Senate Republicans Unveil Text Of Final Health Care Bill, Reportedly Intend To Vote At Midnight
Update, July 27, 10:30 PM: Republican senators have released the text of the Health Care Freedom Act, their final stab at health care legislation. Far from being a "skinny" repeal, the bill not only repeals the individual mandate and the employer mandate but also grants waivers to states that don't want to enforce Obamacare standards for insurance plans, funds community health centers, and defunds Planned Parenthood. Senate Republicans reportedly intend to vote on the bill starting at midnight.
Update, July 27, 7:00 PM: Four Republican senators — Lindsey Graham (SC), John McCain (AZ), Bill Cassidy (LA) and Ron Johnson (WI) — declared that they would not vote for a slimmed-down partial repeal of Obamacare without assurances that it will not become law.
Graham said he could not support a "half-assed" plan that he called "politically" the "dumbest thing in history." But he added that he could back the bill if he is promised that lawmakers could strike a better Obamacare replacement deal in conference.
Johnson said the plan was sold to senators as "a vehicle to get to conference." McCain added that he is "voting no unless I see that there is a path to a conference" and said he would also listen to GOP Arizona Gov. Doug Ducey's opinions on the plan.
Essentially, the senators said they would back the plan only with the assurance that the House will not pass the same bill.
[CNBC]
Update, July 27, 9:00 AM: After the defeat earlier this week of both a comprehensive repeal-and-replace bill and a repeal-only bill, Republican Senators are reportedly gunning for a so-called "skinny repeal," which would eliminate the individual mandate and wreak havoc on insurance premiums:
Top Republicans such as Sen. John Thune (S.D.), No. 3 in the chamber's GOP hierarchy, said that although leaders have not yet found "the sweet spot" between conservatives and centrists, they have picked up support for a more modest plan because it does not include deep cuts to Medicaid. Some Republican senators were simply open to any legislation that could keep alive the roller-coaster push for an overhaul.
"We're edging closer and closer" to getting 50 votes for a bare-bones plan, Thune said. He said leaders were betting that some Republicans who defected on votes this week would feel more pressure to support any bill that emerged from negotiations with the House to face a final vote in the Senate.
Meanwhile, President Donald Trump continued to pressure Senators the only way he knows how: on Twitter.
Original post, July 26: Yesterday, Senate Republicans took a major step toward their goal of repealing Obamacare when they voted to open debate on a health care bill. Then they promptly took a major step back when their first attempt at a replacement bill, the Better Care Reconciliation Act, failed 43-57. And yet the nightmare continues, with the Senate poised to debate, amend and vote on two other versions of the legislation over the next few days. Here's what's going on.
There Are Two Versions Of The Bill Still Up For Debate
The Better Care Reconciliation Act — Mitch McConnell's beleaguered plan to repeal Obamacare and replace it with a complicated series of new rules and block grants that would leave 22 million more Americans uninsured over the next 10 years — is dead, which leaves two less comprehensive plans on the table. The first, the Obamacare Repeal and Reconciliation Act, would repeal most of the major provisions of the 2010 Affordable Care Act. It's also known as "repeal and delay," because the repeal wouldn't go into effect for two years, hypothetically giving Republicans time to come up with a new health care plan to replace Obamacare. [Update, 4:12 PM: As expected, the bill failed, with seven moderate Republicans joining Democrats in voting against it.]
The second plan, which everyone is calling "skinny repeal," would reverse Obamacare's requirements that all individuals obtain insurance and that businesses with 50 or more employees offer insurance to workers. It would also potentially eliminate a tax on medical device manufacturers. The individual and employer mandates are easily the most unpopular parts of Obamacare, which makes "skinny repeal" more politically feasible than a full repeal. However, the individual mandate plays a crucial role in keeping health insurance premiums down, and repealing it would lead to premium increases of 20 percent, which would surely not be popular.
The Congressional Budget Office estimated last year that 15 million people would lose their coverage if the mandate were eliminated without any changes elsewhere. It would also cause premiums on the individual insurance market to spike by 20 percent as plans became dominated by sicker and more expensive customers.
