My predictive skills have been working pretty well on healthcare reform. I suggested that it wouldn’t be easy or quick. I thought the House would fall in line and the Senate would eke something out – and that it ultimately will come to a thumbs up / thumbs down in both houses of Congress. With John McCain’s emotional return for the Senate vote to proceed and Vice President Pence’s tie-breaking vote, we are almost down that long road. Rumors that the circus is closing down are proving false, at least as it appears on the Senate floor. The votes over the past couple of days didn’t really have much of a chance of passage: the outright repeal vote and the Better Care Reconciliation Act vote (which already failed) reemerged only to have Senators on record. (Seriously, doesn’t Washington care how stupid we must look to the rest of the world?)
It seems likely that the Senate will put together something which may pass that doesn’t quite repeal the Affordable Care Act. It may be a skinny version which eliminates the individual and employer mandate and repeals some of the taxes imposed by the ACA. This bill would then be brought to the House for reconciliation with their bill. The reconciled bill must meet the rules to qualify for a simple majority vote. But (and it’s a big but) then the Senate and House will need to pass the bill without modification. While I was hopeful that rational thought would take over, it seems it will need to wait for this last-gasp trapeze act by the Republicans. I am not ready to make a prediction on whether that happens.
This bill, if passed, would be most impactful to the 11 million Americans covered by individual plans and also to those who acquired coverage under Medicaid expansion. To the vast majority of America, this emotional, news-consuming legislation won’t have any immediate effect, but its implications do underpin our healthcare system. Emotions are running wild on all sides. Stay close to the news – I will.