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The fate of Paul Ryan’s “American Health Care Act”

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Will Speaker Paul Ryan’s American Health Care Act (AHCA) ever become law? That seems unlikely unless it undergoes major changes.

According to the Washington Post:

Critics of the legislation warned Wednesday that the measure remains far short of the 216 votes needed for passage. Typically, 218 votes are needed to pass a bill in the 435-member House, but five pending vacancies have reduced that threshold. No Democrats are expected to support the bill, and with 237 Republicans, party leaders can afford no more than 21 ­defections.

Apparently the dissension among rank-and-file Republicans in the House and complaints from Republicans in the Senate have wrested this concession from Ryan: “Now that we have our score we can make some necessary improvements and refinements to the bill,” he said after the Congressional Budget Office (CBO) released its estimate of the AHCA’s cost.

Ryan’s “aides played down his remarks, saying that the speaker had long acknowledged further changes were possible as the bill moved through a multistep legislative process,” according to the Post.  However, that is a departure from the Speaker’s earlier position that the AHCA would fail if substantially changed.  (Indeed, it is now more likely to fail if it is not changed rather drastically.) Yet Ryan has been unwilling to say definitively that he will bring the bill to the House floor next week, suggesting he does not have the votes for passage.

Adding to the problems are GOP moderates in the House who have gotten cold feet after the CBO estimated that 14 million more people would be uninsured under the AHCA. As inaccurate as the CBO is at times, it is enough for Rep. Leonard Lance (R-N.J.) to say, “I do not want to vote on a bill that has no chance of passing over in the Senate. The CBO score has modified the dynamics.”

Ryan did win a small victory yesterday when the AHCA passed the House Budget Committee. But even that portends future divisiveness as the committee passed the bill by the narrowest of margins, 19 to 17. Republicans Dave Brat of Virginia, Mark Sanford of South Carolina, and Gary Palmer of Alabama, all members of the conservative House Freedom Caucus, voted against it.

Over in the Senate, Republicans Rand Paul (Kentucky), Ted Cruz (Texas), Tom Cotton (Arkansas), and Mike Lee (Utah) have voiced their opposition to the bill unless major changes are made. “What’s been introduced in the House in the last 24 hours is not the Obamacare replacement plan, not the Obamacare repeal plan, we’ve been hoping for,” Lee said last week. “This is instead a step in the wrong direction, and as much as anything, it’s a missed opportunity.”

Other Senate Republicans have expressed concern over how older people not yet on Medicare will fare under the AHCA. Sen. Bill Cassidy (Louisiana) said that such people would “have a hard time affording insurance” under the bill.

Would there be anything wrong with Ryan slowing down the process to make much-needed changes to the bill? The legislative fight for Obamacare dragged on for well over eight months. Thus, it would do little harm if Ryan and the rest of the GOP leadership were to spend a few weeks talking with the rank-and-file. The leadership can then release a set of amendments based on those talks that would improve the AHCA.

Here’s what those amendments should include:

-Repeal the prohibition against insurers denying coverage to people with pre-existing conditions.

-Establish a federal “high-risk pool” for all of the people who have insurance through the exchanges and who lose that insurance. These people will have the option of transferring to their state high-risk pool program once it has been established.

-Allow people with pre-existing conditions who are not on an exchange at present to obtain coverage through the high-risk pool until states set up their own high-risk pools.

-Repeal the 10 “essential” benefits the insurers must cover under Obamacare.

-Repeal the ban on lifetime and annual coverage limits.

-Allow the tax credit to be used for a wide array of health insurance options, not just insurance with “essential benefits.” Doing this means the legislation must use an expansive definition of “health insurance.” For more on that, go here.

-Finally, allow employers the option of switching from the current tax break for employer-provided health insurance to a system of large Health Savings Accounts for their employees. For more on that, see “Replacing the Employer-Based Tax Exclusion with Large HSAs” here.

The AHCA can be made into a bill that greatly expands liberty in health care and, in so doing, fixes much that is wrong with our health care system.  But without serious changes, it is a bill that is not worth passing.