[NBC News]
'Repeal And Delay' Is Expected To Fail Today
A vote on the bill to repeal Obamacare with no replacement is reportedly set for 3:30 today. It is expected to fail, since not enough Republicans want to take away health care without offering any new ideas in return.
This measure would repeal major parts of the health law but would not provide a replacement. The legislation resembles a bill that passed the Senate in 2015 but was vetoed by President Barack Obama in early 2016.
Senator Rand Paul, Republican of Kentucky, supports that approach. But some Republicans worry that repealing the law without providing a replacement would leave many Americans without health care coverage. Such a "repeal only" measure is not expected to garner enough votes for passage.
Democrats Are Trying To Send The Bill Back To Committee
Also today, Democratic Senator Joe Donnelly will reportedly propose an amendment sending health care legislation back to committee, further stalling Republicans' plans to proceed with a vote.
On Wednesday afternoon, the Senate will vote on whether to send back the effort to congressional committees for several days. There is a chance that could succeed, given the myriad complaints from Republicans about the opaque process the Senate GOP has been using the last three months to write a bill. Just three Republicans would need to join the Senate's 48 Democrats to throw a wrench into the GOP's plans for a quick vote this week.
[Politico]
Debate Will Last No Longer Than 20 Hours…
Republicans are trying to pass their health care legislation under a process known as budget reconciliation, which allows bills to pass with a simple majority. Budget reconciliation comes with a set of specific rules, which include limiting debate to 20 hours.
Unlike most other Senate bills, where deliberation can last for days or weeks, budget reconciliation rules limit debate to 20 hours. While that 20-hour clock starts running as soon as the Senate votes to proceed to the bill, the debate can be paused. In other words, the Senate can recess for the night, then come back the next day and the clock would resume where it left off the day before. The 20 hours does not include time spent voting on amendments.
… But Senators Will Be Allowed To Offer Unlimited Amendments Under A Process Known As 'Vote-A-Rama'
After debate concludes, Senators will be allowed to propose as many amendments as they want under a process known, delightfully, as "vote-a-rama." This process doesn't involve debate on the amendments — just up-and-down votes. (However, the amendments must be relevant to the bill in question and aren't allowed to "introduce new subjects or expand the scope of the bill.") Democrats plan to use vote-a-rama to stall the legislation and force Republicans to vote against popular provisions, such as funding Planned Parenthood and keeping Medicaid services in schools.
Sen. Jeanne Shaheen (D-NH) said her office was currently evaluating what amendments she might be able to offer. "We'll be looking at all the issues we think are important in providing health care for people," Shaheen said. "Obviously, I've been talking about marketplace certainty and the importance of Cost Sharing Reduction payments, so we'll be looking at that." Asked what amendments Democrats would offer, Sen. Dick Durbin (D-IL) responded simply: "Many."
[Vox]
Republicans will almost certainly vote down all of the Democrats' proposed amendments, and they will likely propose amendments of their own to try to improve the bill's odds of passing.
Finally, The Senate Will Vote On A Final Version Of The Bill
Whatever bill comes out of debate and vote-a-rama — which is expected to be some version of "skinny repeal" — will need a simple majority of votes to pass. Republicans can lose no more than two votes — and definitely not the nine votes it lost when the BCRA went to the floor yesterday.
Democrats Fear That 'Skinny Repeal' Is A Trojan Horse For A Broader Repeal
As Vox's Dylan Scott reports, a number of Republicans are openly admitting that "skinny repeal" is a ruse to get into conference with House. During conference, the houses could agree to a much more comprehensive bill than the one passed in the Senate.
Republican leaders are promising to enter negotiations — and the outcome there could be a bill that resembles the House and Senate's repeal-and-replace bills. That is the desired outcome, as Republican senators openly admit.
"If we can get a skinny bill over (to the House), we can work in the conference committee to actually improve on the product," Sen. Mike Rounds (R-SD) told reporters Wednesday, though he allowed that House-Senate talks might not be any easier than the Senate's internal deliberations.
[Vox]
Of course, any bill that comes out of conference would still have to get a majority of votes in both the House and the Senate. Considering that the BCRA has already failed to get a simple majority in the Senate, this might be a tall order.
Confused? We don't blame you. If you're more of a visual person, Vox has a very handy flowchart of all the possible outcomes, if you're into that sort of thing.