Health care reform

Senate Won't Pass Health Care Bill Until House Agrees Not To Pass It

Yeah, it's weird.

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John Greim John Greim Photography/Newscom

In normal times, when Congress passes legislation, the two chambers are required to approve identical versions of a bill before it can go to the president's desk. It's one of the fundamental rules underpinning our bicameral legislative structure, where House and Senate are equal in importance and the consent of both is required to make law.

This isn't to suggest the process is clean and neat. This isn't Schoolhouse Rock. There are all sorts of political calculations that go into the legislative process and shape the outcome of lawmaking.

Sometimes, when the two chambers can't agree, a bill goes into a conference committee to iron out the differences and settle on a version both chambers can pass. Because, again, both chambers must agree on a bill's language before it gets to the president.

In normal times, when the Senate announces "we are going to pass this bill," and the House responds by saying "we would also like to pass that bill, exactly as it is," all the lawmakers who voted "aye" on that bill should be happy about the outcome.

These, of course, are not normal times.

And so we were treated to the spectacle of Senate Republican leaders Thursday asking a bizarre favor of their House GOP counterparts: an explicit promise NOT to pass the health care bill slated for a final vote in the Senate sometime in the next two days.

Here's how Burgess Everett, one of Politico's congressional reporters, put it on Twitter:

Later in the day, Sen. Ron Johnson would specifically ask for "the assurance that whatever we pass tonight will go to conference." In other words, promise that the bill poised for passage on Thursday night will be rejected by the House.

How did we end up here? After attempts on Tuesday and Wednesday to pass vastly different versions of the Better Care Reconcilliation Act failed, it appears Senate Republican leaders want to go to a conference committee to settle on a final version of the health care bill. To get there, the Senate is prepared to vote on a so-called "skinny repeal" bill Thursday night or Friday.

The bill would repeal some of the Affordable Care Act's taxes and would dump the individual mandate and employer mandate that, respectively, require all Americans to carry health insurance and require all business with more than 50 employees to offer employer-based plans. The bill would maintain several other aspects of Obamacare, including the expansion of Medicaid eligibility. (At least, that's what is widely assumed will be included in the bill, though the actual text of the bill won't be clarified until after a long series of Senate floor votes on Thursday evening.)

It doesn't really satisfy anyone but has a chance of passing merely because senators know it would be worse to pass nothing, and because the reconciliation process being used to by-pass the Senate's 60-vote threshold has a time limit attached to it.

In other words, the Senate wants to pass a bill to avoid the embarrassment of not passing a bill. But under no circumstances does the Senate want that bill to become law.

There are four possible outcomes here.

  1. The Senate could fail to pass the bill, at which point health care reform is dead, for now.
  2. The Senate could pass the "skinny repeal" bill and the House could pass the same language, sending it to Trump (This is what the Senate leaders are apparently trying to prevent).
  3. The Senate could pass the "skinny repeal" bill, followed by the House rejecting it. A conference committee develops a new bill, but one or both chambers fail to pass the conference report, at which point health care reform is dead (for now).
  4. The Senate could pass the "skinny repeal" bill, followed by the House rejecting it. A conference committee develops a new bill, both chambers pass that new version and it goes to Trump. This is what Senate Republican leaders are trying to steer towards.

Even as a libertarian who usually takes comfort in disagreements between the chambers of Congress—usually nothing good comes of agreement—I have mixed feelings about all this. There's not a terrific limited government, free market solution in play, but the "skinny repeal" bill might not turn out to be a terrible compromise, even though it leaves in place the budget-busting Medicaid expansion and some of Obamacare's regulations. It's not great, but it's not awful either. Maybe the Senate will pass it and the House will pull a fast one, pass it too, and call it a day.

But if the Senate leaders get their way and pass this bill, the House rejects it, and something else gets hammered out in a conference committee, there's a chance it will be a better product (and a chance it gets worse).

The House Freedom Caucus, the closest thing Congress has to a libertarian voting bloc, will have an outsized influence on what the conference committee crafts. That's why liberal groups like the Center on Budget and Policy Priorities are warning that the "skinny repeal" bill is a Trojan horse that will be turned into a more robust repeal bill by the potential future conference committee.

Political considerations aside, the way this bill is being passed should concern everyone. Individual senators can bemoan the erosion of political norms and loss of "normal order"—as John McCain did on Tuesday, just as the Senate was about to tip over the edge into the health care abyss—but by passing a major piece of legislation in such haphazard and unconventional manner, they are contributing to that very problem.

