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Former NAIC Exec Puts AHCA Passage Odds at 50/50

Analysis  |  By Christopher Cheney  
   June 19, 2017

A former president of the National Association of Insurance Commissioners, who is also a former member of Congress, describes the potential fate of the bill intended to repeal Obamacare.

This is the second of two parts. Read Part 1.

In Congress, sometimes a crushing legislative defeat is the clearest path to political victory.

The American Health Care Act, the Republican Party's best hope to repeal Obamacare this year, has 50/50 odds of passage in Congress and GOP lawmakers could soon be hoping their big bet goes bust, says Earl Pomeroy.

From 1993 to 2011, Pomeroy, a Democrat, represented his state in the US House of Representatives and served on the Ways and Means committee. Now, he is working in Washington as senior counsel at Atlanta-based law firm Alston & Bird LLP.

Pomeroy served as state insurance commissioner in North Dakota from 1985 to 1992. And from 1990 to 1991, he was president of the National Association of Insurance Commissioners.

In the first half of his interview with HealthLeaders, Pomeroy gave his views on the fate of the Patient Protection and Affordable Care Act. In this installment, he talks about the AHCA's prospects for passage. The transcript below has been lightly edited.

HLM: What is your prediction on passage of the AHCA?

Pomeroy: I expect the Senate will barely pass a bill, then present it to the House on a take-it-or-leave-it basis, which they will take. I give equal odds to the notion that the Senate will come up just short and can't get the votes for the AHCA, then they leave healthcare and go on to other issues.

HLM: What happens if the AHCA fails to gain passage?

Pomeroy: Failure to pass the AHCA will allow Republicans to use the Affordable Care Act for the same kind of politics they have used over the past four election cycles.

They will say, "The law is a mess, and we need more Republicans so we can get it repealed. We almost got it repealed and now we need more Republicans to get it repealed."

Voters would not be looking at the prospect of millions of people losing coverage, which is what would happen if the AHCA passed according to the CBO.

So, this is a rare case where the majority party may fair better if it fails to pass major legislation and takes the issue into the next election, than if they actually pass a bill and the consequences start to hit home.

HLM: What are the key developments to watch as the Senate tackles the AHCA?

Pomeroy: The first factor to look at is whether Senate Majority Leader Mitch McConnell is intent on passing a bill. He is intent on passing a bill—and doing it in June.

He is a very powerful leader, and he is making a sincere effort to repeal the ACA and advance the AHCA. What the majority leader sets out to do has to be taken extremely seriously.

The second question is that there are people on the far right side of the Republican caucus who don't like the bill and there are some moderates who have problems with it, so how does McConnell get to 50 votes, with Vice President Pence providing the 51st vote?

The closer the bill comes to enactment, the easier it is to settle important differences. In the end, senators are looking at whether they want a bill or don't want a bill. When you have a path to enactment right before you, it gets easier to cut the final deal.

Thirdly, can McConnell pass a bill with opposition from the right? It appears the only intransigent senator on the right is Rand Paul (R-TN).

Finally, there are the moderates. In the House, we saw the moderate Republican members folded in the end, and allowed the bill to move. It remains to be seen whether the Senate will go the same way.

In the days ahead, listen very closely to the voices in the moderate side of the caucus and the extreme right, and see whether they are saying, "My way or no way!"

At the moment, it seems most senators are satisfied to engage in bargaining to get to "yes" on the bill.

HLM: Assuming McConnell finds 50 votes for the AHCA, can the House and Senate agree on the same version of the bill?

Pomeroy: When I was a House member, the Senate always had leverage over the House in these major bills. It is entirely possible the Senate will cobble together a deal that will get just enough votes to pass. They will submit that deal to the House on a take-it-or-leave-it basis.

McConnell will tell Speaker Ryan, "This is the best that I can do, if you reject it, you are not going to get another proposal." Under those circumstances, the House usually goes along.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.

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