March 8th, 2017

Obamacare and GOPcare: getting reconciled with the process of reconciliation

Commenter “Frog” asks:

…I do not understand.

If the Obamacare bill was passed in the Senate via reconciliation…, why cannot it be rescinded in the Senate via reconciliation? Is this more Alice In Wonderland?

The question is a reasonable one, and it highlights how very complex the legislative process often is. House and Senate (especially the Senate) have their own arcane and often puzzling rules and arcane and often puzzling strategies/tactics involving those rules. It makes the rest of us scratch our heads and doubt the motives and abilities of our legislators.

It’s not that those in Congress are such well-meaning geniuses, either. There’s plenty of room to doubt and plenty of reason to doubt. But sometimes there is a more innocuous (although complex) explanation for what they’re doing, and I submit that the GOP’s use of reconciliation to deal with Obamacare is one of those times.

For anyone who wants to try to understand the ins and outs of this, I recommend this and this, and this. From the latter [emphasis mine]:

The reconciliation process can only be used to pass bills that affect spending and revenue — budgetary matters, in other words. It was created in the 1970s to make it easier for Congress to keep a budget, by giving the Senate tools to more easily change laws regulating big mandatory spending programs like Medicare, Medicaid, and the like.

Last year, Republicans passed the Restoring Americans’ Healthcare Freedom Reconciliation Act, a repeal bill that uses the reconciliation process. The Senate parliamentarian ruled that all the parts of Obamacare that it repealed — Obamacare’s insurance subsidies, Medicaid expansion, the law’s tax increases, and its mandate to purchase coverage — could be dismantled through reconciliation…

There’s basically nothing that Democrats alone can do to stop this. Budget resolutions can’t be filibustered, so if Republicans vote to include reconciliation instructions for Obamacare repeal, there’s nothing the opposition can do about it. And, of course, they can’t filibuster the actual repeal bill; that’s the whole point of using reconciliation.

So if the plan doesn’t work, it’ll have to be because there are Republicans defections.

That was written in January, and of course the dissension in the Republican ranks is pretty clear right now.

If we have an Alice in Wonderland situation in terms of process (“curiouser and curiouser”), it’s because of the way the bill was passed in the first place and the way the Senate works. The GOP senators are constrained by a number of things, and not all of them have to do with the extreme difficulty of crafting a health care law that is not exorbitant, does not restrict liberty unduly, and yet doesn’t raise a furious hue and cry about gazillions of uninsured Americans. Some of the constraints have to do with the way Congress is structured and the necessity of getting around the filibuster—a filibuster that would give the Democrats the power to block any repeal that is not accomplished through reconciliation, and which prevents an outright and total repeal that doesn’t use reconciliation.

In other words, to answer Frog’s question (at least as I understand the question and the explanatory articles): full repeal cannot use the reconciliation process and would subject the bill to Democrats blocking it. The GOP is using the reconciliation process, which means the repeal is somewhat piecemeal in that it does not and cannot include all items, but it gets around the filibuster difficulty.

Now, some of you might say “Away with the filibuster entirely!” I don’t think the GOP is eager to do that, and it’s not just for lack of cojones. The filibuster, with its protection of the minority party, has stood the test of time to a large extent because each party knows it could be the minority next time. And to those who say “The Democrats would do it in a heartbeat, so the GOP must do it first!” I would answer that I sometimes think that myself, but I am given pause by the fact that the Democrats didn’t do it when sorely pressed during the time they were trying to pass Obamacare.

Why didn’t they do it then? Because (a) even they were afraid to cross that line for fear it would come back to haunt them; and (b) they felt they didn’t need to do it, because they could pretty much accomplish what they wanted through reconciliation.

I believe the Republicans are reasoning the same thing at the moment.

28 Responses to “Obamacare and GOPcare: getting reconciled with the process of reconciliation”

  1. Yancey Ward Says:

    The Republicans, if they wanted to, could simply defund whatever part of the ACA they wanted to through reconciliation. In other words, they could make all the parts of the ACA that passed with 60 votes irrelevant.

    One gets the feeling after the last two days that the leadership in the House and the Senate don’t really want to do anything now that they have to power to actually do something.

    Now, writing their own regulatory changes, such as tort reform etc. would require 60 votes given the Senate rules.

  2. neo-neocon Says:

    Yancey Ward:

    I hear that kind of complaint all the time. But I don’t agree with it.

    What I see is that the GOP members of Congress disagree with each other on what to keep in and what to take out. That’s not at all the same as not wanting to do anything; it’s not agreeing on what should be done.

    And your proposal to simply defund the parts they don’t like would cause an enormous brouhaha. YOU and some others might like it, but most Americans would feel it pulled the rug out from under people (particularly vulnerable people) regarding health care without giving them an alternative way to deal with it. “Repeal” is not enough, because Obamacare dismantled the previous system that was in place. It must be “repeal and replace.”

