This week proved to be the most successful one for Republicans since the GOP took control of the White House, Senate, and House of Representatives. Republicans succeeded in passing major tax reform, averting a government shutdown on the weekend before Christmas, and staving off automatic cuts to government programs as a parliamentary consequence of the deficit-increasing tax bill. All in all, Republicans are heading home for the holiday recess patting themselves on the back - while planning a major marketing initiative to increase the popularity of the tax bill among swing overs, especially women. Meanwhile, Democrats, just a week after being buoyed by Senator-elect Doug Jones' win over Roy Moore in Alabama, are languishing in the fact that they let their biggest point of political leverage, the stop-gap funding bill, pass without including any of their top demands.
Stop-Gap Spending Bill
Yesterday, the House and Senate passed a stop-gap funding bill to keep the federal government running through January 19th - their third stop-gap funding bill since the 2018 fiscal year began on October 1st. Passage of the bill was projected to be contentious, with liberals and other Democrat-leaning pressure groups encouraging Congressional Democrats to use the leverage of a Christmas shutdown (remember that all remaining legislation takes 60 votes to clear the Senate) to fight for some of their top priorities - like DACA, funding for Cost Sharing Reduction (CSR) payments, or a long-term fix to Community Health Center and/or Children's Health Insurance Program (CHIP) funding. Instead, a relatively clean stop-gap measure passed both Houses with a significant buffer, including Democratic votes in both chambers. Moreover, the bill increased funding for the Department of Defense (a Republican priority) while leaving all other agencies to suffer another round of short-term level funding. The bill did include enough funding for Community Health Centers to keep them running through March, along with $2.85 billion to keep CHIP propped up for the same amount of time. This funding is certainly better than nothing, but, as with all short-term continuing resolutions, does not offer any degree of certainty for some very key and vulnerable players. Meanwhile, the nearly $81 billion originally allocated for disaster aid in Puerto Rico, Florida, Texas, and California was stripped from the bill, leaving Puerto Rico, in particular, struggling to recover from devastation as Congress punted the issue to the new year and the next funding bill or for independent consideration by the Senate in January.
Somewhat surprisingly, the bill did include a measure to avoid mandatory $125 billion in "Statutory Pay-As-You-Go Act" (PAYGO) cuts, which would have resulted from the $1.5 trillion in deficit spending created by the tax bill. Those cuts would have included a near-instant $25 billion cut to Medicare - something less than ideal for the Republican party as it heads into an increasingly difficult election year.
For months now, ever since President Trump nixed the Deferred Action for Childhood Arrivals (DACA) program, the vast majority of Members on both sides of the aisle have been pushing for a fix for the nearly 800,000 young people living legally (for now) in the US under DACA. Speculation had grown significantly that the fix for these 800,000 individuals would be included as part of the end of year funding measure (which morphed into yesterday's stop-gap bill). However, after the Democrats failed to push for the inclusion of a DACA fix over fears of bearing responsibility for a Christmas government shutdown, no such measure was included in the bill.
Members from both parties, along with key individuals from the White House, however, claimed to have reached an agreement earlier this week that would allow a DACA fix to pass toward the end of January. Questions remain, however, including whether it will be a "clean" fix for the Dreamers, or whether the White House will attach additional border security provisions to the measure, and whether Congress will really prioritize the issue during the month of January, or allow the DACA fix to lapse closer to the White House's self-imposed March "deadline."
The Future of the Affordable Care Act
Included in the tax bill was the repeal of the Affordable Care Act's (ACA) individual mandate, which required every U.S. citizens and permanent residents to have health insurance, or face a tax penalty from the federal government. The individual mandate, although the least popular element of the ACA, and particularly hated by Republicans, was seen by most health experts as being key to ensuring health care costs did not skyrocket with only sick, elderly, and other "expensive" populations enrolling in health care through the exchanges. The repeal of the mandate was hailed by President Trump as "repealing the ACA," as he seeks a PR win to build his to-date meager list of legislative accomplishments. But even Congressional Republicans will admit that the repeal of the mandate creates a very tricky situation - especially when combined with the lack of CSR payments, which were ended by President Trump's Executive Order this fall. Together, these actions create an extremely unstable insurance market; one that Members from both parties readily admit needs to be addressed.
In spite of this instability, in many ways, ACA enrollment looks strong. Yesterday, the federal government announced that 8.8 million people enrolled in insurance through healthcare.gov, or roughly 96% of the enrollment from the 2016 open enrollment period. The dip came despite a drastic decrease in publicity from the Department of Health and Human Services and an open enrollment period that was roughly half as long as the previous year. Despite efforts to weaken the law (as well as the law's inherent flaws), much of the ACA remains in place.
Going forward, the problem, of course, is that the two parties, and especially the warring factions within each party, have greatly varying views on how to address the issues that remain with the ACA system. Which brings us to: will the GOP try to repeal the ACA again in 2018, or will Congress focus on passing the two bipartisan "fixes," known by their sponsors' names: Alexander-Murray and Collins-Nelson?
Prior to the Senate's vote on the chamber's initial tax bill, Senator Susan Collins, R-ME, was uncommitted, but Leader McConnell secured her vote in favor of the bill in exchange for a guarantee that the Senate would pass Alexander-Murray and Collins-Nelson prior to the conferenced tax bill. Clearly, that is not how things played out in the end. Some observers allege Senator Collins was taken advantage of, while some say we'll see both pieces of legislation pass early in 2018, maybe even with enhanced provisions. Over the past few days, Leader McConnell's remarks on the issue have varied slightly, from, "we'll probably move on" from repeal efforts in 2018 to, "as soon as we have the votes to achieve [the repeal], I'd like to do that." He is likely trying to strike a balance between playing to the more conservative Members of the Senate who truly believe a full repeal of the ACA is necessary and should be the party's number one priority, while recognizing the political realities, including the fact that Senator-Elect Doug Jones, D-AL, will be sworn in soon after the Senate returns from recess, shrinking the Republican majority to a tight 51-49.
At the same time, Senators Alexander, R-TN, and Murray, D-WA, the Chair and Ranking Member of the Senate Health, Education, Labor, and Pensions Committee, have said several times in recent days that they want to resume their talks to pass a bipartisan ACA "fixers package," and President Trump has even publicly called for the passage of their legislation as early as January. The current Alexander-Murray legislation, which likely has enough support to pass the Senate, is potentially significantly less impactful now that the repeal of the individual mandate has passed, so work is needed before the legislation can pass. How the House would treat the bill remains to be seen, which could once again thrust the ACA into the spotlight, as the parties clash over a package of legislative fixes right in the middle of the next government funding deadline, January 19th.