What in the World Is Going On with the Health-Care Bill?

by Robert VerBruggen

Last night, Bloomberg came out with a heck of a scoop: The House’s American Health Care Act has not been sent to the Senate, and in fact, if the Congressional Budget Office scores the bill poorly, the House will have to vote on it again. “House leaders want to make sure the bill conforms with Senate rules for reconciliation, a mechanism that allows Senate Republicans to pass the bill with a simple majority,” the piece explains. It later adds: “According to several aides and other procedural experts, if Republicans send the bill to the Senate now and the CBO later concludes it doesn’t save at least $2 billion, it would doom the bill and Republicans would have to start their repeal effort all over with a new budget resolution.”

Even to many of us who’ve been following the legislative wrangling on health care, this came as a shock. Indeed, the news came as a shock to some of the legislators Bloomberg interviewed; they didn’t even know the bill hadn’t been sent.

In terms of procedure, the important thing to understand is that different reconciliation violations are handled in different ways. If the Senate parliamentarian decides that a certain provision isn’t budget-related and thus violates the “Byrd Rule,” for example, the usual consequence is just that the Senate strikes it from the bill. (It has always been well-known that the House bill might violate Senate rules in this way.) But if the bill doesn’t achieve the required deficit reduction, it violates the very budget resolution that gave instructions to House and Senate committees and got the reconciliation process started in the first place.

How big is the risk here? As the Bloomberg piece observes, “Republicans had a sizable deficit reduction cushion — $150 billion — before several amendments were added to the bill at the last minute, including changes allowing states to legalize much skimpier health insurance plans.”

But paradoxically, cheaper health plans could be a budget problem. As the Committee for a Responsible Federal Budget has noted, if the plans lure a lot of young and healthy people into the insurance market, each of those people will receive a tax credit, which will eat away at the previous version’s deficit savings. “With 6.5 million or more additional enrollees,” it reported, “the entire legislation would likely increase rather than reduce deficits.” That’s toward the higher end of the range the CRFB considered, but the CBO will have to make incredibly subjective assumptions to come up with a single estimate.

A lingering question: When exactly did the House leadership decide to quietly hold on to the bill? Was this the plan all along, to pass the bill with no CBO score while guarding against the possibility that the score would doom the bill?

The Corner

The one and only.