Forget ripping out Obamacare “root and branch”: At this point Senate Republicans are just looking to get something — anything — through the chamber with a bare majority.
After managing to resurrect their repeal bid Tuesday in dramatic fashion, the GOP may have to settle for a bare bones effort that falls far short of their previous pledges to undo the law in its entirety. A vote for a full repeal of the law is expected to fail Wednesday; that comes after the Senate on Tuesday night rejected a comprehensive replacement plan that was hammered out by Senate Majority Leader Mitch McConnell.
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Now the Senate GOP is aiming for what Health and Human Services Secretary Tom Price called the “lowest common denominator” as its likely end game: repealing Obamacare’s individual and employer mandates as well as its tax on medical devices.
Though the contents of that so-called “skinny repeal” could still change, those three elements may be all the Senate can pass at this point. Sen. Lindsey Graham (R-S.C.) on Tuesday called the possibility of a skeletal plan a “political punt,” but it may be that that can clear the narrowly divided chamber. The South Carolina Republican says he would only vote for the slimmed-down plan if House and Senate lawmakers use it to go to conference and come up with an Obamacare replacement proposal.
“We’ll see at the end of the day what’s in it but overall I think I’d support it,” said Sen. Dean Heller of Nevada, the most vulnerable GOP incumbent. He said slashing Obamacare’s Medicaid expansion or its growth rate should be a non-starter.
Sen. Jeff Flake (R-Ariz.) also indicated that he could get on board with the skinny option.
“In Arizona, you have 200,000 people who were paying the fine and can’t afford insurance,” Flake told reporters. “We gotta have relief to those who, one, can’t find affordable insurance so they have to pay the fine and, two, even those that can afford to pay the premium, generally can’t afford to utilize the coverage because the deductibles are so high.”
Whether Sen. Mike Lee (R-Utah) could support a skinny plan “depends how skinny it is,” a spokesman said. But Sen. Rand Paul (R-Ky.) signaled he could live with the minimalist approach.
“I’ve always said I will vote for any permutation of repeal. Obviously I want as much as I can get but I’ll vote for whatever the consensus can be. It’s what I’ve been saying for months: Start on what you can agree on,” said Sen. Rand Paul (R-Ky.) in an interview on Wednesday. “Starting small and getting bigger is a good strategy.”
That would leave out the divisive issues of future cuts to Medicaid spending and efforts to create a new tax credit system for the individual markets. Republicans can only lose two votes on whatever they pass in the end.
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.
Republicans need a score on any proposal from the Congressional Budget Office to vote at a 50-vote threshold. They are aiming for a vote on Friday on their final plan after the unlimited amendment process on the “vote-a-rama,” expected to begin sometime Thursday. In the final bill designed by Republicans at the end of the process, Republicans could try to add in more elements than repealing the mandates and device tax, but that could complicate efforts to get a quick CBO score.
“Look for victories where we should find them. In my opinion the victory will always include: Individual mandate repeal, employer mandate repeal and the medical device tax. I’m not quite sure that we know what that skinny version looks like,” said Sen. Tim Scott (R-S.C.). “If we can add to it, we should … as much as you can repeal, let’s get it done.”
The CBO has scored those three pieces of the proposal in the past and could more speedily deliver an analysis of the “skinny repeal” than a more wide-ranging effort, GOP senators said. Still, Republicans will have to add additional Obamacare provisions to the bill to meet minimum savings requirements required under reconciliation, the budget mechanism that allows for a bare majority instead of 60-vote threshold.
Republicans are likely to cut the Prevention and Public Health Fund, for instance. The goal would be to increase the bill’s scope enough to meet Senate savings targets without losing political support, according to Republican sources.
GOP leaders then would hope that the House would either take up that bill or the two chambers would go to conference and hammer out a healthcare bill that can pass both chambers.
“I can’t imagine at the end of the process that we haven’t agreed on something,” said Sen. Roy Blunt (R-Mo.). “And all we have to do is agree on something that keeps this going.”
But conservatives are wary of a House-Senate negotiation.
“I would favor if we have a skinny repeal, just sending it over to the House and seeing if they can pass it rather than going to conference,” Paul said. “Conference committee to me means big government Republicans are going to start sticking in those spending proposals.”