Friday , March 17, 2017 - 5:30 AM
WASHINGTON — In his effort to save the Obamacare reform bill from crashing and burning, House Speaker Paul D. Ryan has been saying something like this a lot lately: It's now or never for Republicans to pass health care reform legislation.
Health care experts say he's probably right.
But, they add, it's not just Republicans' campaign promise to reform Obamacare that's at risk of imploding if this bill fails. If health care reform fails, it could set off a domino effect for Republicans: A bruising intraparty battle on health care reform could lead to a bruising intraparty battle on tax reform. Failing to pass both of those big-ticket items would deliver a big blow to President Donald Trump. These legislative struggles could even cost some Republicans their seats in the 2018 midterm elections.
In short, a lot of Republicans' legislative and political success is riding on these next few weeks/months.
"This is probably the last best chance for Republicans to replace the Affordable Care Act and put something in its place that is a conservative vision for health care," said Stephen Northrup, a health care analyst and former senior Senate GOP staffer.
And it all balances on this:
To pass Obamacare reform quickly, they need to use a special budget tool called reconciliation that allows them to avoid a 60-vote filibuster in the Senate. Reconciliation is pretty much made for situations like these: You control the majority in both chambers and want to get something done quickly without having to bother to lobby for any minority party votes. But there's a limit to reconciliation's usefulness, in that Republicans can only wield it while they're debating the budget. And that time is right now.
Tax reform, another to GOP priority, is facing the same ticking clock health care reform is. But it'd be a massive headache to combine both tax reform and health care into one budget, so Republican leaders have decided to give themselves a few months to do health care reform while debating the fiscal year 2017 budget, then a few months to do taxes while debating fiscal year 2018 -- with very little time in between.
Except, Republicans' extremely precise schedule is already skirting a potential disaster. The Obamacare reform bill they introduced this month does not look like it can pass Congress as it's written, even by a simple majority. There are now more than 60 GOP lawmakers who have expressed skepticism -- or outright opposition -- to the bill. Republicans can only afford 21 defections in the House of Representatives and two in the Senate.
Gary Claxton, a health care policy expert with the nonpartisan Kaiser Family Foundation, thinks the bill will still somehow pass the House, where members tend to fall in line with leadership at the last minute. It's more likely the bill could get mired down in the Senate, where some 17 Republican senators have expressed concerns about it.
Either way, it could die an inglorious death in either chamber. And instead of picking up the pieces to start all over, it's possible GOP leaders and Trump could shrug, say they tried to change health care, and move onto tax reform. (They have a schedule to keep to, after all.)
And that'd likely be the end of any serious effort by Republicans to repeal Obamacare.
Here's where we get into the domino effect of one failed legislative effort taking down another. After successfully knocking down a health care bill they hate, an energized conservative wing of the Republican Party (plus a united Democratic Party) could dig in their heels to try to get what they want out of tax reform. And the game starts again.
Sure, Republicans could try again next year to reform health care. But you've probably realized by now time is not on their side. The longer they wait to get anything done, the more intraparty opposition hardens. (On health care, conservatives think the proposed bill doesn't go far enough and moderates are worried it goes too far. The lines have yet to be drawn on tax reform.)
All of this — health care, taxes — is running up against a hard deadline. Next year is an election year for Congress, and even though Republicans are fairly comfortable they'll keep control of the Senate, there are enough vulnerable Republicans in the House to make compromise on anything less likely the closer it is to November 2018.
That's why now is Republicans' first, last chance to make good on their promise to reform Obamacare. For procedural and political reasons, that window is rapidly narrowing. That's bad news for their efforts to repeal Obamacare, and pretty much anything else major they want to do in a hurry.
Amber Phillips writes about politics for The Washington Post. She was previously the one-woman D.C. bureau for the Las Vegas Sun. Twitter: @byamberphillips.
(c) 2017, The Washington Post
Sign up for e-mail news updates.