Hey Speaker Ryan: How Will Our Grannies Fare Under Your 3-Step AHCA Plan

My Best Hunch Based on GOP Healthcare Track Record

The strategy right now – the GOP's so-called three-step plan:

Step 1: Used Budget Resolution (reconciliation as a huge loophole): This is what the Senate and House already voted and passed. It is not a special piece of legislation instead it falls under “a budget resolution” which must be passed every year, and because it’s not a law, it’s not something the President has to sign, nor pass by a super majority (60 in the Senate for example with filibuster allowed – now they are not).

Now the Loophole: Written into that budget resolution is a section called a “reconciliation” which basically instructs the four committees that oversee the federal health care program (e.g., two in the House and two in the Senate) to draw up a plan for reducing its toll on the federal budget deficit – that is: how to stop paying for Obamacare.

Why, you might ask? Because while Republicans face an uphill battle to pass a law that makes significant, non-spending related changes to our nation’s health care system (that kind of bill would be subject to a Democratic filibuster, which would take 60 votes to overcome, while Republicans only have 52 Senate seats), they can instead just cut federal spending for the program with only 51 votes, using a budget reconciliation. And what’s the first step to budget reconciliation? Budget resolution.

Step 2: Budget Reconciliation: First on the chopping block will likely be the individual mandate and the expansion of Medicaid. But things like parental insurance coverage up to the age of 26 can’t be touched yet. That’s in step three.

Before that can happen though, the committees have to send their plans to the budget committee, which will combine them into one big proposal — the budget reconciliation. This will then go up for a vote in both houses of Congress. If the Senate gets its 51 votes and the House gets its simple majority, the reconciliation will pass. Only then will the parts of Obamacare detailed within be repealed. The rest of it will have to be disassembled, possibly piecemeal, with bipartisan support.

Step 3: The Still-to-Be-Announced Plan to Replace: Concerns over the chaos that a “repeal and delay” situation might set loose on the insurance marketplace have pressured congressional leadership to revise their timeline. Ryan keeps saying: “It is our goal to bring it all together concurrently.” (Note: He also admits Republicans have yet to agree on the specifics of their alternative).

Trump was unequivocal that an ACA replacement would happen simultaneously, “probably the same day, could be the same hour,” as a repeal, and while Trump has historically not been one to get hung up on technicalities, if the Democrats fight back as hard as they’ve promised to, this may be his first lesson in Separation of Powers 101.

Some GOP governors are asking to let states choose to continue receiving unlimited federal money to treat all who qualify for Medicaid, according to documents obtained by The Associated Press. Currently, the GOP bill would instead give states set amounts for each Medicaid recipient — a pathway to gradually cutting the federal-state health program for the poor.

Many in the hard-right House Freedom Caucus, which claims around 40 members, oppose the GOP bill's proposal for tax credits to help pay medical expenses for people not covered at work or through the government. They object that the credit, geared to age not income, would even go to people who owe no taxes.

They also oppose a proposal by House Speaker Ryan to tax part of the value of expensive employer-provided coverage. That's an abomination for many Republicans, aware that about half of Americans get health insurance at work, one member saying that a new plan that actually taxes the very workers that voted for Donald Trump and voted for many of our members is not moving in the right direction.”  In the senate, Ted Cruz, Rand Paul, Mike Lee are causing headaches. 

And, possibly a major glitch - hell, even call it a roadblock.

Stay tuned and keep this in mind regarding House “Leader” Paul Ryan, who has a lot riding on passage of their GOP “plan” and of course his brand new message for the House Republican Conference: