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Capitolworks: Just the Facts...Health Care Reform, Again: The Final Showdown

The fact that we are once again talking about health care reform is as surprising perhaps to you as it is to us! Like many, we assumed that efforts to pass substantial health reform this year had been exhausted with the defeat of the Senate bill in August. And yet, here we are again! And while many parts of the strategic plan to pass Senators Graham and Cassidy's bill are similar to those we wrote about over the summer, there are significant differences worth noting. Again, our blog will not focus on the substance of the bill as we can assure there are many other experts out there who have offered and are continuing to release, information, data as well as opinion pieces. Our blog will instead focus on what we anticipate the next week will look like and address both why this bill may in fact pass and what hurdles the Republicans will need to clear to make that happen.

We will begin with just a few words regarding how we ended up where we are today. The process of the Graham-Cassidy bill has not received as much attention by the media as the House and Senate’s previous versions of health reform. Senators Graham and Cassidy began developing this bill over the summer as an alternative to the bill that the Senate ultimately voted on and failed to pass. Since the August recess, these two Senators have been quietly building support for their bill with members of the Senate, state governors, and other interest groups. However, even as recently as last week their bill did not seem to be picking up much traction as Congress is focusing on the looming end of this fiscal year and other policy priorities that they hoped to conclude before the end of the month. Something, however, switched behind the scenes and Leader McConnell announced that the Senate Finance Committee would hold a hearing on the bill on Monday, September 25—just five days before they adjourn for the fiscal year. And then on Wednesday, as both chambers were leaving for the Jewish holiday, McConnell announced that a vote would be held next week as well. For many, this came as quite a surprise while for others less so. But no matter how shocking the news was, we are now on track to see the final health care showdown of not only this year but in all likelihood, this Congress.

As of this writing, this is what we anticipate unfolding next week. On Monday the Senate Finance Committee will hold a hearing on the Graham-Cassidy bill at 2:00 pm. If you are interested, you should be able to view it on CSPAN among other outlets. After the hearing, McConnell will call for a vote to proceed. This initial vote is NOT a vote on the bill itself. This vote is simply a Senate rule that is the first hurdle to opening up debate on a bill. There should be no surprises with this vote given its procedural nature.

Nothing more will happen on the Senate floor on Tuesday. Why? Because there is a primary being held in Alabama that day and the Senate will not proceed without all of their members. However, that does not mean inactivity. Either Monday or Tuesday it is expected that Senators Graham and Cassidy will release a “new” version of their bill with tweaks probably being made to win over others in their party. During these two days (Monday/Tuesday) the Congressional Budget Office (CBO) will be working on a score for this new bill however, CBO will only provide a score on the limited information that is required by the Senate’s reconciliation rule. Just as a reminder, Congress is currently working under a reconciliation rule based on instructions included in this year’s budget resolution. Under these rules, the Senate bill cannot cost one additional cent over the House health reform bill.

On Wednesday, with a new bill and a CBO score (that the Senate parliamentarian has cleared to proceed), we get the “exciting” exercise of “vote-a-rama.” You may remember this from August as well but essentially, this is when the bill is formally offered by Leader McConnell and both parties have the opportunity to offer as many amendments as they would like with each side having only a few moments to plead their case before a vote on that amendment is called. Also, there will be all kinds of delay tactics that the Senate Democrats will use such as, having the whole bill read out loud, etc.

The Senate Democrats cannot stall this bill, and McConnell has ways in which he can end the debate and call for a vote. When he does this- probably Thursday night/Friday morning, all members will finally vote on the bill. Remember, under reconciliation, McConnell only needs 50 votes for the bill as Vice President Pence can cast the tie-breaking vote as the President of the Senate.

Phew, that was a lot of information! If you are still with us at this point, let’s touch upon some of the challenges both parties are facing coming into this final fight. First of all, McConnell does not currently have the 50 votes that he needs to pass the bill. There remain uncommitted members, at least publicly, with two exceptions, Susan Collin’s from Maine and now as of last this afternoon, a public statement from Senator McCain. In fact, there are some who believe that McConnell has called for a vote simply to put pressure on the rest of the outlying Republicans to finally commit one way or the other to health care reform.

Second, there is not much time left in this fiscal year for the Senate, and then the House, to pass this bill. The Senate must conclude their business by mid-day next Friday to adjourn for the Jewish holiday and all business by both chambers must be completed by midnight on Saturday the 30th. What this also means is that there will be no time for a conference. No conference is significant because unlike last time when there were grumblings about members trading votes for a position on the conference committee (and therefore having an opportunity to negotiate out their issues) that is not an option this time given the lack of days that remain.

Finally, should the Senate manage to pass this bill, the House must do the same and as we said above, using only the version of the bill passed by the Senate. At the moment, there are serious questions as to whether or not House Speaker, Paul Ryan will have the support of the House to pass this bill and he will not have much time to try to whip up the necessary votes.

In the end, could this bill pass? Yes. Are there still many hurdles to overcome to reach that conclusion? Yes. While many questions remain and at this point it is anyone’s guess as to how this will end, and if we learned anything from August, it is not over until it is over. The only thing for sure is that all will be decided by midnight on September 30th.

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