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AHCA: Where do we stand now? UPDATED, 4:15 p.m.

Ok - I'm doing one of those poorly researched quick reaction things again. Because things are moving fast, it's almost impossible to keep up. I'll update more through the day.

As of yesterday around 6pm, you could confidently say that the AHCA could not pass the House in the then-current form. There were at least 30 "No's", and possibly many more. Recall that 23 No's are enough to block passage. The opposition is coming from both sides: so-called moderates, concerned about the 24 million people losing coverage and House Freedom Caucus (HFC) members, ultra-conservatives who wanted to end even more of the ACA's insurance protections. The No's appeared split almost exactly 50-50.

Around 10pm, word started coming out of a deal: HFC members would support the bill if repeal of the Essential Health Benefits (EHB) of the ACA was included. There are several good reasons why EHBs were not repealed in the original bill:

  • Most likely, they would not be able to pass the Senate through reconciliation. If you don't know the details, now isn't the time to worry, but just know that not using reconciliation would require 60 Senate votes. Which the GOP definitely doesn't have.

  • Ending EHB would effectively remove one leg of the 3-legged stool. There are a lot of explanations out there about why ending EHB without completely changing many other parts of the system would be a disaster. Here is one. The CBO score of a bill with this will almost certainly say that it will reduce non-group population by 90+% = 30-40 million uninsured (vs. 24 million in current bill).

  • And it could be worse - it could destabilize the entire private health insurance market - i.e. it might cause you, sitting there, reading this, with employer sponsored health insurance, to no longer be able to get such insurance.

  • The same CBO score would likely show that ending EHB would be very expensive - it might make the bill deficit increasing, which would again prevent it from getting through reconciliation for a slightly different reason.

  • The 2018 attack ads write themselves: "Rep. Goober McPoyle voted to cut hospital care, doctor care and prescription drugs out of your health insurance."

I'm not the first one to say it - but at this point, the strategy seems to be "Get a win by passing anything, it doesn't matter what's in the bill." This, about ~18% of the US economy - the part of said economy that keeps you healthy.

So what happens now?

Well the "EHB deal" isn't done yet. And even if it is, not clear it will swing enough votes. Rep. Justin Amash (MI, HFC) has said that getting rid of EHB worse than current - Amash is a good barometer of "not insane HFC members." Some of you might have seen - I'm trying to keep up a live vote tracker. Here is the link on Dropbox. Note that I've now split the "No's" into those who I'm pretty sure will still be opposed if the EHB deal goes through - I see 12 of those right now, but that is conservative estimate. Will update later. Enjoy. Godspeed.

UPDATE: 3/23/17, 4:15 p.m.

The vote is cancelled for today. I haven't seen it said "we cancelled it because we knew we didn't have the votes"...but they cancelled it because they knew they didn't have the votes. And given that they probably could have twisted arms to get a couple during the roll call - they knew they weren't close. This lines up with my count - at least 30 "No's".

Where do we go from here? I really have a tough time saying. I don't think this bill is going to age well - hence the hurry in the first place. I feel safe to say that no bill this unpopular has ever passed a chamber of Congress. I don't see how they are going to make it more popular. If they dumb Essential Health Benefits, then the attack-ads write themselves and the CBO will show coverage losses that make 24 million look like a walk in the park.

And I don't see how they are going to give concessions to win a vote on the far-right without losing at least a vote on the near right. And vice-versa. To rephrase that: if you were Paul Ryan and your goal was to pass "a health bill," with no consideration as to what it contained or what it would do to the health care system, this was probably your best shot. And it's gonna fall around 10-15 votes short, so not really that close. So we have a corollary: if Mr. Ryan can't solve this problem ASAP, the Distinguished Gentleman from Wisconsin will likely find himself under a similarly Distinguished Bus.

But don't get me wrong, this could still pass - at least the House.

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