House Speaker Paul Ryan, R-Wis., insisted Thursday in a professorial PowerPoint presentation that the House leadership’s American Health Care Act is the Republicans’ only hope to repeal and replace Obamacare because of the constraints of Senate rules.

Ryan contends there are certain provisions of Obamacare that can’t be repealed in his bill because of the Senate’s “Byrd Rule,” which stipulates that if a measure doesn’t impact federal finances, it can’t be struck from the bill unless a waiver is passed with a 60-vote supermajority. Republicans have only a 52-48 majority in the Senate.

Sen. Mike Lee, R-Utah

Sen. Mike Lee, R-Utah

But members of the House Freedom Caucus, along with senators such as Rand Paul, R-Ky.; and Mike Lee, R-Utah; argue the bill that passed Congress in 2015 through the reconciliation process and was vetoed by President Obama already has proved it can do the job of repealing Obamacare.

It’s the bill that Sen. Paul and co-sponsor Sen. Lee have re-introduced along with companion legislation by Rep. Jim Jordan, R-Ohio.

“If you’re already admitting there is only so much you can do through reconciliation, and we need to have a second bill that will attack one of these other reforms, then let’s just do the clean repeal now that we did in 2015 and deal with the other issues later,” said Conn Carroll, Sen. Lee’s communication’s director, in an interview with WND.

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Among other things, the revived 2015 bill would repeal Obamacare’s medical device tax and the so-called Cadillac tax on high-end health plans. It also would reinstate deductions for medical expenses, repeal the so-called “Obamacare slush fund,” eliminate expanded eligibility for Medicaid and prevent taxpayer bailouts for insurance companies.

Earlier Tuesday, Ryan used his weekly press briefing to make a case for the GOP leadership’s bill, which he said is the first prong in a three-pronged strategy.

“This is the closest we will ever get to repealing and replacing Obamacare,” Ryan said.

“The time is here, the time is now. This is the moment, and this is the closest it will ever happen.

“It really comes down to a binary choice.”

The Freedom Caucus and its allies, however, believe there is a third way. They contend the leadership’s bill creates a new entitlement program through tax credits, and they oppose its expansion of Medicaid and its 30 percent premium penalty for those who choose to drop their insurance coverage for at least two months and want it reinstated.

Ryan said the second prong of the leadership’s plan would be to repeal Obamacare regulations via executive order, followed by passing legislation that would accomplish aims such as allowing people to purchase insurance across state lines.

‘Leave it to the Senate to determine what is doable’

Ryan said Thursday that some of his congressional colleagues are among opponents of his bill who don’t seem to understand that “reconciliation has certain limits.”

“There’s a lot of frustration, a lot of confusion out there, frankly, among conservative groups — and even among members,” he said.

Despite speaking out against sanctuary cities and Syrian refugees House Speaker Paul Ryan has done nothing to defund them. (Photo: Twitter)

House Speaker Paul Ryan

“There are folks,” he continued, “who would love to see us put in this reconciliation bill all these other ideas,” but the measures would be filibustered because of Senate rules.

Lee’s spokesman, Carroll, reacted.

“I think it’s pretty funny that Paul Ryan is trying to tell us what the Senate rules are,” he told WND.

“When they passed the 2015 bill, they said they couldn’t get rid of the Medicaid expansion because of the Senate rules, and they were wrong,” he pointed out.

Ryan and his leadership are “in the House,” Carroll said, “and they should stick to the House rules, and they should leave what is doable in the Senate to us.”

Carroll pointed out the current House leadership plan addresses issues such as abortion, health-care tax credits and illegal immigrants, which would be subject to the Byrd Rule.

“They’re just basically making up out of whole cloth what can and can’t go into this bill,” he said. “I mean they’re not talking to any parliamentarian to come up with this stuff.”

The 2015 bill already has passed reconciliation, he emphasized.

Yuval Levin, a fellow at the Ethics and Public Policy Center in Washington, said in a National Review Online blog post that the 30 percent surcharge on premiums for people who haven’t been continuously insured is unlikely to survive a Byrd Rule challenge.

“Other structural elements of the proposal seem to be functions of a similar process of imaginary negotiation with an imaginary Senate parliamentarian,” he wrote.

In an interview Wednesday, Freedom Caucus member Rep. Louis Gohmert, R-Texas, asserted Republicans are hiding behind the Byrd Rule to cover for inaction on Obamacare repeal.

