First, several readers commented that 24 million fewer Americans would have health insurance by 2026 rather than the 24,000 stated in my last blog.  Of course 24 million is correct.  No matter how many times I edit a blog I frequently miss something that should have been obvious to me.  Sorry about that.  If you are on my blogsite you can scroll down to read my previous blog on the American Health Care Act (AHCA).  The number has been corrected.

Rather than make my May 6 blog boringly long I left out some important points that I will pass along in this update.  They relate to certain provisions in the AHCA that will likely cause significant procedural issues in the Senate.  Representatives like Mark Meadows (R-N.C.), Tom MacArthur (R-N.J.) and certainly Speaker Paul Ryan (R-Wis.) should have realized the problems they were creating.  They can’t be totally ignorant of Senate rules.

As mentioned in several blogs, Republicans want to use the reconciliation process in the Senate to pass the AHCA.  That way they can pass it with a simple majority vote after 20 hours of debate and avoid a filibuster by Democrats that requires 60 votes.  But reconciliation has some restrictions.  The major one is the Byrd Rule, which is named for former Democratic senator Robert Byrd from West Virginia.

Among other things, this rule limits reconciliation to provisions that affect the federal budget, primarily spending or taxing.  And it limits consideration of other matters that are “extraneous” to the budget process.   Even some Republicans have pointed out ways the ACHA might run afoul of the Byrd Rule.  So it is highly likely that Democrats will challenge the following in the AHCA:

·         The MacArthur amendment that allows states to seek a waiver and opt out of the Obamacare’s regulations that require policies cover specific essential health benefits and require insurers to cover people with pre-existing conditions at the same rates as other insureds

·         The change to Obamacare that allows health plans to charge older policyholders five times what they charge young adults

·         The 30 percent surcharge on people who let their coverage lapse

·         The elimination of the Obamacare mandate on larger employers that requires them to provide health insurance to employees

·         The reforms to Medicaid, such as imposing work requirements and capping federal payments to states

This reconciliation will be a complex process.  It involves objections (points of order) by Democrats and rulings by the Senate parliamentarian.  It is likely that some of the above provisions will be stricken from the AHCA or require a vote of 60 members to remain.  In other words it could be a battle royal.

Several GOP senators have stated that the Senate will draft a separate bill using the AHCA as a guide.  Regardless, it is unlikely the AHCA will survive as it was passed in the House and could go back to the House for a second vote.

One report indicated that conservative Sens. Ted Cruz (R-Texas) and Rand Paul (R-Ky.) suggested that the parliamentarian’s rulings should be ignored if they get in the way of passing a GOP healthcare bill in the Senate.  But that suggestion evidently didn’t get much traction and it is not difficult to see why.

The GOP leadership has a justification for the AHCA.  I think they have advised their members to just keep repeating that Obamacare is failing and must be replaced.  But even if that were true, Obamacare could be fixed.  It should not amended by this monstrosity of a bill that primarily gives tax breaks to the wealthy while depriving millions of citizens of a health care plan.