Ryan Calls Trumpcare Vote For Thursday; What's The Rush?

Well, it looks like the Paul Ryan is intent on getting the House to vote on Trumpcare this Thursday. That means sometime between now and Wednesday night, Ryan will unveil whatever tweaks he has made to the bill and then ask the House to vote on the measure just days or even hours later. Apparently Ryan believes these changes will bring enough conservatives on board to allow the bill to squeak through to passage and that wavering House members will be too afraid to vote against "repeal", having campaigned on that theme for the last seven years.

Reports indicate that, after a meeting at the White House with Trump, Ryan, and the Republican Study Committee, whose membership somewhat overlaps the Freedom Caucus, it was agreed that a work requirement for Medicaid recipients would be added to the bill and that states would have the option to receive a fixed sum or a per-capita amount when applying for their Medicaid block grant. Depending on when Ryan announces the changes to the AHCA, it may not be possible for the CBO to score the new plan. But if these are the only changes to the plan, it is hard to see how the CBO numbers will change significantly and, in fact, the number of newly uninsured under Medicaid might even climb even higher than the original estimate with the work requirement in place.

As Chris Hayes noted last week, if the House goes forward and votes on the bill on Thursday, it will only have been 17 days since the original proposal was released. There will be no hearings or testimony from experts before the vote and the number of amendments will be limited or non-existent. 17 days to reorganize 20% of the US economy. At this point it looks like Ryan is taking a huge gamble on just ramming this through as quickly as possible. I'm pretty sure not even he knows whether he has the votes to pass it at this time and a failure in the House would imperil his position as Speaker. I do believe that he thinks he can get the vote close enough to where he can twist the few remaining arms to get the bill passed, even if it means keeping the vote open for as long as that takes.

If the bill passes the House, it is not going anywhere in the Senate as it is currently written. The Senate has its own issues on getting a bill passed, especially as the change allowing the ratio of rates for insurers to charge older versus younger enrollees to move from 3:1 to 5:1 will probably not be eligible to be passed under reconciliation and will need 60 votes, allowing Democrats to filibuster that provision. But eventually the Senate will probably be able to craft a bill of its own that will only lose one or two Republicans and get passed. At that point, the two bills will go to conference to hash out a final bill that both houses of Congress will again then have to pass. It is hard to see how the two bills could actually be reconciled in a way that could pass the House and the Senate but, at this point, Republican leaders would simply be happy to just get to that point. But that scenario actually works in Ryan's favor with the vote on Thursday as most House members will believe that there will be a second vote on the AHCA which "frees" them somewhat on this vote.

Meanwhile, the April deadline for insurance companies to make their decisions about participating in the ACA exchanges next year is fast approaching. As I have written before, if we get to mid-to-late April and the GOP is still bickering about the details of the AHCA, with no agreement between the House and the Senate, it could spell disaster for the exchanges in 2018 and Democrats had better be prepared to make sure Republicans get blamed for that.

It is an open question why Ryan feels the need to move this bill through the House with such haste. Is it because he knows the longer people have to look at the details, the harder it will be to pass? But it is hard to see how much worse it can get after the CBO score came out. Is it because the GOP is feeling the pressure of that April deadline for insurers? But Republicans have been saying Obamacare is imploding for years and the collapse of the exchanges would actually give them "proof" of that, even though the GOP would have actually caused the 2018 collapse. Or is it because the GOP leadership realizes that the repeal and replace of Obamacare has now become a political loser for the party and it would be better to simply have a vote and see the bill go down to defeat? Sure, they would take some heat from the base but they tried and they failed. With healthcare out of the way, they could move on with the rest of their agenda like tax reform.

The next four days are critical. If Republicans can not get this bill to pass the House, it will partially derail the rest of their legislative agenda, as the tax cuts that are the real driver for the GOP in the AHCA are key to tax reform and other Republican plans going forward. Intense pressure on GOP House members such as what happened to Pete Sessions yesterday will make them think long and hard about this vote. Not only do they have to take into account their constituents in revolt at home, but they also have to consider the fact that the bill may die in the Senate or that Trump will realize how bad this bill is for his base and not sign it, as he threatened to do in his Fox interview last week. Do they really want to be left hanging out there as potentially the only votes for ripping healthcare away from 24 million Americans, especially when they know full well that Trump will not provide them any cover if the bill fails. For Democrats and progressives, it is time for a full court press between now and Thursday.