Tomorrow the Republicans’ American Health Care Act goes to the Budget Committee. What looked like another rubber stamp for Speaker of the House Paul Ryan’s and President Trump’s bill may instead mean the demise of the bill, at least this version of Republican health care. Moreover, a bombshell dropped in a meeting between Senate Republicans and the White House that would surely doom the AHCA.

The Post reports that as many as six Republicans could defect, including three Freedom Caucus members:

Republicans hold an eight-vote advantage over Democrats on the Budget Committee, and if four GOP members oppose it, the bill could stall. Three of the 22 Republicans on the panel are members of the House Freedom Caucus.
Aides to those three [Freedom Caucus] members — Reps. Dave Brat (Va.), Gary Palmer (Ala.) and Mark Sanford (S.C.) — did not respond to inquiries Tuesday about whether they intended to support the legislation in committee. Three other Budget Committee Republicans, Reps. John Faso (N.Y.), Mario Diaz-Balart (Fla.) and Bruce Westerman (Ark.), said Tuesday that they were undecided on their committee votes.

If the Budget Committee chairman Rep. Diane Black (R-Tenn.) doesn’t have the votes locked up she could postpone the vote, but that would certainly signal the bill is stalled.

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Diaz-Balart is under extreme pressure given that his colleague Rep. Ileana Ros-Lehtinen (R-Fla.) came out strongly against the bill, citing the large number of people to lose coverage according to the Congressional Budget Office score. Faso, a freshman, is one of the most vulnerable Republicans, and is one of 59 Republicans targeted by the Democratic Congressional Campaign Committee.

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Meanwhile, the bill’s outlook was dealt a blow yesterday, one that barely got noticed. In a White House meeting with staunchly conservative senators, including Sens. Mike Lee (R-Utah), Rand Paul (R-Ky.), Ben Sasse (R-Tenn.) and Ted Cruz (R-Tex.), at least one attendee explained the existing bill cannot pass the Byrd rule in the Senate. (The Byrd rule governs what items can be included in reconciliation, generally only those with a revenue impact.) “Many of the policy details surrounding the tax credit, including who is eligible, the insurance surcharge, and the age rating regulation will not survive the Byrd rule,” a senior aide of one senator present said.

Conservative policy guru Yuval Levin noticed the problem as well, citing unreasonable assumptions the House made in trying to craft a bill to survive the Byrd rule:

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The bill assumes that Obamacare’s core feature—the federalization of health insurance—cannot be undone through reconciliation. So it does what it does within the boundaries of Obamacare’s imposition of specific guaranteed-issue and community-rating rules on the insurance system. But some of Obamacare’s insurance regulations, like the premium age bands (that determine how much higher the premiums of older people may be than those of younger people) are altered in the House proposal. And the proposal also introduces some elements, like a 30 percent surcharge on premiums for people who haven’t been continuously insured, which seem (to me) very unlikely to survive a Byrd Rule challenge.

Other provisions to get nixed may include those regarding abortion funding and coverage for illegal immigrants, two hot items for the GOP base.

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To sum up, the AHCA is on life support. It might not have the votes in the Budget Committee, or, more importantly, on the floor. Its survival is made all the more unlikely by the realization that without even getting to its merits, the bill will bite the dust in the Senate. House members — including those six on the Budget Committee — should consider why they are voting for a bill so widely panned that it will never become law.

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