GOP under pressure to deliver health care reform, crowded agenda

President Donald Trump has set a high bar for Congress when it comes to health care: “insurance for everybody,” including people with pre-existing conditions, at “much lower” cost. And he wants Congress to act fast, at the same time that lawmakers repeal the Affordable Care Act (ACA), as Obamacare is formally known. “We have to take care of the American people immediately, so we can’t wait,” he told Republican lawmakers at their retreat last week in Philadelphia.

Donald TrumpRepublicans say they plan to have legislation on the House floor before April. It’s not at all clear what will be included, but there is expected to be a budget reconciliation measure that doesn’t require 60 votes to pass the Senate. The fact that the measure would be filibuster-proof is critical since Republicans only control 52 votes and Majority Leader Mitch McConnell said he doesn’t expect any Democratic support.

A reconciliation measure would allow Republicans to change much of the ACA – but not all – because such bills must be limited to provisions of the law that have budget implications. A reconciliation bill that Congress passed in 2016 would have repealed the individual mandate, the Medicaid expansion and the premium subsidies but it didn’t provide a replacement. That measure never had a chance of becoming law, since lawmakers knew that then-President Obama would veto it, as he did.

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