An emerging Republican strategy to get a health-care bill through a closely divided Senate faces serious head winds in the House, and lawmakers are already skeptical that the differences between the two chambers can ever be bridged.
The “skinny repeal” plan floated by Senate GOP leaders would scale back the effort to repeal and replace the Affordable Care Act from an Ohio-class battleship salvo to the plink of a BB gun. Rather than undo the ACA’s bevy of insurance regulations and its costly Medicaid expansion, senators could settle for an effort to simply undo the law’s coverage mandates and one relatively minor tax, on medical devices.
Some in the Senate have suggested that the downsized bill would represent a bridge to a conference committee, where the two chambers would meet to resolve their differences.
But House Republicans who fought tooth and nail over the course of months earlier this year to expand the scope of the repeal legislation are saying “fat chance” to the skinny repeal — including key members on the conservative and moderate ends of the GOP — and say it is difficult to see what legislative product could span the divide between the chambers.
“I don’t think it’s going to be very well received,” said Rep. Mark Walker (R-N.C.), chairman of the conservative Republican Study Committee. The group with dozens of members met Wednesday and had a “fairly negative” reaction to the skinny-repeal plan, Walker said.
Rep. Mark Meadows (R-N.C.), chairman of the House Freedom Caucus and a key player in the negotiations that produced the House health-care bill, told reporters in recent days that a skinny-repeal bill would be “dead on arrival” in the House and that a conference committee would have to be convened to work out a compromise.
Several other Freedom Caucus members echoed that view Wednesday. “I’m not interested on having a vote on something that they’ve done,” said Rep. Paul A. Gosar (R-Ariz.). “If you don’t change the trajectory on lowering prices, rebuilding the market and having choices, dress that pig up however you want to — it’s still Obamacare.”
It wasn’t only conservative who were skeptical. Rep. Tom MacArthur (R-N.J.), a moderate who brokered a compromise with the hard right, allowing the House bill to proceed, said skinny repeal is “just a vehicle” for a conference. “I don’t think that’s a serious effort to fix the health-care system,” he said.
No formal skinny-repeal proposal has been released by Republicans, and the Congressional Budget Office has not issued any analysis of its effects. But there is fear among health policy experts that the elimination of the ACA mandates, requiring most businesses to provide insurance for their employees and requiring individuals not covered through work or government programs to purchase policies, would lead to the collapse of the existing insurance markets — potentially leading to a dismal CBO estimate of coverage effects.
A House GOP leadership aide said no determinations have been made about how a Senate-passed skinny-repeal bill might be handled in the other chamber. Options, the aide said, include simply trying to pass the bill outright, convening a formal conference committee or simply entering informal negotiations in hopes of striking a quick deal.
MacArthur said he did not discount the possibility that the chambers could reach a compromise, pointing to the process that produced the House bill.
“It’s an uphill battle, but we found a way in the House,” he said. “Look, the fault lines are the same on this issue in the House and in the Senate. They’re no different — it’s about how to care for vulnerable people and how to bring everyone else’s costs down at the same time. .. . . They both have to get reconciled, and if the Senate hasn’t had enough time to get there, then maybe in conference we will.”
There are some who hold out the possibility that the House will simply take whatever the Senate passes, however “skinny” it might be, pass it and declare victory.
Rep. Chris Collins (R-N.Y.) said he would be willing to swallow just about anything the Senate could pass.
“It is better than nothing,” he said of the skinny repeal. “I will support, I’ll be honest, pretty much anything that comes over.” He added that he believes his House Republican colleagues would follow: “If it comes down for the binary choice of voting for skinny repeal or keeping all of Obamacare in place . . . I think you’ll find our Republican conference voting for the skinny repeal, at the same time being disappointed that that’s all we’re doing.”
But other Republicans have drawn lines in the sand already that could complicate final passage of a bill that emerged from the House with a two-vote margin. Collins’s fellow New York Republicans, for instance, are wary that a provision that would affect Medicaid funding to their state might be dropped in the Senate bill. One House member who previously supported the bill, Rep. Tom Reed (R-N.Y.), has already said he will not support a health bill that does not include the provision.
Walker said that, absent a workable conference agreement, House members would be faced with an ugly dilemma.
“It’s very difficult to predict how the House wants to deal with that,” he said. “Do we just take what we can get and move on? Or do we say, ‘No, these are the fundamental foundation of the promises we made to the American people, and you guys didn’t deliver on it.’ So that’s where we are.”