Several investigations related to Russia and Washington, D.C., are beginning to unfold — one into former National Security Adviser Michael Flynn and former FBI Director James Comey, another led by a special counsel scrutinizing potential ties between the Trump campaign and Russia, and a third looking at potential Russian involvement in the 2016 presidential election. With these investigations dominating the news cycle and Congress' attention, it is possible domestic initiatives, such as healthcare reform, will lose momentum from the early days of the presidency.
Here are five quick thoughts on the situation.
1. All major hospital groups publicly opposed the American Health Care Act. Hospitals reliant on Medicaid, in particular, expressed concerned about the legislation. For example, Chip Kahn, President and CEO of the Federation of American Hospitals issued a statement after the House passed the AHCA May 4: "As passed by the House of Representatives, the AHCA fails to protect the health coverage and access to care for so many Americans. It also makes it more difficult for hospitals to deliver the care we all rely on. With these concerns top of mind, FAH could not support the House legislation today."
Rick Pollack, President and CEO of the American Hospital Association said in a statement: "[The AHCA] does little to help the 24 million Americans who would be left without coverage following repeal and makes deep cuts to Medicaid, which provides essential services for the disabled, poor and elderly people in this country." He added, "As the backbone of our nation's health safety net, America's hospitals and health systems — which include more than 270,000 affiliated physicians and 2 million nurses and other caregivers — believe it's vital that Medicaid be protected."
2. However, deficit hawks are keen on the legislation. The most recent Congressional Budget Office estimate of the bill — which does not include the Upton and MacArthur amendments — projected the bill would reduce the federal deficit by $150 billion over the next decade. The MacArthur amendment added an option for states to seek federal waivers from the ACA's essential health benefits requirement and community rating rule if they establish high-risk pools, and the Upton amendment expanded the funding for those pools. Those focused on the budget will likely push to keep healthcare at the top of the agenda.
3. President Trump had a hard time corralling the House to pass a bill. An official vote scheduled for March 23 was delayed to March 24 and then cancelled due to lack of support. The decision was pushed past the 100-day mark and several amendments were made before it narrowly passed 217-213 on May 4. Several investigations related to the President Trump's ties to Russia now underway put strain on political support for the administration. Considering the bill passed by such a small margin, it is unclear if the AHCA will be able to survive as or if support for the administration erodes.
4. The Senate appears to be less responsive than the House to President Trump. The upper chamber is moving much more slowly on healthcare reform than the House did, in part because Republicans want to pass the bill through the budget reconciliation process, which has specific requirements. Many senators from Medicaid expansion states have also voiced concerns about potential changes to the program.
5. Whether or not the Russia investigations or the Comey firing are politically motivated, the commotion leads to more uncertainty for Senate and House Republicans and may make them less susceptible to lobbying from President Trump. Before the AHCA passed in the House, President Trump made personal calls to many representatives to gain their votes. Now with the Russia investigations thrown into the mix, senators may be distracted and healthcare could lose momentum, or they may simply feel less inclined to support the administration. After Mr. Comey was fired from the top post at the FBI, several senators said the change was a distraction to domestic issues. When asked whether Mr. Comey's firing would affect the healthcare debate, Sen. Susan Collins (R-Maine) told the Miami Herald, "I think it already has."
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