuesday, said the CBO report will show "how many millions of Americans will be kicked off their health care because of the reckless and heartless Republican policies."

Given the heat some House Republicans have drawn from constituents since voting for the bill, some Democrats are questioning whether Republicans could get enough of their own members to pass the bill again if they have to rewrite it to conform with the rules.

"I will not ask you whether or not you think you still have 217 votes," Hoyer jabbed at Majority Leader Kevin McCarthy of California in a discussion on the House floor Friday.

Ryan said Tuesday, "We just want to make sure that we dot our I’s and cross our T’s exactly the right way so that when we send the bill over to the Senate it is not, as we say, fatal."

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