The Graham-Cassidy Bill currently in the news is the final GOP attempt to repeal and replace the Affordable Care Act [ACA, or “Obamacare”] before the Reconciliation opportunity closes on September 30th.
If that Bill passes next week, we all need to be watching for the next step. Will the GOP send its conflicting health care reform plans to a Conference Committee?
Why should we care?
Because the final decisions about our health care will be made behind closed doors.
What is a Conference Committee?
Conferences are marvelous. They’re mystical. They’re alchemy. It’s absolutely dazzling what you can do.”
-Alan Simpson, former GOP senator from Wyoming [cite]
Any law passed by Congress must be approved by both the House of Representatives and the Senate before it is presented to the President.
It must be the same law- paragraph by word by comma.
Frequently that is not what happens, at least initially.
An idea may be submitted to both parts of Congress identically- but as each body holds hearings, considers amendments, and appeases members to gather enough votes the contents of the bills will frequently diverge. The flavor is the same- but not the specifics.
When this happens, there must be a series of compromises to rectify the contents of the law so each chamber can then vote again to pass identical legislation.
When a series of amendments becomes too cumbersome, however, Congress may decide to form a Conference Committee.
Appointed by the leadership of both chambers- the committee will consist of one-half Senators and one-half House members (notice I did not say one-half Republicans and one-half Democrats!). They are sent behind closed doors to compromise on all the details and produce one final version of the law in question.
That compromise law must then be passed again- independently- by both the Senate and House without any further changes.
The Appeal of a Conference Committee
The attraction of a Conference Committee lies in the phrase “Behind Closed Doors.” They function without the wall of microphones or the lights of the Press, the analysis by TV talking heads, or the editorials in media across the spectrum.
Another attraction is that the standard Congressional Rules of procedure don’t apply.
“Conference committees are like Narnia for legislators. They are magical places where many of the normal rules are suspended and where scrutiny, whether from parents or press, is less than normal.” [cite]
Powerful enough to be called “The Third House” of Congress, a Conference Committee is an ideal place to draft legislation as controversial- and emotional- as an upheaval of our health care system.
Can you imagine a setting more ideal for the resolution of how- finally- to kill Obamacare?
A Conference Committee Was the GOP Goal in July
On May 4th there was a signing celebration in the Rose Garden with President Trump after the House of Representatives passed its version of Obamacare Repeal and Replace (the American Health Care Act or AHCA).
But the AHCA was dead on arrival in the Senate– that body wanted to write its own law to replace the Affordable Care Act.
With two versions of the law from the get-go, resolution through a Conference Committee was part of the GOP plan all summer.
That idea, however, became more important as the Summer progressed, and the Senate Repeal & Replace Bills became less attractive to more GOP Senators.
By July 27th/28th, when Mitch McConnell presented what was called “The Skinny Repeal Bill” in the dead of night- the certainty of a Conference Committee became imperative. (This was the attempt to Repeal and Replace Obamacare that was defeated in the wee hours by Senator John McCain.)
Fear of the “Skinny Bill” becoming law was so significant that some Senators (including John McCain and Lindsay Graham ) would not vote until they received “ironclad assurances” that the House would not adopt the Skinny Bill if the Senate passed it.
Speaker Paul Ryan delivered those assurances that night:
“Senators have made clear that this is an effort to keep the process alive, not to make law. If moving forward requires a conference committee, that is something the House is willing to do” [emphasis added, cite]
Hours later John McCain still cast the deciding “No” vote.
But his friend Lindsey Graham, calling the Skinny Bill a “disaster” and a “fraud,” voted “Yea.”
Is the GOP Trying to Get Behind Closed Doors Again?
That same Senator Graham is now pushing the last version of Obamacare Replace & Repeal which he co-authored with Senator Bill Cassidy (R-LA).
Individuals will also be affected, as will premiums, but no one knows how significantly because the CBO projections are not expected before the vote next week.
But is the Graham-Cassidy Bill as drafted really the end goal?
Just to be clear- Senator Graham has not (to my knowledge) expressed any interest in a Conference Committee for his own Bill, but his recent history would suggest an openness to the idea. Regardless- that decision would not be in his control.
The next move will lie with the House of Representatives.
What Will the House Do if Graham-Cassidy Passes the Senate?
If the Senate does succeed in passing Graham-Cassidy (and the possibility is tracking higher) the ball will land back in the court of the House of Representatives.
Speaker Ryan has said the House of Representatives will vote on Graham-Cassidy if it gets through the Senate.
But if there is one thing we all learned in May- although he is the Speaker, Paul Ryan is not always able to keep his Chamber in line with his promises.
To stand by the bill they already passed in May, or decide they want to tinker with Graham-Cassidy.
Either option will trigger a Conference Committee, and we will see the entire issue of health care reform go behind closed doors.
Should that happen- we will not know the details of where our health care is headed until the doors reopen. Stay tuned.
What To Know More?
The Tortured Legislative History of Obamacare:
In my Fontenotes on the reconciliation process I said that Obamacare was passed in the Senate with a straight 60 count vote (all Democrats). That was true- but only part of the story.
The drama around the passing of the ACA came after the Senate vote and the loss of the 60th vote with Senator Ted Kennedy’s death. The startling gymnastics of the Democratic Controlled Senate after that were (for the most part) meant to avoid having to go to a Conference Committee- because there weren’t enough votes to pass any compromise legislation on the other side.
The maneuvers to get the Affordable Care Act to President Obama’s desk are legendary- and the source of much of the anger that remains against the law 7 years later. For more details on that history, I suggest these three resources: “How Obamacare Became Law” by Brian Sussman here; “History Lesson: How the Democrats pushed Obamacare through the Senate” by the Washington Post here; and “Senate passes historic healthcare reform legislation in 60-39 vote” from The Hill here.
For More on Conference Committees
If you would like a quick video explanation of the Conference Committee process, you will find a 3 and a half minute video (with technology eerily similar to the old “Pong” video game) posted by Congress here.