by Steve Rixen
Government Relations Director, Public Policy and Government Relations


A few weeks ago, Alex Honnold, the groundbreaking 31-year-old rock climber scaled Yosemite National Park’s El Capitan wall without using ropes or any other safety gear. The astounding, and beyond dangerous, “free solo” climb was viewed by many as one of the most memorable rock climbing achievements ever accomplished.  

Watching the risky feat made me think about the current battle over health care reform.  OK, I know that’s a bit of stretch, but bear with me.

The coveted crown jewel in legislative achievements – health care reform – is as difficult of a political mountain as you can imagine. If accomplished, there are real-world implications that will impact every American. Right now, this effort is being led carefully by one man, Senate Majority Leader Mitch McConnell (R-Ky.), and he is scaling that steep precipice without a safety net.

McConnell recently unveiled a draft of the Senate’s plan, the Better Care Reconciliation Act, in the ongoing legislative fight around repealing and replacing the Affordable Care Act (ACA). The plan was to introduce the bill with a quick vote for passage to follow shortly after. However, those plans were dashed when members of both the more conservative and more moderate factions of the GOP spoke up and raised opposition to the draft bill.

The already challenging situation was further exacerbated by the release of a “score” from the nonpartisan Congressional Budget Office (CBO) on June 26. The CBO estimated that draft bill would leave an additional 22 million Americans without health insurance and cut Medicaid spending by $772 billion (or 26 percent relative to current law). A supplemental CBO report was released June 29 examining the longer term impacts of the bill. It estimates that BCRA will cut Medicaid even deeper in the second 10 years after passage – with cuts reaching 35 percent.

After the CBO score, the flood gates opened, with all of the expected swing votes – and even some unexpected senators – raising opposition to the bill. With the loud and growing chorus of doubts raised and concerns echoed, Majority Leader McConnell chose to delay the vote and the chamber will not be considering the bill before the July 4th recess.

So…the vote was dramatically cancelled, and it looks questionable whether a deal can ever be reached. Sound familiar?

Beginning in March, an eerily similar scenario took place with House leadership dramatically pulling their version of “repeal and replace” (the American Health Care Act) from the floor when it became clear they didn’t have the votes for passage (also after a damaging CBO score). 

We all know how that played out, with House Republicans patching together enough side deals and changes to the bill to pass it with a very narrow margin.

Here’s why it could happen again. The CBO score of the Senate bill found that its provisions would reduce federal spending by $321 billion. Under the rules of budget reconciliation – the process being used in an effort to pass this bill – the Senate bill has to achieve at least the same level of savings as the House bill, which saved $119 billion. That means that Majority Leader McConnell, a well-known tactician and negotiator, has about $200 billion dollars to make side deals and compromises to salvage this bill.

These are the key areas we are watching over the coming days to see if he can strike deals to reach an agreement that will get to the magic number of 50 votes (with Vice President Mike Pence able to cast a tie-breaking vote).

  • Medicaid funding inflationary growth rate and Medicaid expansion concessions
  • Additional funding to combat the opioid crisis
  • Potentially maintaining a controversial ACA tax on investments for higher income Americans
  • Funding for Planned Parenthood
  • Adjusting subsidies or making changes to their structure to provide more support for individuals with pre-existing conditions and older Americans
  • Expanding the use of health savings accounts

The challenge for McConnell is that for every change to the bill that appeals to one wing of the party, he risks losing support from the other end of the spectrum. It’s a high-stakes game, and one misstep could put the brakes on their health care reform efforts. 

Even if the Senate GOP reaches an agreement, the legislative process is far from over. Both chambers must pass an identical bill before it goes to the White House for President Trump’s signature.

Vizient has put together a brief summary of the Senate bill and we will continue to closely monitor the Senate’s efforts to reach a compromise. As this process continues to advance, you can be sure we will also be working toward solutions that will help our member hospitals continue to serve their communities and provide a meaningful safety net for Americans in need of care.

But we hope you don’t mind if we bring a helmet and some climbing rope. We aren’t that crazy.

About the author. As government relations director for the Vizient office of public policy and government relations, Steve Rixen closely tracks legislative and regulatory challenges for hospitals, and helps shape advocacy strategies to effectively communicate with policymakers on behalf of Vizient and our members. He has previously served as a strategic policy and communications consultant and also worked as a professional staffer for U.S. Senator Byron Dorgan.

Published: June 30, 2017