From Wall Street Journal
By LOUISE RADNOFSKY
Mar 15, 2017
Republican leaders have been talking about a three-part approach to reworking the U.S. health-care system in recent days. What does that mean and why are they doing it?
On Tuesday afternoon alone, White House press secretary Sean Spicer repeatedly described “three prongs” and Vice President Mike Pence talked about a “multi-step process” within minutes of each other.
What they mean is that Republicans’ plan to overturn the 2010 Affordable Care Act and enact their own vision in its place has several different stages. Each is fraught with challenges, and some are contingent others.
Prong One: Repeal Through Reconciliation
GOP lawmakers aim to strike large swaths of the 2010 Affordable Care Act through a budget maneuver known as “reconciliation,” which requires only a simple majority to pass in the Senate. Republicans control 52 Senate seats and can’t expect Democratic support to undo a signature achievement of President Barack Obama.
Even getting a simple majority is tough, as various factions in the House and Senate and outside conservative groups all threaten to withhold their support. The Senate parliamentarian ultimately rules what can and can’t be included in a budget maneuver.
The administration is trying to persuade wary lawmakers to vote for the repeal package by saying they can’t tackle everything at once but will address fresh issues later. They also think the analysis by the nonpartisan Congressional Budget Office, which found the current House Republican bill would lead to 24 million more people in the ranks of the uninsured by 2026, is an unfair way to judge their overall effort because the CBO only weighs the repeal package, not what they intend to do next.
Prong Two: Regulatory and Administrative Changes
Conservatives say the package doesn’t strike enough of the law. They say that by backing tax credits to make insurance more affordable on the individual market, the administration is hewing too closely to the framework of the Affordable Care Act, which they would rather sweep away entirely.
That’s why administration figures are drawing attention to what they say Health and Human Services Secretary Tom Price and Centers for Medicare and Medicaid Services administrator Seema Verma can do through regulatory action. The Obama administration took a fairly expansive view of the secretary’s ability to make decisions about the health law, particularly during the tenure of Secretary Kathleen Sebelius; GOP leaders figure they can do the same now to undo parts of the health law left in place by any limits set on the budget process.
“Prong two is actually fairly easy to do. Because the same authority that was granted to Secretary Sebelius now had is in the offices of Dr. Price,” Mr. Spicer said Tuesday.
The administration is making the same pitch to centrists worried that fragile state insurance markets could be further destabilized if large parts of the 2010 law are undone. For one, Health and Human Services points to a draft rule that would boost insurers by paring back consumer rights insurers have deemed too costly.
Prong Three: More Legislation
Leaders of the Republican effort say fresh legislation will follow the simple-majority reconciliation vote, chiefly a measure enabling insurers to sell insurance across state lines.
To pass substantive new legislation through the Senate, Republicans need 60 votes — at least eight from the Democratic side.
Centrist Republicans might find areas of common ground with centrist Democrats (including four who voted in support of Seema Verma’s nomination on Monday.) Conservatives have also espoused this strategy in the past, arguing that Democrats will only be persuaded to support GOP health ideas once the health law has been swept away.
The three-prong approach has its skeptics, among them Arkansas Republican Sen. Tom Cotton, who criticized it as “just political talk.” He said the regulations described in prong two would be held up in court, and he doubted Republican legislation in the third step would get 60 Senate votes.
“If we had those Democratic votes, we wouldn’t need three steps,” he said in a radio interview this week. “We would just be doing that right now on this legislation altogether.”