House Republicans passed the American Health Care Act in a hurry on May 4. They held no hearings on the final version, and it passed with only two votes to spare. Twenty of their members voted against it, and they failed to convince a single Democrat to sign on.
And in their rush, they didn't wait for the Congressional Budget Office to analyze the bill's likely budget impact. That kind of haste is highly unusual. The CBO analyzes almost all major legislation before members of Congress are asked to vote. The AHCA's sweeping changes to health coverage for millions of Americans certainly qualify it as major.
In other words, Republicans were in such a hurry to abolish Obamacare that they voted on a repeal bill without having any clear idea of what the financial effects would be.
That is because Republicans plan to fast-track the bill through the Senate's budget reconciliation process. Under it, bills can pass with only 51 votes, not the 60 needed to overcome a filibuster. But only bills projected to cut the deficit by a minimum amount qualify. If CBO's projections come in too low, budget reconciliation won't work, and Democrats could use the filibuster to prevent the bill from ever reaching a vote.
While they wait for CBO's report, House Speaker Paul Ryan has taken the highly unusual step of holding onto the bill without sending it onto the Senate. In other words, a bill that was passed more than two weeks ago is still sitting on the Speaker's desk. The legislative process has been turned on its head.
If CBO's deficit reduction projections are too low, the AHCA in its current form will stay on Ryan's desk. It will have to be amended to increase projected budget savings – and then reintroduced for a second vote. Republican leaders think the result will be the same, but some in their ranks who voted for it reluctantly the first time may not be eager to do so again.
Even if it overcomes this hurdle, the AHCA has a more fundamental problem. As a replacement for Obamacare, it makes no sense and would do tremendous damage throughout the health care system. Its contraction of Medicaid, which does nothing to address the functioning of the insurance exchanges that it is supposed to fix, will cause millions of people to lose coverage (the CBO analysis will offer a precise estimate) and turn many of them into charity patients. Hospitals throughout the country would be hard pressed to absorb the cost
The AHCA's changes to the Obamacare insurance exchanges will make them less stable, not more. Millions will see their subsidies slashed and find themselves unable to afford coverage. And the bill's loosening of regulatory standards for policies will diminish the value of coverage for those who can afford it.