GOP promise to torch the ACA veers toward bare-bones repeal
(Bloomberg) — Senate Republicans who have promised to demolish the Affordable Care Act are swerving toward a bare-bones approach that might eliminate just a few pieces of the landmark healthcare law.
Struggling under their slim 52-48 majority, Republicans say this week’s debate -- including an all-night blizzard of amendment votes late Thursday known as vote-a-rama -- may ultimately lead to a bill that merely ends the mandate that all Americans have insurance or pay a penalty, along with a few other provisions.
The idea, Republicans say, is to get a bill through the Senate and then negotiate a final agreement with the House, which passed a broader Obamacare overhaul, H.R. 1628, in May.
"All we’re looking at is a way to get to that conference quick so we can begin to have those discussions and get a result,” said Senator John Cornyn of Texas, the No. 2 Republican leader. Republicans are discussing how many elements of an Obamacare repeal they must include to get enough support to pass, he said. The House could also choose to pass the stripped-down repeal and send it to President Donald Trump.
"This is a high-wire act," Cornyn said. "The whole thing."
Senator John Thune of South Dakota, the No. 3 Republican leader, said a plan also might eliminate Obamacare’s requirement that most employers offer insurance to their workers, as well as a medical-device tax estimated to generate almost $20 billion over a decade.
The behind-the-scenes talks Wednesday contrasted with what was taking place on the Senate floor, where lawmakers were debating whether to replace Obamacare with a broad revision or even repeal it outright.
Early votes have underscored the majority party’s difficulty in pushing through a GOP-only bill amid unified Democratic opposition.
The Senate rejected a fuller repeal of Obamacare 45-55 Wednesday. Seven Republicans voted against it, including Senate Health Chairman Lamar Alexander and Senator John McCain, who returned to Washington from Arizona after a brain-cancer diagnosis to help advance the debate.
Late Tuesday, a 43-57 Senate vote swept aside a revised version of Majority Leader Mitch McConnell’s Obamacare replacement, a measure negotiated in secret during weeks of tense GOP talks. Hours earlier, senators barely agreed to start the debate on a 51-50 vote with Vice President Mike Pence casting a tie-breaker after two Republicans defected.
Bigger challenges await on the Senate floor, including the vote-a-rama, a fusillade of votes on dozens if not hundreds of amendments. Democrats may offer poison pills, and other proposals might divide Republican moderates and conservatives.
‘No such thing’
Senate Minority Leader Chuck Schumer of New York warned that the passage of a "skinny repeal" alternative is a gambit to get Senate and House Republicans together in talks on a broader replacement plan.
“There is no such thing as ‘skinny’ repeal,” Schumer said Wednesday on the Senate floor. “It’s a ruse to get to full repeal, with all the concomitant cuts to Medicaid and tax breaks, which are so unpopular and which so many of my Republican colleagues here on the other side have opposed.”
Senate Republican leaders haven’t released a text of a "skinny bill," even to members of their own party.
Schumer’s office, however, put out a Congressional Budget Office estimate of a bill that mirrors Republicans’ description of such a measure -- one that would eliminate the individual and employer mandates, as well as repeal the medical device tax and defund Planned Parenthood. The CBO said such a measure would result in 16 million Americans losing their insurance, compared to the 22 million more envisioned under the most recent version of McConnell’s replacement bill.
It’s also not certain the splintered Republican caucus would agree to back a pared-back Obamacare repeal. Senator Shelley Moore Capito of West Virginia said she’s "unsure" if she can support such a bill.
Senator Lindsey Graham, a South Carolina Republican, said he won’t support it unless he’s assured his proposal for a broad Obamacare alternative can be considered in House-Senate conference negotiations.
“I’ve told our leadership that I wouldn’t vote for the skinny bill believing that would be the only thing we do, because that would be a complete abdication of what we’re trying to do,” Graham said.
There is debate over whether repealing the individual-coverage requirement would have much impact because the financial penalty for noncompliance isn’t high. The Trump administration also has suggested it won’t enforce the mandate, and some insurance companies have already taken that into account in their rate requests to states for 2018.
A plan to repeal only a few parts of Obamacare isn’t uniformly embraced by the House -- particularly since some senators say they hope the House would accept it as the most Republicans can do to fulfill their campaign promise to ax Obamacare.
House Freedom Caucus Chairman Mark Meadows said Wednesday there’s "zero" chance the House will pass a "skinny repeal" of Obamacare if the Senate approved it first. To emphasize the point, he made a hand signal that read zero.
At the same time, Meadows said, he’s thinks the House and Senate might feel enough pressure to forge a final agreement. The idea of repealing and replacing Obamacare won’t be “dead” if sharply different measures head into negotiations, he said.
Representative Chris Collins of New York, a member of House Republicans’ moderate Tuesday Group, said he’d prefer a bare-bones repeal of Obamacare "if comes down to that or nothing."
"Everyone agrees that the employer mandate, employee mandate and the medical device tax all gotta go," Collins said. "It would be a significant disappointment if that’s all it was. But if that’s literally all it was, never anything else, it’s better than nothing."
In the Senate, some senators at polar opposites in the debate say they’re willing to see what their leaders come up with. Tea Party-backed Texas Republican Ted Cruz said he will consider supporting any approach that reduces premiums on the Obamacare insurance exchanges.
The Senate rejected, as part of the McConnell proposal, a Cruz plan to let insurers sell low-cost insurance plans with few regulations or coverage requirements, so long as they also sell more robust plans.
Senator Lisa Murkowski, an Alaska Republican who voted to block debate on the bill, said her vote on a final proposal “depends what’s in it,” and pointed to her concerns about the impact of cuts in Medicaid and other programs on constituents in her state.
Senator Bill Cassidy of Louisiana said a skinny repeal would "move the process forward" on health care, which he wants to do.
Faced with what appear to be dwindling chances to replace Obamacare, Wisconsin’s Ron Johnson said senators have little choice but to consider a smaller option.
"A skinny repeal would kick the can into a conference and get the process going,” Johnson said. “It’s the reality we face.”