Getting a health care bill through Congress fraught with difficulties

IMAGE: CNS photo/Chaz Muth

By Mark Pattison

(CNS) — When the vice president has to cast a vote to break a tie in the
Senate on whether to debate U.S. health care policy, let alone revise it — as
Mike Pence did July 25 — it is obvious that passing legislation to repeal,
and/or replace, and/or reform the Affordable Care Act is going to be a heavy
lift in Congress.

who boasted of a veto-proof majority to avoid a Senate Republican filibuster,
got the ACA passed in 2010. Now, they’re in the minority in both the Senate and
the House.

in the rush to reject Obamacare, as the ACA is popularly known, there lacks
unanimity among Republicans in each chamber to make changes.

first House effort to pass the American Health Care Act never got to a vote
before it was withdrawn. A second version passed 219-215 despite GOP

Senate’s Better Care Reconciliation Act never came to a vote, either, when enough
Republican senators gave it a thumbs-down for leaders to recognize its chance
of passage was nil. The procedural vote July 25 required not only Pence’s
tiebreaker but the return to the Senate floor of Sen. John McCain, R-Arizona, who
had undergone eye surgery that revealed brain cancer, to create the tie in the
first place.

Later July 25, the Senate rejected a revised version of the Better Care Reconciliation Act in a 57-43 vote with nine Republicans voting against it. On July 26, in an afternoon vote, senators rejected a repeal-only measure. More votes and proposals lay ahead.

no such thing as perfect legislation. As things pass, you realize that things
don’t work out as well as it should,” said former Rep. Bart Stupak, a
Michigan Democrat who fought to retain pro-life provisions in the ACA and who has written a book, “For All Americans,” about the
legislative tussling behind the ACA’s passage. After it became law, he and other pro-life Democrats also pressed President Barack Obama to sign an executive order stipulating no federal funds could be used to pay for abortions.

in an interview with Catholic News Service, said the ACA was modeled after
“the Massachusetts plan that was instituted by then-Gov. Mitt
Romney,” a Republican. “Surely we would get other Republicans to join
us” for a bipartisan piece of legislation,” he added. “That didn’t
happen. But we did end up with the insurance exchanges. But no one anticipated
that 30-some states would never participate. The federal government had to set
up exchanges for these 32 states.”

have been imploring Congress to pass a national health care plan” for a
century, said Stupak, a Catholic, noting that President Bill Clinton’s plan in 1993 —
when he famously assigned his wife, Hillary, to lead the task force to design
the bill — never got out of committee. “I’m pleased we got it done,”
Stupak said of the ACA. “Does it need work? Yes.”

the political will” to pass the ACA “resulted in a fairly large number
of moderate- and low-income people getting health insurance in a more stable
way than what they were used to getting, and that’s quite an achievement,”
said Jim Capretta, a resident fellow and health care policy expert at the
American Enterprise Institute, which leans toward the conservative side of the political

Affordable Care Act passed with only Democratic votes. I think that’s the
primary reason why that’s unstable now. You don’t get buy-in from the other
party,” he added, making the law “subject to a lot of dispute and
disagreement, and half the country sort of distrustful of what was passed.”
With both parties working together, Capretta said, it shields it from “elements
of either party to attack it. That’s why (with) big policy changes, you’re
better off trying to do it in a bipartisan way.”

to hear first-term Republican Rep. Francis Rooney of Florida — a former U.S. ambassador
to the Vatican — bipartisanship is hard to come by. “There has been no
evidence of any Democrat wanting to team up to repeal and replace Obamacare and
give America patient-centric, choice-oriented care,” he told CNS July 20.

the country is very polarized, and we have two radically different views on the
size of government,” Rooney said later. “I don’t know how well
they’re going to be reconciled. I tend to think that our way is the right way.”

are not bad people. We may disagree on some concepts, but I think everybody
agrees on the essentials,” Stupak said. If Republicans want to repeal the ACA’s
individual mandates imposing a fine on people who will not buy insurance, for instance, he added, “once again, you go back to
the health care infrastructure. Who pays for it?”

think President (Donald) Trump will sign any reasonably conservative measure. He said he
would sign the House bill, or the Senate bill or the repeal bill,” Rooney
said during a break from a House session. “So the president isn’t the
problem. It’s the Senate. And all the Republican senators, except maybe one or
two, have voted to repeal or replace Obamacare.”

added, “I’d be pretty disappointed if we can’t get across the finish line
with what we’ve been saying we want to do for six or seven years and what every
Republican in office campaigned on. That would take some serious thought on where
we are going and do we have the capability to lead the way we’ve told the
people we’ve wanted to lead.”

a law is passed,” Stupak told CNS, “the duty and responsibility of Congress
is to fix the legislation — or repeal it.” While he said he doesn’t
begrudge the Republicans for the effort to repeal the ACA, he cautioned them to “do
it with the best interests of the American people at heart.” If up to 32
million Americans would be without health insurance by 2026 — as the Congressional Budget
Office said in scoring the since-scuttled Better Care Reconciliation Act — “then what
would you would do with them?”

Rooney acknowledged, “It might be a little irresponsible to the American
people not to pass a comprehensive repeal and replace.”

argued that the unwieldy nature of America’s public-private health care
structure could be at fault. “Decide what we want,” he said. “Right
now we have a mishmash.” While Capretta favors market-based solutions, the
main goal should be cost controls. “One way or the other, there needs to
be more discipline in the system on costs,” he said, and without them,
there will be “more government control.”

still have faith in the United States Congress — 99.9 percent are there for
the right reasons,” Stupak said. “Call it whatever you want — Trumpcare,
Ryancare, the Better Health Care Act. Most members of Congress don’t care what
you call it, but make sure it is equal to, if not better than, what we already

added, “Let the talking heads step aside. Let both sides sit down. I think
you’d be surprised how quickly it could come together.”

– – –

Follow Pattison on Twitter: @MeMarkPattison.

– – –

Copyright © 2017 Catholic News Service/U.S. Conference of Catholic Bishops. All rights reserved. Republishing or redistributing of CNS content, including by framing or similar means without prior permission, is prohibited. You may link to stories on our public site. This copy is for your personal, non-commercial use only. To request permission for republishing or redistributing of CNS content, please contact permissions at

Original Article