Conservative activists say GOP Congressional leaders are hiding behind Senate rules so they don’t have to fully repeal Obamacare, but they warn that passing an imperfect overhaul of the health care law will undermine basic free-market and states’ rights principles and anger voters who want to scrap the law entirely.
Opinions about the right process to pursue varies among Republican groups and lawmakers, with some pushing a harder repeal through the same budget reconciliation process that requires only a simple majority to pass the Senate, rather than the 60 votes normally needed for controversial measures.
Others are pressing GOP leaders to scrap the budget reconciliation process entirely because they think using it will lead to an imperfect overhaul of Obamacare. In order to pass the measure outside of that process, Senate Majority Leader Mitch McConnell, R-Ky. would have to go nuclear and change Senate rules to end the Senate filibuster, something McConnell, a Senate institutionalist, is very reluctant to pursue and unlikely to do unless faced with a backlash from the Right and Trump’s supporters across the country.
Rick Manning, president of Americans for Limited Government, argues that GOP leaders are making the same mistake Democrats did when they drafted Obamacare behind closed doors using budget reconciliation.
Republicans are relying on that process again this year to repeal the Affordable Care Act because it requires only 51 Senate votes, instead of the 60 needed to overcome a filibuster in the Senate. But this process has its limitations, and won’t allow Republicans to make the law vanish, which is why conservatives see it as a mistake.
“Because of the Senate filibuster, the GOP Congress feels trapped into the flawed reconciliation process as the only vehicle to get rid of parts of Obamacare,” Manning told the Washington Examiner Friday. “But reconciliation does not allow for a full repeal of Obamacare, and the inevitable outcome will be more federal regulation with minimum coverage standards imposed on states that will once again be robbed of decision-making, driving health car costs upward for Americans.”
“Quite simply, Republicans in Congress will be making a monumental political and policy mistake if they attempt to put lipstick on the Obamacare pig, as it is not salvageable,” he argued.
Instead, Republicans need to think outside of the “D.C. rules trap” by ending the legislative filibuster, a concept known as going “nuclear.” That decision would alter the rules and allow legislation to advance in the Senate with just a simple majority vote, instead of the 60 normally needed for legislation.
Manning said that radical move would let the GOP repeal Obamacare entirely and pass a replacement that “returns health care governance to the states from where it was stolen by the previous administration.”
The reconciliation process doesn’t allow for a complete repeal of Obamacare because it can only be used to pass bills impacting spending and tax revenue, leaving other parts of the law alone, including the mandate that insurers cover young adults through age 26 and the requirement to cover anyone with a preexisting condition.
Manning cited a Feb. 28 paper from the Texas Public Policy Foundation, or TPPF, titled “Repeal and Respect: Key Principles for Renewing American Healthcare.” He said that paper presents the right way forward, a wholesale overhaul with state-based solutions based on free-enterprise and federalist principles.
The paper is circulating among the House Freedom Caucus and the House and Senate Texas delegations with strong support of Sen. Ted Cruz, R-Texas, one of the three conservative senators, along with Sen. Rand Paul, R-Ky., and Mike Lee, R-Utah, who are fighting a partial repeal.
Two of Cruz’ former staffers now work at TPPF, including Chip Roy, the director of the group’s Center for Tenth Amendment Action and the author of the “Repeal and Respect” paper.
“Full repeal is what the GOP has been promising for four elections cycles, but every indication we’re getting from the GOP Speaker is they think they can con the American people into replacing Obamacare with Congresscare,” Roy said in an interview.
Roy argues that the Senate is hiding behind its own rules to justify only passing a partial repeal of Obamacare but says the Senate can fully repeal the law under the process if it wants to.
Republican leaders in Congress, he said, think they can fulfill their campaign promises with “a fake repeal and repackaged Obamacare…and they expect that the American people will not get the joke,” he added.
“The Senate has the power to fully repeal Obamacare under their rules and are refusing to do so,” he said.
The Senate parliamentarian, a holdover from fomer Sen. Harry Reid’s time as majority leader, is expected to rule that the most popular and costly parts of the law, including the provisions preventing insurers from discriminating against people with pre-existing conditions, cannot be undone through budget reconciliation. The budget reconciliation process can only be used for elements of the law that impact spending and tax revenue. Some on the Right argue that the reconciliation process can be used to fully repeal the law because the Senate has the power to overrule the parliamentarian’s decisions by a simple majority vote.
More broadly, Roy argues in his paper that conservative health reforms “should focus on empowering states to allow them to make the decisions that benefit their citizens.” That empowerment, according to the paper, would start with federal block grants for Medicaid, allowing states to manage the health of their low-income populations without federal “micro-management.”
“Reforms should also include incentives for states to reform their insurance markets and liberalize restrictions on providers – for example by removing unnecessary scope-of-practice regulations,” the TPPF paper stated.
TPPF and other conservatives argue that trying to retain some of Obamacare’s most popular mandates robs states from deciding which type of health care reform is right for them. Those mandates, which include barring insurance companies from discriminating based on pre-existing conditions and allowing young adults to remain on their parents’ plans until the age of 26, are among the most costly parts of the law.
The think tank is staffing up to help provide a view from outside of Washington, said Roy, who most recently has served as the first assistant attorney general of Texas and previously served as then-Texas Gov. Rick Perry’s director of state-federal relations. TPPF has recently hired Drew White, a former chief domestic policy advisor for Cruz and Chris Jacobs, a former Heritage Foundation fellow focused on healthcare policy.
Republican leaders, he said, are “so hung up on replacing the law with a Washington-based solution, they are missing the forest for the trees of what the problem is – lack of access to high-quality affordable care,” he said. “[President Trump] talks about draining the swamp. We don’t need a swamp-based solution.”
