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Dec. 1 — As debate began Dec. 1 on a measure that would repeal much of the Affordable Care Act, Senate Republicans continued to express confidence they will have the votes to pass it.
A substitute amendment to the bill that makes technical changes is expected to be offered Dec. 2. The language was provided to Bloomberg BNA by Senate sources.
The bill—which is being debated through the reconciliation process—would go much further to repeal the ACA than the version (H.R. 3762) passed by the House in October. The reconciliation process means the bill needs just 51 votes in the Senate, rather than the usual 60.
Senators said the bill would roll back the law's Medicaid expansion and eliminate the financial penalties associated with the individual and employer mandates for health coverage. This is on top of the provisions in the House version that would repeal the Cadillac tax on higher-cost insurance plans and the 2.3 percent medical device excise tax. The bill would also eliminate the ACA's Prevention and Public Health Fund, and prohibit federal funding to abortion providers for one year.
Senators said rolling back the optional state Medicaid expansion would happen over the course of two years, giving states the opportunity to have a transition plan to provide coverage for the millions of people who have already gained health care under expansion.
President Barack Obama said he would veto the bill, which Republicans have acknowledged. However, they said it's important to pass the measure to force a veto, and make Obama take responsibility for what they say is the failure of his signature law.
The reconciliation process will begin by senators introducing an amendment that strips from the House bill all the language that was deemed by the Senate parliamentarian to be noncompliant with the Senate “Byrd” rules for reconciliation. That will occur no later than the morning of Dec. 2.
The House-passed measure simply repealed the ACA's individual and employer mandates to have and provide health-care coverage, which was a violation of the Senate rules. The Senate amendment would keep the mandates in place, but would remove any financial penalties associated with them, essentially gutting the mandates without repealing them.
Further amendments to make changes to the House bill will be offered through Dec. 3, or whenever the 20 hours of debate on the measure allowed under reconciliation rules are used up. Democratic and Republican staff have been meeting with the Senate parliamentarian about amendments since Nov. 30.
After the 20 hours, an unlimited number of amendments will be allowed by both parties, leading to a so-called vote-a-rama. Senate Majority Leader Mitch McConnell (R-Ky.) told reporters he expects the process to finish “sometime Thursday,” Dec. 3. Senate Majority Whip John Cornyn (R-Texas) did not answer questions about how many amendments Republicans would offer.
Democrats also didn't say how many, or what amendments they will offer, but there is expected to at least be one amendment stripping the abortion provision from the bill. Senate Minority Leader Harry Reid (D-Nev.) said Democrats will offer a “small number” of amendments. Other Democrats have decried the amount of time Republicans will continue to spend attempting to repeal the ACA, especially when the Senate has government funding deadlines looming in the coming weeks.
Republican leadership will have to win over members who were reluctant to support the House-passed version. Senate Republicans control only a 54-vote majority, leaving a slim margin for any defections. Some senators have already expressed concerns about voting to defund Planned Parenthood. In addition, any member can raise a “point of order” objection that the bill violates the complicated Senate reconciliation rules.
Bridging the gap between the two sides could prove challenging, but senators Dec. 1 said they felt the bill would be able to accomplish that.
“We feel pretty good about where most of our members are,” Sen. John Thune (R-S.D.) told reporters. “The ultimate resolution is one that will attract the requisite number of votes to send it to the president's desk. I think we’re moving in the right direction and I think the changes that have been made actually have been very conducive to attracting our members who previously had said they weren’t going to support the House-passed bill.”
Sen. Roy Blunt (R-Mo.) told reporters Dec. 1 the bill contains “a number of things that get pieced together in a way that produces 51 votes, but more importantly, in a way that lets us talk about the failures of Obamacare and how this system isn’t working.”
Blunt said the gradual phaseout of the Medicaid expansion would allow senators in expansion states to vote for the measure without being seen as taking away health care from their constituents.
Sen. Susan Collins (R-Maine) told reporters Dec. 1 she wasn't sure how she might vote on the bill, because of the abortion funding language.
“It is a major problem for me that the defunding of Planned Parenthood would lead to the closing of clinics. It’s important to remember that federal funds are already prohibited for the use of abortions except in the case of rape, incest and the life of the mother,” Collins said. “So my concern is that this total prohibition of federal funding, including Medicaid funds for Planned Parenthood, would cause millions of women across the country to find new health-care providers.”
Bloomberg Philanthropies provides financial support for Planned Parenthood.
Collins reiterated that she opposes the ACA, but said it's not something that can be unraveled overnight. “I don’t think you can just gut the law and not replace it with some provisions that are going to help those that are without health-care coverage,” she said.
Sen. Mike Lee (R-Utah), along with Republican presidential candidates Sens. Ted Cruz (Texas) and Marco Rubio (Fla.), voiced their opposition to the House-passed bill for not going far enough to repeal the ACA. Conn Carroll, a spokesman for Lee, said the senator is “strongly leaning” toward voting for the bill, but was waiting until the Senate parliamentarian signs off on the full text to publicly commit.
A spokesman for Cruz said the senator's position hasn't changed.
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Text of the substitute amendment is at http://src.bna.com/bky.
The Congressional Budget Office score of the amendment is at http://src.bna.com/bkz.
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