    The Democrats count on—and thrive on—Republicans and conservative attacking the GOP in Congress and turning on them. I’m not saying the GOP must be praised and supported no matter what they do or don’t do—certainly not—but I think it is very unwise to criticize them and impute rotten motives to them in the absence of better evidence of those rotten motives. The point of this post is to explain why it is that the Republicans in Congress can’t just do what people would like them to do, and that there are explanations for that other than bad faith on their part.

  3. Manju Says:

    The answer to the question is very simple. Obamacare was not passed thru reconciliation.

  4. parker Says:

    ACA was over 2,000 pages and none of those who voted for it knew what was in it, even that genius Pelosi. It also gave the Secretary of HHS wide spread powers to create regulations in order to administer the act and to ‘interpret’ the provisions of the act. It is a bureaucratic behemoth. It will take more than one bill to stick a fork in obamacare.

    IMO health care issues should be determined in the laboratories of the 50 states. It is important to realize your zip code determines what types of health (or any type of) insurance will be available and what it will cost. That should be the goal of the gop. My unsolicited advice is to be patient.

  5. Manju Says:

    So the long/short is this.

    Dems overcome a Senate filibuster and pass Obamacare. See here.

    Bill goes back to the House. Kennedy dies.

    This means Dems can no longer overcome a filibuster. That’s a problem if the House passes a different version of the bill, because then the Senate must vote all over again. Republicans see a path to victory.

    But Senate Dems convince the House to pass the Senate version. They do, and Obamacare becomes law.

    Later, the Senate uses reconciliation to amend the bill to make the budgetary changes that the House wanted originally.

  6. neo-neocon Says:

    Manju:

    Yes, there were several ways the Democrats could have gotten to Obamacare. In the end, they used reconciliation to pass the bill and to get the House and Senate versions to match, because to change and perfect the bill and pass it in the ordinary way was no longer possible because of Brown’s victory..

    I don’t feel the need to go through the entire legislative history every time I discuss Obamacare. The point is that reconciliation was part of its legislative history because of the filibuster, and the GOP feels it also has to rely on reconciliation for a similar reason.

  7. Manju Says:

    The point is that reconciliation was part of its legislative history because of the filibuster, and the GOP feels it also has to rely on reconciliation for a similar reason.

    If the GOP feels it needs to rely on reconciliation for a similar reason, they will have to overcome a Senate filibuster first…just as Dems did.

  8. neo-neocon Says:

    Manju:

    Did you read the links I gave? They appear to saying that they will not have to do this (just as the Democrats didn’t have to do it at the end), because they will not be passing a completely new bill.

  9. Geoffrey Britain Says:

    The GOPe, Ryan and McConnell are protecting themselves. They greatly fear that, if they actually repeal ObamaCare, the dems and MSM will crucify them with the incessant mantra, “millions will lose their insurance!”

    That fear is somewhat justified, not only because that mantra is already being beat like a drum but most importantly because only single-payer, socialized healthcare can guarantee to provide ongoing healthcare for everyone.

    The brutal truth is that real progress requires losers. No losers equals no winners. No losers means an equal playing field of misery. Canada’s six month wait for heart surgery. Death squads run by unelected beancounters.

    Completely repeal Obamacare.
    Pass a free market, simple healthcare bill.
    Eliminate restrictive insurance provisions that increase costs.
    Eliminate denial of coverage for prexisting conditions, while accepting that the cost of health insurance must reflect that burden.
    Determine why healthcare is so outrageously expensive and address those factors.
    Extending life for the aged is exceptionally expensive, either pay a premium for it in your insurance or accept that when its your time, its your time.
    The choice is simple; progress requires winners and losers. Socialized medicine’s cost to providing healthcare as a ‘right’ to all is the equal sharing of misery and a severe retardation of progress.

  10. J.J. Says:

    Paul Ryan was on the Tucker Carlson show tonight and did a pretty good job of explaining why (as did your post, neo) the first stage of their three stage process has to done by reconciliation. Carlson pressed him pretty hard and Ryan had his ducks in a row. Unfortunately for him, it’s a lot like herding cats. I hope the Repubs get their act together and get this done. But they’re not called the stupid party for nothing.

  11. The Other Chuck Says:

    GB, perfectly said. I haven’t seen the Rand Paul bill but believe it is what you propose. Either we have a free market solution or continue to stumble our way to socialized medicine.

    Most people living today are too young to remember the 1950’s and what medicine was like before federal intervention. As an anecdote to show it, here is my little story:

    At 12 years of age I got terribly sick with stomach pains, vomiting, and couldn’t get out of bed. My mother, then a widow, stayed home from work to tend her sick child. As my fever approached critical state, she called the family doctor’s office. He made a house call. After examining me and determining that the pain in my right abdominal area indicated appendicitis, he picked me up in his arms, carried me down the stairs and out to his car. He laid me in the back seat and drove directly to the hospital where within the hour he was operating on me before the appendix could rupture.

