From the start, we have been taking a step-by-step approach to repeal and replace Obamacare. Because building a better, patient-centered system is going to take more than just one bill.The folks at Conservative Treehouse, who are not big fans of Paul Ryan, offer an excellent explanation of why a full repeal bill can't be passed without 60 votes in the Senate unless they eliminate the filibuster for all legislation, which constitutional conservatives might be (and should be) unwilling to do.
As Speaker Ryan explained at his press conference, this approach has three overarching phases:
--The American Health Care Act, which takes full advantage of the budget reconciliation process to avoid a Democratic filibuster;
--Administration actions, notably by HHS Secretary Price, to stabilize the health insurance market, increase choices, and lower costs; and
--Additional legislative policies, such as allowing individuals to purchase coverage across state lines, that by Senate rules cannot be included in a reconciliation bill.
Here’s how Speaker Ryan put it:
“Let me describe to you what the three phases are…Number one is this bill, which we use as reconciliation. As you all know, you can’t filibuster a reconciliation bill so this repeal and replace bill is what we pass through reconciliation…Phase two: all the regulatory flexibility that the Secretary of HHS has to deregulate the marketplace to lower the cost and stabilize the market…Phase three is to pass the bills that we want to pass that we cannot put in reconciliation because of those budget rules. What’s an example of that? Interstate shopping across state lines. We love that policy, we think it’s critical, but as you well know, you cannot put that in a budget reconciliation bill.”
Here is what Secretary Price wrote in his letter to congressional leaders:
“Achieving all of the President’s goals to reform healthcare will require more than what is possible in a budget reconciliation bill, as procedural rules on this type of legislation prevent inclusion of key policies such as selling insurance across state lines, lowering drug costs for patients, providing additional flexibility in Medicaid for states to manage their programs in a way that best serves their most vulnerable citizens, or medical legal reforms.”
Learn more about the American Health Care Act here.
But one need only look no further than the recent Redding tax measure to see what can happen when you take a piecemeal approach. The more desirable aspects of the proposal don't pass and you end up not really accomplishing what you set out to do.
An alternative, it seems to me, would be to pass a bill the old-fashioned way and stop looking for shortcuts. Introduce it, debate it, perhaps merge aspects of it with competing legislation, negotiate for it and visit the districts of recalcitrant opponents to explain to their constituents what could happen to them if the bill doesn't pass. In the end, you have compromise legislation that nobody really loves, but will get enough votes to pass and will be signed by the president. Or if it is defeated, you can make the next election a referendum on its defeat.
But if Republicans think they can just sit around for two years while Obamacare collapses and not be blamed because it wasn't their program, they're in for a rude awakening.