How to Repeal and Replace ObamaCare ASAP

Even if the House passes The American Health Care Act [“AHCA”] next week, it must overcome what have been — falsely — portrayed as insurmountable Senatorial procedural hurdles.

One circuitous method to overcome them would necessitate the Vice President  overruling the parliamentarian regarding compliance with budget reconciliation-based constraints, so that TrumpCare could include more features and adjustments to insurance mandates and other ObamaCare rules, and pass by a simple-majority.

It would be preferable to alter the Senate’s arcane rules, thereby neutralizing any such constraints.

From the GOP’s perspective, it is desirable to work backwards from the intended endpoint, namely, to eliminate the two major onerous components of Obamacare: the insurance mandates and the taxes.

To do so, it is necessary for all Republicans to unify behind recognition that a “Phase III” in Speaker Ryan’s 3 phase approach — budget reconcilation that requires 51 Senate votes, issuance of new HHS rules by HHS Secretary Tom Price, and then new legislation requiring 60 votes — may never be reached, due to inability to  overcome a 60-vote Senatorial threshold  for Phase III absent any Democrat support.

Therefore, Phase I must encompass all that the conservatives want in a putative Phase III by insertion of a Manager’s Amendment introduced by Speaker Paul Ryan.

Because President Trump reportedly told a closed-door meeting of grassroots conservative leaders on March 7 to expect another, companion healthcare bill to hit the House as early as this past week, it is likely that a set of modifications has already been codified (articulating such additional desired features as interstate competition, expansion of medical savings accounts, and promotion of insurance-pools).

To ensure prompt Senatorial passage, a simple-majority vote would be necessary to abolish the Byrd Rule, allowing for a simple-majority vote to suffce to pass the AHCA.

Senators who are nervous about a rapid shift in the percentage of federal support for those covered by the Medicaid expansion in 31 states, or that tax credits may be insufficient for some seniors, lower income adults, or rural Americans to pay for health insurance policies offered in their locales, could have their concerns met by adjustments to the AHCA within the Senate bill before passage, if they are not in the final House bill that passes that chamber.

Then the “ping-pong-ping” mechanism (House→Senate→House) could then be invoked — without the need for a conference committee to be appointed — to assure House passage. This of course was how Obamacare was passed in 2009 and 2010.

Dr. Sklaroff presented this idea on March 15 during the on-line version of Fox News Channel's "Special Report" via an instant-message that was read on-air and that received instant-support from all panelists.

Watch @ 18:50.

In particular, it resonated with Heritage Action’s Michael Needham, who has led the effort to modify the current version of the bill.

There would be no requirement for face-saving behavior because publicly-expressed rationales have not overlapped, inasmuch as conservatives have focused on structural modifications of the D.C.-controlled model while moderates have focused on ensuring older and poorer adults are not burdened with a sudden increase in insurance rates and an inadequate tax credit.

Throughout, the theme must be to remind the electorate that carrying an insurance card won’t guarantee the provision of services, even as modifications are made that will transition as the economy surge helps people regain gainful employment.

This would yield an initial and significant legislative triumph for President Trump, after which others can be anticipated reasonably to flow.

The liberals' heads would explode, but the table would be set for the 2018 / 2020 campaigns, based on the fact that the Republicans had unified behind recognition that adults-in-the-room could restore individual responsibility principles within a limited-government, rule-of-law, constitutional-federalism approach.

And the historic outcome could become the basis for other cooperative initiatives within a GOP that has (finally) recognized behaviorally the benefits accrued via the no-longer-nascent Tea Party Movement.

Robert B. Sklaroff, M.D., is a political activist and Richard Baehr is the Chief Political Correspondent of American Thinker.