Ignoring the criticism of Democrats, Republicans on two key committees in the U.S. House worked through the night into Thursday on a GOP health reform measure, as backers argued that the bill's approval is the right first step on the way to making major changes in the Obama health law, as President Trump again signaled his strong support for the effort, despite some grumbling among conservatives.
The House Ways and Means Committee approved a series of GOP tax provisions at 4:30 am, after nearly 18 hours of debate and votes; one of the most notable changes was zeroing out the penalty for not buying health insurance under the individual mandate of the Obama health law.
The House Energy and Commerce Committee was still meeting as the sun rose on Thursday.
Here is a look at the first day of committee work on the new GOP health plan.
1. Democrats hammer tax break for health insurance industry. One item tucked into the GOP health care bill is a section that relaxes a provision in the Obama health law, which restricted how much health insurance companies could deduct on their taxes related to executive pay. Congressional tax experts testified that the provision will cost taxpayers $400 million over ten years - meaning that health insurers will pay about $40 million less in taxes annually. Democratic lawmakers were more than happy to go on the attack over that. Republicans in the Ways and Means Committee stuck with their bill, and voted to keep that plan over the objections of Democrats.
2. The tanning tax could get burned. Right after the debate on the tax change for insurance companies, the Ways and Means Committee moved into a debate over whether to repeal a tax on tanning bed businesses. Most people probably don't remember that a 10 percent tax was levied by the Obama health law. The tanning bed industry has argued that over half of the tanning salons in the United States were forced to close because of that provision, though some have disputed that number. Democrats raised some concerns about the idea, arguing it might lead to more cases of skin cancer, but that argument was not carrying the day with Republicans.
3. And then there are 'messaging' amendments. Not everything in a committee markup is all about policy. Sometimes it's about the message as well, and Democrats showed that in the House Energy and Commerce Committee, as after about 10 hours of initial skirmishing, critics of the GOP plan offered their first amendment. Was it on the Medicaid payment formula? Or maybe rolling back certain changes in the Republican bill? Did it deal with coverage under Medicaid? No. It was all about sending a message, as the first amendment from Rep. Frank Pallone (D-NJ) was to change the name of the GOP bill to the, "Republican Pay More for Less Care Act." It's not the first time something like that happened. Back in 2009, Republicans offered an amendment to take the word "affordable" out of the Democratic bill title.
4. Some in GOP keep pushing for a simple Obamacare repeal. While GOP leaders and the White House were operating 'full speed ahead' on the health bill, there were some more conservative Republicans in the Congress signaling that they are not ready to go along just yet. Sen. Ted Cruz (R-TX) said he did not think the House bill could pass the Senate, not as currently written. Various members of the House Freedom Caucus said they did not want to vote for the bill. Instead, some like Rep. Jim Jordan (R-OH) rallied behind a plan to simply repeal the health law, as conservatives argued that too much of Obamacare might be sticking around.
5. Digging deep into the GOP bill's details. As lawmakers on two committees started their work on the Republican plan, both sides were looking for answers on what exactly would change under the GOP proposal. In the House Energy and Commerce Committee, there was an interesting exchange on Wednesday evening about how mental health care coverage might be impacted, as the panel's counsel acknowledged that states would be able to drop mental health coverage for those on Medicaid. Democrats labeled that "despicable." "There is no excuse for gutting mental health care," said Rep. Tony Cardenas (D-CA).
6. The GOP can't do everything in this bill. There's a lot of people expressing outrage at the GOP plan - not because they oppose the effort, but because they say it should go further. But, as I have discussed repeatedly, when you use "budget reconciliation" - you cannot repeal everything in the Obama health law because of the special budgetary rules which streamline the debate. Want to sell insurance across state lines? That has to go in a regular bill. Want to actually repeal the individual and employer mandates? That has to go in a regular legislative vehicle. Those could be filibustered in the Senate. You need 60 votes to rip out all of Obamacare. And the Republicans don't have that in the Senate.
7. If you don't believe me, go back to 2015. I had multiple people message me yesterday to say that the GOP had voted to fully repeal the Obama health law in 2015, so why aren't they doing that again? BZZZZZZZZZZZZZZZZTTTTT. No, the Republicans did not vote to fully repeal the Obama health law then. They used the same procedure known as 'budget reconciliation,' which does not allow them to strike out everything known as Obamacare. Back on January 6, 2016, I wrote that the GOP Congress had voted to repeal "significant chunks" of the Obama health law. The only way you get rid of the whole thing is to have 60 votes in the U.S. Senate. And Republicans do not have that many votes (in fact, the American people have never elected a Senate with more than 55 Republicans).
8. Haven't I covered this debate before? There is nothing that tends to aggravate my listeners and readers more, than me calmly saying, "both parties do it." It drives people nuts. But as we delved into the debate over the GOP health care bill, the back and forth is bringing back some memories. Only the roles have changed. In 2009, it was Republicans claiming that the process was being rushed, that the bill hasn't been read. This time, it's Democrats who are complaining about the process. Some of them got some points for being inventive, as one lawmaker went back to 2009 and found an amendment by Rep. Kevin Brady (R-TX), who now is the chairman of the House Ways and Means Committee, and used it in 2017.
9. A familiar Congressional Budget Office dance. As work got underway in two House committees on the GOP health plan, Democrats did all they could to remind everyone that the Republicans were moving ahead without cost and coverage estimates from the Congressional Budget Office. "We need to know what this is going to cost," said Rep. Anna Eshoo (D-CA). Meanwhile, GOP lawmakers and the White House did their best to question the CBO's work. "If you're looking at the CBO for accuracy, you're looking in the wrong place," said White House Press Secretary Sean Spicer. Nothing against Spicer, but if the CBO was trumpeting out numbers that showed fantastic stuff for the GOP plan, then Spicer would be more than happy to repeat those numbers.
10. Remember, it's not just the cost of the GOP plan. In the debate over the cost estimates of the Congressional Budget Office, don't focus just on dollar signs. The CBO also does estimates on the number of people who will be covered - or who won't be covered, and that will also be a big bone of contention between the two parties. Yes, the CBO forecasts were not that accurate on who was covered, but they actually did the best of anyone else who tried to take on that task under the Obama health law.
11. Only on Capitol Hill. In this town, you see some interesting t-shirts and other political items at times. 28 years ago, I remember owning a shirt that riffed on the resignation speech of Speaker Jim Wright, who bemoaned the "mindless cannibalism" of politics in the Congress. On Wednesday, there were some who showed up at the committee markups on the GOP health bill with their own homemade shirts. Not often you see someone sporting a shirt about the Congressional Budget Office.
A little while later, while I was watching the proceedings, suddenly the same woman popped up on my TV screen:
Work continues in the Congress on Thursday on the new GOP health plan. Check back for the latest from here in the halls of Congress.