“We need to at least be as bold as we were in 2015,” he told the Fox News Channel’s Jon Scott, referring to the bill that has now been re-introduced.

Gohmert insisted the rule hasn’t prevented Congress from enacting health care reforms in the past, noting the Democratic Party used budget reconciliation to pass the Affordable Care Act.

Sen. Tom Cotton, R-Ark., tweeted early Thursday morning his belief that the House bill can’t pass the Senate without “major changes.”

“To my friends in House: pause, start over. Get it right, don’t get it fast,” he wrote.

An eye for the marketplace

In his presentation, Ryan made a case for allowing the competitive, free market to function in health care, recounting his personal experience several years ago with Lasik eye surgery.

He pointed out that because insurance companies won’t pay for the procedure, there is a clear price tag for it, unlike most health-care costs.

What’s more, free from the constraints and interference of insurance companies, the cost of Lasik surgery since then has gone down while the quality has gone up.

“I think at the end of the day, Congressman Ryan and Senator Lee have very common views of what the ideal health-care policy will be,” Carroll said. “But we also live in a world where we have Senate filibuster rules, and Republicans don’t control 60 seats in the Senate, so there’s only so much we can do through the reconciliation process.

“So, if we could write whatever bill we wanted, I think Paul Ryan and Senator Lee would end up in much the same place.”

The question is how best to try to get there.

Carroll said Lee met with Health and Human Services Secretary Tom Price Wednesday morning and had dinner with Vice President Pence that evening to discuss his differences with the leadership’s plan.

“Price seemed receptive to the changes that Senator Lee brought forward, but we’ll see if those are at all incorporated,” Carroll said.

Asked the senator’s response to the warning to House Republicans Tuesday from President Trump, who has endorsed the Ryan plan, that they would suffer an electoral “bloodbath” if they didn’t repeal and replace Obamacare, Carroll replied: “All the more reason we need to pass the 2015 repeal bill.”

“We campaigned on that, we voted for it in 2015 and ran on it last year in 2016, and the people of Utah re-elected Senator Lee and they expect us to uphold our promise and vote for that again,” he said.

‘Delicate procedure’

As WND reported Tuesday, along with conservative members of Congress, the GOP leadership’s plan already has been rejected by major think tanks on Capitol Hill, including Heritage Action, Americans for Prosperity, FreedomWorks and the Club for Growth.

Rachel Bovard, director of policy services for the Heritage Foundation, told WND she thinks the American Health Care Act, as written, cannot make it through reconciliation in the Senate.

“Paul Ryan is right. Reconciliation is a very delicate procedure to work with in the Senate,” she said.

“But that’s why the 2015 bill is so important, because it did pass reconciliation.”

Bovard said conservatives are saying: “Let’s just bring this bill back. We know it can pass. It already passed. It just got vetoed by Obama. Now we have Trump; it will pass this time.”

She described Ryan’s bill as “partial repeal, partial replace, partial repair.”

The 2015 bill, she noted, contains a two-year phase-out of Obamacare, meaning people will not lose coverage immediately.

“And in that window, that’s when you have the full, transparent debate about what should replace Obamacare,” she said.

“You don’t want to replace Obamacare with a Republican Obamacare, which is kind of what Paul Ryan’s bill does,” Bovard said. “You want to actually fix the marketplace and institute free-market reforms that make coverage more accessible and affordable for everybody.”

She said the Heritage Foundation “has always said if you try to repeal and replace Obamacare simultaneously, you will end up doing neither.”

Bovard acknowledged that any replacement measures would need 60 votes in the Senate.

“Democrats are never going to want to support replace options, but at least if you’ve actually repealed Obamacare — if they pass the 2015 bill again — then the pressure is on them to support replace,” she argued.

At the moment, she said, Democrats “can oppose everything, because Obamacare is still there.”

“But once you take that away, and in an election year you force them to be obstructionist about fixing the health-care market, it’s a much worse position for them to be in,” Bovard reasoned.

She said the 30 percent penalty in the Ryan bill is “very similar to the Obamacare solution, which is, ‘We’re going to punish you if you don’t buy health care.'”

The problem it’s trying to solve she said is to ensure that there are enough healthy people in the risk pool as possible.

“The way you encourage participation in the marketplace is by actually allowing the market to work,” Bovard said.

That would include creating larger risk pools by opening up the market across state lines and putting catastrophic health care back on the market.

“Conservatives are saying, look, if you want to incentivize people to purchase health care, make it easier for them,” she said. “Allow them to purchase plans that they want to buy.”

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