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  1. Alt text: Chinese democracy

  2. I am confused by this. I suppose that means I’m normal.

  3. Senate Won’t Pass Health Care Bill Until House Agrees Not To Pass It.

    Carry on.

  4. The asshole McCain was just on the radio barking his orders about how this illusion has to go down. Could the very public vacuum of ideas here implode the stupid party right here? I’m gonna need a bigger popcorn bowl.

    1. Could the very public vacuum of ideas here implode the stupid party right here?

      It should, but remember the other team is just as retarded, so the GOP could still stay in power.

    2. “The asshole McCain…”

      No one gives a rat’s ass about McCain’s Hanoi Hilton shit. He probably ended up there because he was a crap pilot with low skills.

      God, I hate this guy.

    3. McCain knows (or maybe he doesn’t because of brain thing) that this is his last term as senator. He wants some legacy or has just lost his mind.

      It does not seem like he wants any full repeal of ObamaCare and Medicaid expansion to come to the Senate either.

  5. These, of course, are not normal times.

    Ahem. These are the *new* normal times.

    1. something something won’t get fooled again, something something same as the old boss

      1. YYEEEEEEEEEOOOOOOOOOOOWWWWWWWWWWWW!!!!!!!

  6. So, upon reflection, and with the passage of the centuries, perhaps taxation with representation is not so much different after all.

    How long does it take to get a permit in DC to build barricades?

  7. Correction: The important adjective for the Medicare expansion isn’t “budget-busting”. It’s murderous, having racked up an impressive body count.

  8. Are you touched in the head? Skinny repeal would be the worst of all possible worlds. By leaving in place guaranteed issue for pre-existing conditions while stripping the individual mandate and not putting anything in its place, it all but guarantees acceleration of death spirals because healthy people will have no incentive to enter the nongroup market until they get sick. It pours gasoline on the dumpster fire and puts a Republican stamp on it ensuring the Democrats can run on health care and push through Medicare-for-all in 2020 (or 2018 if Trump flips back to the presumably genuine position he held before running for President).

    1. Let’s say the death spiral does accelerate. Doesn’t that create pressure to stop it? Is that not a good thing?

      Let’s say they don’t stop it, & health insurance is no more. Docs & hospitals will still be operating, & we’ll just be back to where we were less than a century ago. Price of medicine no longer bid up. Problem solved, no?

      1. You’re assuming that a rational solution to the death spiral problem will actually be implemented. Repealing Obamacare IS the rational solution and it apparently can’t be implemented now because the Republicans have no principles.

        What’s more likely to happen is the Republicans screw this up and lose in future elections, ensuring that the Democrats can save the day with single-payer.

  9. How did we end up here?

    We shoulda taken a left at Albuquerque.

    1. HEY! This isn’t Pismo Beach!

      1. Jack*, is that you?

        *Jack Web.

      2. Since when is Pismo Beach inside a cave!?

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  11. “UPDATE: WASHINGTON (AP) ? Congressional Budget Office says 16 million more uninsured would result from GOP’s pared-down health care bill.”

    “UPDATE: SAN FRANCISCO (SEVO) —- Congressional Budget Office says 16 million more won’t get free shit from GOP’s pared-down health care bill.”
    It’s all in how you ask the question, isn’t it?

    1. Congressional Budget Office says 16 million more uninsured would result from GOP’s pared-down health care bill.

      Seems like awkward phrasing, until you realize that they’re including in that count people who would choose not to buy health insurance, once they don’t have to worry about the indie mandate penaltax. So they can’t say “16 million people lose their insurance”, though that’s clearly what they are trying to imply.

  12. This is another example of why I don’t want what the progs call by the bogus name “single-payer”. Just imagine, if you will, that the Democrats had gotten “single-payer” through during the Obama administration, and thus we’d be in that system right now. This ridiculous clusterfuck is how the budget for all healthcare spending would be handled! And it would be administered by…a Trump appointee. Who would take his orders from…Trump.

    If the progs think that’s the definition of heaven they seriously need to find a new religion.

  13. Rope. Lamp posts. Politicians. Some assembly required.

  14. Is Team Stupid TRYING to lose in the midterms to the identity politiking retards that Team Blue have become? This may be anecdotal, but when I was in line to vote during the last cycle I heard a couple couples discussing who and why they were voting. They were voting AGAINST the ppaca. Team Red better get a clue.

  15. All the contortions and half- measures the GOP has put into its health insurance bills has been to appease McCain’s fastidious notions of how the Senate is supposed to work. The unfortunate thing is that we are now stuck with this ACA, at least until it collapses.

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