Jeff Duncan has got to be one of the best if not THE BEST communicator in Congress.  From his Facebook page:


Wanted to dive back into the healthcare discussion. So far I’ve outlined some of my concerns with the House GOP bill, and wrote a post specifically on the section dealing with pre-existing conditions. In this post I hope to explain the “process” arguments for and against the bill, and gather your feedback.

One concern I have about this healthcare debate is I keep hearing from people who hate ObamaCare, but also oppose the House GOP bill. When I try to dig deeper into why people oppose the House bill, I’m not getting very specific answers. This tells me that Republicans (myself included) need to do a better job explaining what is and what is not in this bill. Without people being able to specifically tell me what is wrong with the bill, it’s difficult to know where the goal posts are in making this a bill that people can support. I have a pretty good idea of what kinds of changes I want to see in this bill, but I want to know where the people are in this process.

The process we are using to repeal ObamaCare is called budget reconciliation. Reconciliation eliminates Senate Democrats ability to filibuster the bill and allows legislation to pass with 50 votes (assuming the Vice President breaks the tie) in the Senate. This is extremely important to remember since Senate Republicans only have a 52 vote majority in the Senate, significantly smaller than the majority Democrats had in 2009. Secondly, it’s important to know that reconciliation does have some limits as to what it can accomplish. It is primarily a budget tool, and is not designed for major legislating. However, since reconciliation is the process Democrats used to help enact ObamaCare, it is entirely appropriate that we use it repeal the law. Reconciliation can allow us to repeal 90% or more of ObamaCare but not the entire law. If you want to see how much can be repealed using reconciliation look at the bill Congress passed in 2015 that President Obama vetoed. Third, in order for reconciliation to work, the bill has to save the taxpayers money. This is easier to do in reality than it is on paper due to restrictions concerning the budgetary process. For example, ObamaCare is filled with over $500 billion in tax increases. For budgetary purposes, every time we repeal a tax increase that is a “cost” to the government. This is extremely important to remember when you start hearing statistics on the “cost” of this bill, verses the “cost” of ObamaCare, but it also makes repeal tricky.

Examining the House GOP bill, you will find that it repeals less than the reconciliation bill in 2015, but why? I believe the reason is because House Republicans are trying to use reconciliation to both repeal AND replace ObamaCare, instead of just repeal.

The White House and House of Representatives strategy is a three phase approach. Phase I is the House GOP bill, Phase II is regulatory reform, Phase III is additional legislation. The White House and GOP leadership only have confidence in being able to implement Phase I & II. In my opinion, the House GOP bill was written to be self sustaining in the event Phase III never happens. Unfortunately, Phase III has a lot of the reforms that conservatives like such as expanded HSAs, selling across state lines, and association healthcare plans.

I know this is extremely complicated, so let me explain it another way. Using reconciliation to repeal AND replace ObamaCare is like trying to fit a square peg in a round hole. It involves strategically repealing large parts of ObamaCare, but using the hull of the law to implement conservative reforms. Then Sec. Tom Price uses the broad authority granted to him under the parts of ObamaCare that you don’t repeal to smooth out the edges and make reform possible.

My preference would be to pass the 2015 reconciliation bill that repeals most of ObamaCare. Once the law is off the books, we then move forward on a replacement bill even though that bill would require 60 votes. At that point, Democrats can either join Republicans in supporting an overhaul to free-market based healthcare or they can be responsible for things going back to way they were before ObamaCare. That way, Democrats have an incentive to work with us on reform and we have a greater chance for a bipartisan, free-market based bill. But the question is, would we have enough votes in the Senate to pass a repeal without a replace, and if we did would the President sign it?