    I don’t know what the final bill for an appendectomy and 3 day hospital stay was back then, but my mother paid it out of savings and with help from her parents since we didn’t have health insurance. Practically no one had insurance then. If you were unable to afford a private hospital, you had to rely on the county hospital and donated medical services. I believe that most GP’s as well as specialists donated time at the county facility to augment the sparse staff there.

    Of course none of the above could happen now. Can you imagine a doctor doing anything like that in a society that expects perfection and relies on lawsuits to achieve it?

  12. Frog Says:

    I also caught Ryan on the Carlson Show. He explained the need for “three steps” to complete the repeal. But without ending the filibuster, it seems a vain and irresponsible claim that steps two or three can be accomplished, save for a GOP Senate supermajority in 2019.
    Seems like a chancy plan.

  13. Yancey Ward Says:

    Most of the regulations that passed under the 60 vote rule were of the form granting the executive the power to produce regulations- they were not written specifically into the law. What the Senate can’t do with reconciliation can likely be done with simple regulatory changes made by Secretary Price.

    Neo, I am not advocating an immediate repeal, I am just pointing that the leadership doesn’t appear to have put much effort together for a blueprint for even getting a majority in House or Senate. The bill as it is seems already dead in the water.

  14. Vanderleun Says:

    Include me out on this whole now tedious argument. I went through the Obamacare argument when it was “passed.” Don’t have the patience to do a variation. Wake me when it’s over. Right now the whole thing is just one big MEGO.

  15. David Says:

    Why don’t we just take the only healthcare program that is proven to be good in our country and extend it to everyone else – medicare. If the oldest and most unhealthy people are already covered by it, how much more expensive could it be to just include the rest of the country who are way younger and way healthier?

  16. David Says:

    Why do we have to reinventing the wheel when we already have something that works in hand? We should look at Medicare and how we can apply it to everyone else, not reinventing something that might be worse that the system we are trying to replace.

  17. Frog Says:

    Let us pause to consider, exactly what was the health care “system” and how was it regulated before Obamacare?
    Fact is, the “system”, totalling 17%+ of GDP, was not regulated previously to any degree resembling Obamacare. There were and are big players with power, like Medicare, Aetna, etc., but though difficult to oppose, they could and were opposed, from the health care delivery point of view. From the financial, not so much.

    Obamacare is an imposition placed on all of us from above by a pretty small number of people (Congress, Grubers). We still await its more evil components, like the autonomous Independent Payment Advisory [sic] Board. The IPAB and its spiritual founder, Ezekiel Emanuel, will decide what may or may not be done, no appeal possible, based largely on Quality Adjusted Life Years (QALY), a concept so easily manipulated to cancel medical advances for the broad populace. People in their 80s are now getting bad aortic heart valves replaced without opening their chests! That will not occur under Ezekiel and IPAB, thanks to QALY. No one, including our host Neo and me, knows all or most of what really lurks in the >2000 page Obamacare Bill.
    85% of the previously uninsured, before Obamacare, are now on the dole, because they were enrolled in Medicaid. MEDICAID. Not private insurance. Nearly as many are now effectively uninsured because they can now longer afford insurance premiums and high deductibles. The net gain in population numbers is close tozero.
    Obamacare is simply a power grab. Period.

  18. Frog Says:

    Regretfully, David clearly knows next to nothing about the myriad flaws of Medicare. Medicare is not “good”. it is simply the ONLY insurance plan available to seniors. I’m on it, I don’t like it, I have no choice but to be on it. As a doc, I fought Medicare arbitrariness regularly as a member of my specialty society, usually without good result, no righting of wrong. Making it universal is simply going to single-payer, aka the National Health Service. We have that model already in our VA system. It is as rotten today with my MD daughter having to work in it part-time as it was in my day when I had to work in it part-time.
    Talk to us again when you have identified how to fix the VA, David.

  19. David Says:

    Frog, universal healthcare is always about the lowest denominator safety net to protect those without the resources, not providing luxury highest class of service for everyone. For most healthy young people, the low quality safe net is good enough, better than dying at least. For many places like Hong Kong where I came from luxury private hospitals are still available those who can afford it. Conservatives have a misconception about universal healthcare that you can’t purchase high standard services even if you have money to spend, that socialist healthcare means everyone suffers together, which is I think what most of the hate for it come from. It is not very hard to find the right balance that a safety net can be established for everything while more luxurious options are still available.

