Benefits Buzz

The Most Important Person in the Healthcare Debate Right Now

Posted on June 8th, 2017

The most important person in the healthcare debate right now isn’t President Donald Trump. It isn’t Speaker of the House Paul Ryan, and it isn’t Senate Majority Leader Mitch McConnell. Heck, it’s not even Health and Human Services Secretary Tom Price. 
The most important person in the healthcare debate, right now, is Elizabeth MacDonough. You’re probably not familiar with MacDonough because she likes to stay out of the spotlight, but she has a lot of power and influence in Washington. 
MacDonough’s role is Parliamentarian to the United States Senate, or simply put, she is an attorney who advises the Senate on official matters. MacDonough has a huge task ahead – advising the Senate on how they can proceed with the American Health Care Act (AHCA), which aims to repeal and replace much of the Affordable Care Act (ACA). 
Normally, 60 votes are needed to pass a bill in the Senate. However, if it’s a bill that just impacts federal spending (referred to as a budget reconciliation bill), only 51 votes are needed. Republicans currently hold 52 seats in the Senate, Democrats and Republicans can’t seem to agree on anything, so Republicans are using the budget reconciliation process to try and oust key parts of the ACA. This means the ACA can’t be repealed in its entirety, but the financially-driven components of the law can be overturned.  
Here’s where MacDonough’s role becomes so important. She instructs the Senate on what provisions can (or can’t) be included in a budget reconciliation bill, and there are some things in the AHCA (at least in its current form) which walk a fine line. 
For example, the AHCA would let insurance companies charge older people a premium five times higher than that of a younger person. It would also give states the ability to determine which benefits are essential and must be included in health insurance plans. 
Are these budget-related items? Or are these insurance rules? 
Republicans will tell you these types of things impact premiums, which tie back to subsidies, and therefore affect federal spending. Democrats will tell you that’s a far stretch and these types of things are nothing more than insurance rules which require 60 votes to pass in the Senate (which Republicans don’t have).   
But it doesn’t matter what Republicans or Democrats think. It matters what MacDonough thinks. MacDonough, after hearing arguments from both sides of the political aisle, will provide the Senate with guidance on provisions that are budget-neutral and must be removed or changed under the current version of the AHCA.

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