FY 2018 Appropriations
A potential budget deal between House Speaker Paul Ryan (R-WI) and conservatives in his caucus could change the dynamic of this year’s Appropriations process, effectively disenfranchising the representative voice of the minority. The deal, if passed, would lead to steep cuts to mandatory programs such as SNAP, Medicaid, and TANF and the addition of work requirements of 100 hours per month for able-bodied adults to SNAP and Medicaid while limiting waivers on existing work requirements under TANF. The disenfranchisement of Democrats would also likely mean the inclusion of Republican policy riders within the Appropriations bills. Even if this deal is reached, there will still be obstacles to advancing these Appropriations bills through the Senate, where Democrats have enough votes to stop the passage of egregious or counterproductive spending bills (which require 60 votes to pass).
Affordable Care Act Repeal
Senate Republicans could vote as early as next week on their version of the American Health Care Act, the House-passed bill that would repeal and replace the Affordable Care Act (ACA). The current goal of Senate Majority Leader Mitch McConnell (R-KY) is to introduce the bill in the next two weeks so that the nonpartisan Congressional Budget Office (CBO) will be able to score the bill prior to the July 4th recess. Then, Senators could vote promptly on the bill and pass it with only 50 Republican votes. Democrats would not be able to filibuster the bill, as it is being passed under budget reconciliation.
A small group of Republican lawmakers have been working behind closed doors since May to draft the Senate’s version of the legislation. Key lawmakers outside this small group—including Democrats and Republicans—still do not know what is in the bill. The secrecy of this process is not normal for a bill of this magnitude. In contrast, although the ACA was passed with all Democratic votes in 2010, the legislation was debated and voted on by three committees in the House and two in the Senate, with plenty of opportunities to amend it before it was passed.
Senator Marco Rubio (R-FL), a key Senate Republican, said over the weekend that work by Republicans is “only a starting position” and that there should be “plenty of time for debate, analysis, and changes and input” on the bill by lawmakers from both parties. Based on the goal of passing the bill before the July 4th recess, however, a window for contributions by excluded Republicans and Democrats is virtually nonexistent.
As the healthcare industry represents roughly 1/6th of the nation’s economy, not to mention the reality that 20 million Americans will be directly impacted by what happens to the ACA, leading Senate Democrats are considering steps to halt Senate business to protest the secrecy of the healthcare bill process. Democrats may use parliamentary moves to prevent committees from meeting for longer than two hours, which would make it difficult for Republicans to schedule votes on even routine matters.
One aspect of the Senate’s ACA repeal-and-replace debate that has been brought to light is the question of Medicaid spending. The small group of Republican lawmakers is apparently considering a proposal to make even deeper cuts to Medicaid than the bill passed by the House. The proposal would start with the growth rate for a new cap on Medicaid spending at the same levels as the House bill, but then drop to a lower growth rate starting in 2025 that would cut spending more deeply.
Democrats and some moderate Republicans have already voiced opposition to the Medicaid cuts in the House-passed bill, which reduces Medicaid spending by more than $800 billion over 10 years. The CBO found that the House bill would kick 14 million people off Medicaid over 10 years.
A separate Medicaid issue is how quickly to phase out funding for the expansion of the program. Moderate Republicans have pushed for a seven-year phase-out, while leadership has called for the phase-out to happen over three years