  20. David Says:

    If you compare healthcare to the auto industry, the problem with America’s healthcare system today is that only Mercedes Benzs are available but no Honda Civic or sentra for lower income of people to purchase . Conservatives’ concern about Healthcare is that if we have a socialize system of healthcare there will only be Civic and Sentra available and no Mercedes even if we can afford one. The perfect balance would be where you both have Mercedes for the rich and Civic for the poor.

  21. Richard Saunders Says:

    David — that’s pretty much what we have now. When you exclude all the people who were kicked off their plans and had to sign up for Obamacare (“If I like your plan, you can keep your plan.”) basically all that Obamacare did was let more people sign up for Medicaid. So If the intent was really to cover the uninsured, all you needed was a one-sentence bill — “Anyone who wants can sign up for Medicaid, and we will take (pick a number from 1 to 10) percent of your income to pay for it.”

    Of course, the real purpose wasn’t just to cover the uninsured, the real purpose was to have the federal government take over the entire healthcare system, hence the 2,000-page bill.

  22. neo-neocon Says:

    Yancey Ward:

    Please read this carefully. I think it deals with the issues you raise.

  23. David Says:

    Perhaps the insurance model of our healthcare system is fundamentally flawed. For auto insurance, most of insured will never use their insurance since car accident is not a frequent occurrence, that allows the auto insurance industry to make great profit while offering a reasonably priced product.
    Health insurance is a whole different story, everyone will get sick eventually, Health insurance companies can only remain profitable by not insuring high risk people with pre existing coditions or charge them a higher premium. a health insurance that requires to insure everyone without charging the riskier clients more is doomed to fail as a business model. We need to think outside of the box, if the insurance industry is he hurdle keeping us from successfully reforming healthcare, get rid of it, those working in it can move on to other fields, no need to keep everyone suffering just because we need to save the jobs of the people working in an obsoleted industry.

  24. The Other Chuck Says:

    David:
    Perhaps the insurance model of our healthcare system is fundamentally flawed.

    And perhaps you’re a big old socialist troll.

  25. David Says:

    health insurance is a thing only America has and its a complete failure. the core concept of insurance is a group of people paying a small amount of money into a pool in the case when an accident happens a person can take money from the pool as compensation. To make it works the occurrence of the accident must be relatively rare or else if the occurrence is so frequent that everyone will make a claim the pool of money will not be enough to cover and it will eventually bankrupt. Health insurance does not work especially in America because the cost of healthcare for every person will eventually outweigh the money a person will ever pay into the system given that the cost of healthcare here is so ridiculously expensive and lack any oversight due to this little thing called free market that conservatives blindly worship. Americans are so generally unhealthy that everyone will develop type ii diabetes if live long enough, everyone will develop cancer if live long enough, everyone will have a heart failure when live long enough. yes, government lacks efficiency and a hotbed for corruptions if let grew too big, but there are few things the government can do better than the free market and it is health care one of it. If you let the free market takes care of everything some people with rare diseases will never get cure since the resources put into researching on it doesn’t justify the financial profitability from it.

  26. David Says:

    also, for those who complains about medicare, have you ever thought about how health insurance companies can ever remain profitable if the government doesn’t take people over 65 off their hands when that is the stage in life people use healthcare the most? medicare contrary to your belief is a subsidence to the insurance industry from the government, if there is no medicare, either every health insurance bankrupts or they have to charge each elderly a ridiculously high premium that will eventually eat up everyone’s retirement fund.

  27. Ymarsakar Says:

    The Democrats have killed more people than Jihadists have, with that Hussein care plan. And Americans are complicit in this atrocity, in more than one way.

  28. Yackums Says:

    “Perhaps the insurance model of our healthcare system is fundamentally flawed. For auto insurance, […] Health insurance is a whole different story, everyone will get sick eventually. […] The core concept of insurance is a group of people paying a small amount of money into a pool in the case when an accident happens a person can take money from the pool as compensation. […]”

    That’s amazing, David. You’ve just laid out in a nutshell the main driver of the conservative, free-market position on health care and health insurance for the past twenty years.

    Maybe everyone will get sick eventually, though some never do. But many, many people may never get anything worse than the flu, or a broken bone. These are things that HEALTH INSURANCE is NOT meant to cover. These are things the treatment of which is relatively trivial and inexpensive. These are things that nearly everyone could afford to pay cash for, or would be able to afford in a competitive free market.

    Just like with auto insurance, health insurance is meant to cover the catastrophic expenses. Complex surgeries, long hospital stays, dialysis, chemotherapy. When policies are only paying for these types of things, and not for regular doctor visits and birth control pills, that’s a lot of money freed up for the insurance business model to properly function.

    And let’s be absolutely clear about one thing. From my experience with this debate in a different country where the same argument takes place, I can tell you there is NO FRICKIN’ WAY that the Progressive Left will abide a situation in which there is a basic level of coverage for all, but “the rich” can purchase upgraded levels of health care services. You cannot imagine the howling. Oh, the inequality!!!

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