The News
Wednesday 29 of May 2024

Republicans Strain for Modest 'Skinny' Redo of 'Obamacare'

House Speaker Paul Ryan of Wisconsin meets with reporters on Capitol Hill in Washington, Thursday, July 27, 2017,photo: AP/J. Scott Applewhite
House Speaker Paul Ryan of Wisconsin meets with reporters on Capitol Hill in Washington, Thursday, July 27, 2017,photo: AP/J. Scott Applewhite
On their own, the changes in the skinny bill could roil insurance markets and send premiums skyrocketing

WASHINGTON – Battered by repeated failures to repeal or replace “Obamacare,” Senate GOP leaders retreated to a narrow approach Thursday that would undo just a few of the most unpopular elements of Barack Obama’s law. Democrats vowed opposition as the Senate prepared for a bizarre Capitol Hill ritual, a “vote-a-rama” on amendments that promised to last into the wee hours of Friday morning.

The “skinny repeal” they were considering was being touted as a way for Republicans to get something, anything, out of the Senate after frittering away the first six months of Donald Trump’s presidency trying unsuccessfully to abolish the current law. Talks with the House would follow, with the aim of crafting a compromise repeal-and-replace bill that could pass both chambers sometime in the fall.

Whether Republicans can make it that far looks iffy at best. But Trump tweeted his encouragement, albeit with an ominous touch:

The “skinny bill” strategy emerged after Republicans barely succeeded earlier this week in opening debate on health legislation in the narrowly divided Senate, winning the procedural vote to do so thanks only to Vice President Mike Pence breaking a 50-50 tie.

Hours of debate followed, as well as a few amendment votes that starkly revealed Republican divides. On Tuesday, on a 57-43 vote with nine GOP defections, the Senate rejected a wide-ranging proposal by Majority Leader Mitch McConnell to erase and replace much of the Affordable Care Act. Then on Wednesday, a straightforward repeal measure failed 55-45 with seven Republicans joining Democrats in voting “no,” even though nearly identical legislation had passed Congress two years earlier.

That left Republican senators hunting for other options, and the skinny repeal rose to the top. The measure has not been finalized, but senators have said it could eliminate Obamacare’s two mandates — for individuals to carry insurance and for employers to offer it.

Lobbyists said Republicans were also planning to include a one-year ban on federal payments to Planned Parenthood, extra money for community health centers and waivers for states to permit insurers to sell policies with far narrower coverage than current law allows.

But leaders were encountering problems. The Senate parliamentarian advised that the waiver language violates chamber rules, meaning Democrats could block it. And plans to eliminate Obama’s medical device tax could be abandoned because Republicans need that money for their package.

“It is being called a skinny bill because it won’t have much in it,” said Sen. Lamar Alexander, Republican from Tennessee. “It is not a solution to the Affordable Care Act problems. But it is a solution on how we can get to a place where we can write a solution to the Affordable Care Act.”

Whether Republicans have the votes even to pass that much is unclear. And in a peculiar twist, some GOP senators were seeking assurances that the House would not pass the “skinny repeal” as-is, but would commit to going into a conference committee with the Senate to hammer out a more comprehensive replacement.

On their own, the changes in the skinny bill could roil insurance markets and send premiums skyrocketing. Yet the scenario at hand, with senators trying to pass something while hoping it does not clear the House or become law, was highly unusual.

“We’re in the twilight zone of legislating,” said Democratic Sen. Claire McCaskill of Missouri.

A countervailing argument was also circulating, that House passage of a Senate skinny bill could allow Republicans to claim at least partial victory and move on to other issues. With tax legislation and other priorities waiting in the wings, Republicans are eager to rid themselves of the burden of making good on their many campaign promises to repeal and replace Obamacare, which has proven far more difficult than they seem to have expected.

During the “vote-a-rama,” unlimited amendments can be offered from both sides.

Most will be dismissed along partisan lines; some may resurface in years to come in the form of attack ads. But at some point along the way McConnell is expected to offer the skinny bill as an amendment of his own, with hopes it will get a majority.

“I think it is quite likely we will be here much of the night, if not all night,” said Sen. Ted Cruz, Republican from Texas. “And at the end of it hopefully we’ll have a bill that can bring us together.”

Yet as has happened every step of the way, no sooner did the latest bill emerge than opposition arose against it.

The insurance company lobby group, America’s Health Insurance Plans, wrote to Senate leaders Thursday saying that ending Obama’s requirement that people buy insurance without strengthening insurance markets would produce “higher premiums, fewer choices for consumers and fewer people covered next year.”

And a bipartisan group of governors including John Kasich of Ohio and Brian Sandoval of Nevada also announced against it.