As pressure mounts on GOP lawmakers to address health care, some Republican lawmakers have suggested they go it alone again through the process known as reconciliation.
After all, they proved they could already do it once this Congress.
To hear it from one of the key lawmakers who helped shepherd the first reconciliation bill this year, House Budget Committee Chairman
That’s a lot easier said than done.
Passing President Donald Trump’s domestic tax and spending law was a herculean task for Republican leaders even with the strongest incentive, extending Trump’s 2017 tax cuts, to force GOP lawmakers to get behind the bill.
There is no deadline this time around. The enhanced Affordable Care Act subsidies that brought health care to the forefront are all but guaranteed to expire and premiums are set to skyrocket. The vast majority of Republican lawmakers are loath to extend anything related to Democrats’ landmark health care legislation and have dismissed extending the credits.
That’s not to mention that reconciliation has its own specific set of rules and Republicans have failed for 15 years to find consensus around health care. It is ambitious, to say the least, to think that Republicans can do that in an election year with a razor-thin House majority.
The rank-and-file moderate lawmakers most interested in health care legislation are keenly aware of the challenges of another party-line bill and have acknowledged a bipartisan deal is likely the only path forward.
In a tense meeting between moderate House Republicans and
Johnson, forever the optimist and who has proposed a second party line bill centered on health care, was heard responding, “take those words out of your mouth.”
But Johnson and Trump know very well how hard it will be to pass a second reconciliation bill. That’s why they insisted on passing just one massive bill, jammed with policy sweeteners to appease as many lawmakers as they can, as opposed to Senate Republicans’ proposed two-bill plan.
For all the enthusiasm from Johnson and other reconciliation-happy Republicans, the process has significant limitations.
Provisions in a reconciliation bill have to comply with the “Byrd rule,” which demands the legislation be budgetary in nature. If any provisions violate the rule, the bill is subject to a 60-vote threshold, defeating the purpose of a party-line reconciliation bill.
“Reconciliation can tune some dials, but it can’t really accomplish much else,”
Several of Republicans’ health care proposals from the first reconciliation bill were axed by the Byrd rule. They included provisions that expanded the exemption for Medicare price negotiations for “orphan drugs,” and language that would have banned Medicaid funding for gender-affirming care.
The legislative work and policy debate to craft a health care bill that would also comply with the Byrd rule would be an enormous lift, one that vulnerable Republicans aren’t likely eager to get caught up in in an election year.
Moderate GOP lawmakers already had to swallow deep Medicaid cuts that hurt many of their constituents from the first reconciliation bill and evident from Lawler’s argument with Johnson, they aren’t interested in another party-line bill and putting the onus entirely on themselves to address health care.
But in what might be a relief for Lawler and his fellow swing-state Republicans, Trump himself appears largely uninterested in giving reconciliation another go. Republicans “don’t need” another party-line bill, “because we got everything in” the first package, he said.
“Rinse and repeat,” sure, but this load might be stuck in the wash cycle for a while.
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