A number of Republicans who oppose the American Health Care Act are being asked to trust the Trump administration to give them what they want in the long run. House Speaker Paul Ryan concedes their entire wish list is not in the bill, but says there's a good reason for that, and says Republicans need to have faith that they'll get what they want in due time.
Ryan said the AHA is just the tip of the iceberg when it comes to the entire replacement plan, nicknamed "Trumpcare," which he says will be executed in 3 phases.
3 Phases of Trumpcare
1. Reconciliation: The American Health Care Act bill currently being proposed
2. Administrative Action: Action taken my HHS Secretary Tom Price
3. Additional Legislation: Future bills enacting policies not covered in phases 1 and 2
The proposed AHA bill is only phase one. Republicans are being asked to pass it and trust that its imperfections will be corrected in phases 2 and 3.
Many Republicans on the far right oppose the bill because it's missing many of the elements they want, such as
- the ability to purchase health insurance across state lines
- caps on malpractice damages recieved
- lowering drug costs for patients
- Medicaid flexibility for states
However, as Speaker Ryan explained, all the elements Republicans want can't be included in the bill. That's because it's a budget reconciliation bill. This is a smart move because a reconciliation bill can not be filibustered.
Phase 1, Reconciliation: Good News/Bad News
This is a good news, bad news scenario. The good news is, because Democrats can't filibuster a budget reconciliation bill, it is likely to pass. The bad news is the rule that reconciliation bills can only contain budgetary items...and things like selling insurance across state lines and tort reform do not qualify.
Ryan is urging Republicans to put aside their desires to have everything they want put into the bill. He says if they put their entire wish list in the bill it will not qualify as a budget reconciliation bill and therefore, will never pass.
Instead, Ryan says Republicans need to trust they'll get (most of) the rest of what they want in phases 2 and 3. However, he offers no guarantee. President Trump supports this plan, so the question is, will Donald Trump keep his word? One thing's for sure: he has a lot riding on it.
Phase 2, Administrative Action: Tom Price
Phase 2 is all about what Dr. Tom Price will do. He is the new Secretary of Health and Human Services and chief architect of Trumpcare. He has tremendous administrative power to deregulate the marketplace to lower the cost of healthcare and stabilize the market. The question is: will he do it? It's a matter of trust.
Phase 3, Additional Legislation: Mop-Up Bills
This is the phase where congress passes bills that Republicans want that could not be put in the reconciliation bill because of budget rules, such as interstate shopping across state lines for health insurance.
Many of the Republicans who oppose the AHA say, "What's the hurry? Why not slow down and take our time to 'get it right'?" There are 4 reasons to hurry:
1. Fulfill Promise: President Trump promised to repeal and replace Obamacare immediately after taking office.
2. Best Chance for Passage: Republicans control the House, Senate and White House, which could change in less than two years.
3. It's Ready: Despite claims to the contrary, this plan has been in the works for seven years.
4. Tax Reform: In addition to fixing healthcare, candidate Trump vowed to enact tax reform. That can't be accomplished until the healthcare reconciliation bill is off the table.
Finally, even if all three phases of Trumpcare are enacted as laid out, it still won't satisfy certain Republican idealogues who refuse to vote for any legislation unless it's perfect in their eyes. Although it sounds noble to hold firm to pure and extreme conservative standards, by doing so in this case, they risk total failure, and America will be stuck with Obamacare, which even many Democrats admit doesn't work. As President Ronald Reagan, no stranger to compromise, so famously said on many occasions, "I'd rather get 80 percent of what I want than go over the cliff with my flag flying."