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Time Is Running Out For “Repeal and Replace” As Scandal and Summer Loom

| May 22, 2017

Not a great view from up there these days. (Vsevolod Pulya)

Back in January, Republicans boasted they would deliver a “repeal and replace” bill for the Affordable Care Act to President Donald Trump’s desk by the end of the month.

In the interim, that bravado has faded as their efforts stalled and they found out how complicated undoing a major law can be. With summer just around the corner, and most of official Washington swept up in scandals surrounding Trump, the health overhaul delays are starting to back up the rest of the 2018 agenda.

One of the immediate casualties is the renewal of the Children’s Health Insurance Program. CHIP covers just under 9 million children in low- and moderate-income families, at a cost of about $15 billion a year.

Funding for CHIP does not technically end until Sept. 30, but it is already too late for states to plan their budgets effectively. They needed to know about future funding while their legislatures were still in session, but, according to the National Conference of State Legislatures, the local lawmakers have already adjourned for the year in more than half of the states.

“If [Congress] had wanted to do what states needed with respect to CHIP, it would be done already,” said Joan Alker of the Georgetown Center for Children and Families.

“Certainty and predictability [are] important,” agreed Matt Salo, executive director of the National Association of Medicaid Directors. “If we don’t know that the money is going to be there, we have to start planning to dismantle things early, and that has a real human toll.”

In a March letter urging prompt action, the Medicaid directors noted that while the end of September might seem far off, “as the program nears the end of its congressional funding, states will be required to notify current CHIP beneficiaries of the termination of their coverage. This process may be required to begin as early as July in some states.”

CHIP has long been a bipartisan program — one of its original sponsors is Sen. Orrin Hatch (R-Utah), who chairs the Finance Committee that oversees it. It was created in 1997, and last reauthorized in 2015, for two years. But a Finance hearing that was intended to launch the effort to renew the program was abruptly canceled this month, amid suggestions that Republicans might want to hold the program’s renewal hostage to force Democrats and moderate Republicans to make concessions on the bill to replace the Affordable Care Act.

“It’s a very difficult time with respect to children’s coverage,” said Alker. Not only is the future of CHIP in doubt, but also the House-passed health bill would make major cuts to the Medicaid program, and many states have chosen to roll CHIP into the Medicaid program.”

“We’ve just achieved a historic level in coverage of kids,” she said, referring to a new report finding that more than 93 percent of eligible U.S. children now have health insurance under CHIP. “Now all three legs of that coverage stool — CHIP, Medicaid and ACA — are up for grabs.”

But it’s not just CHIP at risk due to the congested congressional calendar. Congress also can’t do the tax bill Republicans badly want until lawmakers wrap up the health bill.

That is because Republicans want to use the same budget procedure, called reconciliation, for both bills. That procedure forbids a filibuster in the Senate and allows passage with a simple majority.

There’s a catch, though. The health bill’s reconciliation instructions were part of the fiscal 2017 budget resolution, which Congress passed in January. Lawmakers would need to adopt a fiscal 2018 budget resolution in order to use the same fast-track procedures for their tax changes.

And they cannot do both at the same time. “Once Congress adopts a new budget resolution for fiscal year 2018,” said Ed Lorenzen, a budget-process expert at the Committee for a Responsible Federal Budget, that new resolution “supplants the fiscal year 2017 resolution and the reconciliation instructions in the fiscal year 2017 budget are moot.”

That means if Congress wanted to continue with the health bill, it would need 60 votes in the Senate, not a simple majority.

There is, however, a loophole of sorts. Congress “can start the next budget resolution before they finish health care,” said Lorenzen. “They just can’t finish the new budget resolution until they finish health care.”

So the House and Senate could each pass its own separate budget blueprint, and even meet to come to a consensus on its final product. But they cannot take the last step of the process — with each approving a conference report or identical resolutions — until the health bill is done or given up for dead. They could also start work on a tax plan, although, again, they could not take the bill to the floor of the Senate until they finish health care and the new budget resolution.

At least that’s what most budget experts and lawmakers assume. “There’s no precedent to go on,” said Lorenzen, because no budget reconciliation bill has taken Congress this far into a fiscal year. “So nobody really knows.”

–Julie Rovner, Kaiser Health News

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12 Responses for “Time Is Running Out For “Repeal and Replace” As Scandal and Summer Loom”

  1. Brian says:

    Its about time congress was forced to due a budget, The Democrats passed nothing but continuing resolutions, just a bunch of cry babies to do the hard work and actually cut something.

  2. PC Citizen says:

    If the Senate passes anything like the bill that passed the House that should be enough to wake up some of the Trumpsters who will lose their health insurance or have family members lose their health insurance.

  3. Merrill Shapiro says:

    Isn’t it just like our very own US Representative Desantis to take healthcare away from poor children?

  4. Lazaruis says:

    This health bill will be delayed , stalled and not passed by the Congress. This health care bill is worse crap than Obama care crap.!!

  5. Robjr says:

    I am still waiting to see that health care for everybody promise come to fruition.

    Not only healthcare for everyone but at a lower cost.

    And I thought, in a free market, the supplier set the price point.

  6. Sherry Epley says:

    Excuse me. . . it’s the “Republicans” who have held the “majority” in Congress. . . both houses. . . and who have NOT passed a real budget for years!

  7. Makeitso1701 says:

    Talk about being a cry baby,all trump does is whine, whine,whine. I think he is way, way over his head in this job, and he is definitely way way and I mean way under clalified.

  8. Katie Semore says:

    @Brian, it is amazing how you always manage to accuse the Dems of doing what the Reps did. There hasn’t been a Dem Congress for years. It was Rep Congress who kept the CR’s going year after year after year.

  9. Sw says:

    Sometimes @Brian its just a “failure to communicate” because one is” too close to the forest to see the trees” Jed Clampett would tell the Donald to “quit blowin on the fur and get to the hide boy”.

  10. Pogo says:

    @Katie Semore

    Voting Republican is mere self interest for hereditary wealth (winning the hard way by inheritance, marrying for money and so on), pass-through and passive income, etc, etc. – and the food chain it feeds. It’s a big family: Banking, insurance, trading stocks and bonds, advertising, public relations, law, lobbying, professions of every ilk (each with its own association for every level of government), businesses of every ilk (each with its own association for every level of government). Somehow they manage to survive…

    And then there is the rest of us (which includes many from the aforementioned) who don’t belong to an organized party – we’re Democrats. The only thing we’ve ever done for people (with absolutely no help whatever from Republicans) is win WWI (and lose the peace – because of Republicans) save us all from the Great Depression (in spite of the Republicans) lead the victory in WWII, rebuild the post war world, and support every step forward of progress for human rights. Oh, and save us from the abyss created by Reagan-Bush-Bush. Thanks Obama.

    Along the way, the Republican party was devoured by white collar criminals, crack pots with more money than God, religious fanatics, bigots, and haters. Eisenhower and Reagan (Goldwater too) would be defeated for dog catcher by today’s so-called Republicans.

    Imagine if people who think the ‘death tax’ is a danger to passing down a used car or mobile home would just quit listening to clowns like these:

    Imagine if they just read, or, or – instead of the teasers on Drudge.

    Imagine if the read Flagler Live instead of what they actually do.

  11. Edith Campins says:

    The Republicans had 7 years t come up with a better plan. They didn’t.

    The Republicans had 7 years to fix the flaws in Obamacare. They didn’t.

    Trump said he had a plan that would cover everyone and cost less. He had nothing.

    He is going to cut healthcare so he can build his useless wall, pay for his trips to Florida, pay to keep Melania
    in Ny and give the rich a tax cut.

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