The battle lines were drawn before Rep. Greg Walden (R-Ore.) could make it through the first sentence of his opening remarks Wednesday at the House Energy and Commerce markup session of a proposal to repeal and replace sections of the Affordable Care Act (ACA).

Democratic members of the committee lashed out against the draft American Health Care Act, which would change the ACA provisions dealing with insurance coverage and an expansion of Medicare. "Unimaginatively evil," "a prescription for disaster," "a sham," "a recycle of failed ideas," "reverse Robin Hood," "a mockery" and "a disgrace" were just some of the comments fired at the draft. (See BioWorld Today, March 8, 2017.)

Some of the discord swirled around the rush to move the proposal through the committee before the Congressional Budget Office had a chance to score its impact on the federal deficit. "We need to know what this is going to cost," Rep. Anna Eshoo (D-Calif.) insisted. But Democratic efforts to postpone the markup until after the CBO has scored the bill failed on party lines, strengthening the divisiveness that could be the insignia of the 115th Congress.

"This is the first step," Rep. Larry Bucshon (R-Ind.) reminded the committee, adding that the CBO typically doesn't score drafts until after the markup, which often results in additional provisions that can affect the cost.

Discrediting Democratic claims to the contrary about the committee's actions in the passage of the ACA, Walden and Vice Chairman Joe Barton (R-Texas) pulled out the official records to show that no CBO score was available when the committee marked up the first draft of that bill in 2009.

Numerous changes are likely as the American Health Care Act proceeds through the congressional process. Although no amendments were submitted ahead of the markup, Ranking Member Frank Pallone (D-N.J.) said that at least 100 amendments would be offered from Democrats throughout the session, which looked like it was headed into the nighttime hours.

Using the budget reconciliation process, both the House Energy and Commerce Committee and Ways and Means Committee were marking up the draft American Health Care Act Wednesday as a "committee print" intended to be forwarded to the House Budget Committee before advancing to the Rules Committee and then to the House floor.

While most of the Republicans and Democrats on the Energy and Commerce Committee agreed that the ACA has its problems and that patients and access must be at the heart of any fix, they've become entrenched on how to move forward in an atmosphere rife with political gamesmanship that's often grounded on perspective and semantics.

During the markup, the Democrats pointed to the millions of people who now have insurance because of the ACA; the Republicans spoke of their constituents who have no choice in insurance coverage and who can no longer afford necessary therapies and health care because of hikes in premiums, deductibles and co-pays. The Democrats urged their colleagues to work on improving the ACA instead of repealing it. The Republicans proposed "repealing" parts of the ACA and replacing them with provisions intended to be an improvement.

The resulting rancor that permeated the Energy and Commerce markup and the challenges to Walden, the new chairman of the committee, may not bode well for future health care bills, such as the user fee agreements, that must get through the committee on a tight deadline and, preferably, with bipartisan support.

Amid calls of "you're out of order" and accusations of plagiarism, revisionist history and outright lies, Pallone told Walden that he may "regret the consequences" of how the draft was being pushed through the committee. And Rep. Mike Doyle warned the Republican members of public disruptions at future town hall meetings, referencing the concerted protests that shut down some town halls last month.

Noting the acrimony, Barton called for more camaraderie. "At some point, we're going to work together this year," he reminded his colleagues.

No Comments