Senate Republicans Narrow Expectations on Obamacare Repeal

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By Colleen Murphy and Alex Ruoff

Republican senators are building a life raft to get a health care bill to conference with the House after a series of failed votes and weeks of fraught negotiations.

Republicans acknowledged July 26 that a “skinny repeal,” axing the Affordable Care Act’s individual and employer mandates and the 3.8 percent medical device tax, may be all they can agree on at the end of their debate this week. The measure would then move to the House, where some conservatives already oppose it for keeping too much of the ACA in place.

“It just seems to me that’s the easiest common denominator to get to and the real goal is to then continue to work with the House,” Sen. Roy Blunt (R-Mo.) told Bloomberg BNA. “I think it keeps the issue alive, I think it is likely to address a couple of significant points that we have thought from day one would create more problems than they create solutions.”

Blunt said he first floated the concept in a July 25 Republican policy lunch and said all that would need to be included is a repeal of the mandates and any savings needed to meet the requirements of reconciliation.

The idea of such a narrow bill already has some prominent opponents in the House.

“Obviously the votes are still not there for the skinny in the Senate, but I think ultimately they would be there. Would we send that to the president? The answer is no,” House Freedom Caucus Chairman Mark Meadows (R-N.C.) said, adding there is no chance a skinnier bill would pass the House outright.

Welcome in the House?

House Republicans said July 26 they are open to a conference committee, and acknowledged that may be their only option to work through discrepancies. The bill (H.R. 1628) that passed the House May 4 makes cuts to Medicaid that are unpalatable to more-moderate senators, and many said its system of age-adjusted tax credits was too small for older and low-income individuals.

“It all depends on what they produce. If it’s a token measure, then I think conference is the only way to go to ferret out relief, like for example on the individual marketplace. They don’t address that. We need to address that. That’s the pressing concern,” said Rep. Tom Reed (R-N.Y.), a member of the House Ways and Means Committee.

Getting to conference would also buy senators time to get Congressional Budget Office scores on amendments they could pass without Democratic support, Sen. Mike Rounds (R-S.D.) said.

The idea of repealing the medical device tax—one of the ACA elements Republicans dislike most—could win some House support.

“I mean there’s a lot of concern over here about the employer mandate and the medical device tax, and I’ve been extremely critical of those two provisions in particular,” said Rep. Charlie Dent (R-Pa.), co-chair of the moderate Tuesday Group.

Still, a conference committee is something House leadership hasn’t committed to because they need to see what the Senate produces, said AshLee Strong, press secretary for House Speaker Paul D. Ryan (R-Wis.). The House is set to leave for August recess at the end of the week, but leadership has said they would return to vote on a health bill.

Going to a conference committee also may not lead to a stronger bill, Katherine Hayes, director of health policy at the Bipartisan Policy Center, said July 26 during an event hosted by Bloomberg Government. Democrats took the Affordable Care Act to conference seven years ago, she said, and it resulted in partisan changes that still plague the law.

Thinking Skinny

Senate Republicans also don’t support the idea of a whittled-down bill becoming law. Rather, they see it as a necessary outcome if they can’t pass something else.

“It’s not a solution,” Sen. Lamar Alexander (R-Tenn.) said.

Meadows, the Freedom Caucus chairman, also told reporters he thinks Senate Republicans will reach agreement on a bill that falls in the middle of their version of the House bill, the Better Care Reconciliation Act, and a bill that leaves most of the ACA intact.

“Given a set of difficult choices it’s always much more difficult to make the hard choice, but in the end I think the Senate will make the hard choice,” he said. “Whether you’re a moderate or a conservative in the Senate, I can tell you they’re working around the clock to get it done.”

Senate Democrats panned the idea during debate. The 20 hours of debate ongoing in the Senate are equally divided between parties, in accordance with chamber rules.

“Skinny repeal is equal to full repeal. It’s a Trojan horse designed to get the House and Senate into conference, where the hard-right flank of the House Freedom Caucus will demand full repeal,” Senate Minority Leader Charles E. Schumer (D-N.Y.) said on the floor.

Floor Debate Continues

The Senate turned down a “clean repeal” of the ACA July 26.

The 45-55 vote fell far short of the bar for passage, as expected. No bill is likely to pass until the Senate completes hours of debate and negotiations.

Senate leaders offered a straight repeal with a two-year delay after realizing there weren’t enough votes to pass the Senate version of the House bill.

The measure, offered by Sen. Rand Paul (R-Ky.), called for killing Obamacare’s tax credits and all tax provisions, eliminating eligibility for Medicaid expansion, stopping reinsurance payments and ending the Prevention and Public Health Fund. It would also stop the Cadillac tax—a tax on portions of high-cost health plans that is set to start in 2020.

“If you want to get rid of the taxes it has to be done today,” Paul said in a floor speech. “We have to figure out what that replacement is, and the only way we’re going to be forced into a bipartisan compromise is if we repeal it. If we do not repeal it today there’s no impetus from either side to work on replacing it.”

The Senate also rejected a motion from Sen. Joe Donnelly (D-Ind.) to take the bill from the floor and send it back to committee. Late July 25 , a vote on Republicans’ comprehensive plan to replace the ACA failed 43-5.

With assistance from Laura Davison and Alex Ruoff.

To contact the reporters on this story: Colleen Murphy in Washington at cmurphy@bna.com; Alex Ruoff in Washington at aruoff@bna.com

To contact the editor responsible for this story: Meg Shreve at mshreve@bna.com

Copyright © 2017 The Bureau of National Affairs, Inc. All Rights Reserved.

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