President Donald Trump announced his “Great Healthcare Plan” to little fanfare on Capitol Hill last week.
The question now is how willing and able congressional Republicans will be to actually pass any of it into law after stumbling for years over politically toxic plans to undo Obamacare. The prognosis is not encouraging for the White House.
Key parts of the light-on-details proposal likely won’t meet the strict Senate rules for party-line legislation that could skirt a Democratic filibuster. Similar cost-reduction proposals from Republicans ran into problems on that count in last year’s tax-cuts-focused megabill.
White House officials argue the new health care plan features initiatives that should garner bipartisan support, but Democrats are already balking. They’re in no mood to help Republicans out after Trump’s megabill slashed Medicaid funding, and they’re still fighting to revive the expired Obamacare subsidies that the Trump plan rejects.
“Time and again, Donald Trump has made empty promises to the American people about lowering their health care costs, and today’s announcement is no different,” Senate Finance ranking member Ron Wyden (D-Ore.) said in a statement following the release of the White House framework.
Even without the procedural hurdles, uniting Republicans behind a health care plan has repeatedly proven next to impossible. The fate of the enhanced Obamacare subsidies roiled the party for months before they lapsed Jan. 1, and now there are major divisions over whether to pursue more health initiatives using the partisan budget reconciliation process.
One key House faction, the conservative Republican Study Committee, released a blueprint last week for a party-line bill that included health care provisions, and its leaders now argue Trump’s plan mirrors key parts of it. They are among a significant GOP bloc that sees reconciliation as the only way the party can pass health legislation — or any other substantive policy — ahead of the midterms.
“Our framework for a second reconciliation bill includes many of these historic reforms, because that’s how we’re going to secure real wins for the people who sent us here,” Rep. August Pfluger (R-Texas), who leads the group of nearly 200 House Republicans, said in a statement to POLITICO.
But vulnerable incumbents have much less of a stomach for taking up a new health care package before Election Day — especially after the bruising Medicaid and Obamacare subsidy fights.
One House Republican granted anonymity to speak candidly about conference dynamics described the appetite among GOP moderates for another major party-line bill — especially a health-focused one — as “not good.”
“You’re going to need 218 votes, which means you’re going to need to build consensus across the conference on what it is we’re pursuing,” said Rep. Mike Lawler (R-N.Y.), a centrist in a tough reelection fight who said the RSC’s plans are “not reflective of the entirety of the conference.”
There’s also major skepticism among Senate Republicans, including some top Trump allies, who understand that many of their ideas don’t qualify under reconciliation rules, which generally allow only for initiatives that are primarily fiscal in nature. Senators have long deferred to the chamber’s parliamentarian on those judgments.
“A lot of the reforms my colleagues thought about earlier, the parliamentarian didn’t accept,” said Sen. Josh Hawley (R-Mo.), adding that he expected only “a pretty limited universe” of health care proposals to pass muster.
Indeed, Senate Republicans tried to include one of Trump’s health care proposals in their megabill last year — funding a kind of insurance subsidy for out-of-pocket payments in a bid to lower premiums for some Obamacare plans. The parliamentarian ultimately ruled the measure was noncompliant.
Trump’s call for insurers and providers to publish their prices is also unlikely to qualify for inclusion, considering that any fiscal impact of the transparency measures would be purely incidental to the policy.
Two senior Republicans involved in the internal conversations granted anonymity to speak about them said GOP leaders will likely have to carve out a narrow slice of the Trump health plan to pursue via reconciliation, if that’s even possible. Other pieces, they said, would have to advance through bipartisan talks with Democrats, who have in the past endorsed proposals to crack down on pharmaceutical industry intermediaries who help negotiate drug prices.
A senior administration official said Thursday that “reconciliation would not be necessary” because the ideas sketched out under the health care framework could get bipartisan support. But at a White House event Friday, Trump acknowledged that was unlikely, saying “the problem we’ll have with this is, we’ll get no Democrat votes.”
There’s another complication: A key plank of the Trump plan — codifying “most favored nation” drug pricing deals — is opposed by many senior Republicans. Speaker Mike Johnson said last year he was “not a big fan” of the policy as White House officials tried unsuccessfully to shoehorn it into the GOP megabill.
Still, many Republicans are making a public show of embracing the Trump framework — including Sen. Rick Scott (R-Fla.), who quickly reinforced the need for a party-line bill to implement the White House plan after it was released Thursday.
Sen. Bill Cassidy (R-La.), who chairs a Senate committee dealing with health care, said he would take “action” on some of the president’s proposals, including codifying transparency rules. Meanwhile, House Ways and Means Chair Jason Smith (R-Mo.), who has previously expressed deep skepticism about the GOP’s ability to pass another party-line bill, complimented the plan’s “bold vision” and said his panel would move to advance it.
Any action will be in the hands of the top Republican leaders. Johnson and Senate Majority Leader John Thune discussed a second reconciliation bill during their regular weekly meeting last week. Thune said the two will “coordinate” but that the House will be “first movers” on any new partisan package.
“They’ve got some ideas about what they want to do with it,” Thune said. “As I’ve said before, you’ve got to have a reason to do it.”
Cheyenne Haslett contributed to this report.
