Even a bare-bones repeal of Obamacare is no sure thing in the Senate.
A handful of key Republican senators who had spurned earlier overtures from GOP leadership endorsed the latest plan to gut Obamacare’s individual and employer coverage mandates and its medical device tax. But several centrists said they’re undecided on the so-called “skinny repeal,” leaving the GOP in limbo through at least the end of the week.
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Jockeying on the scaled-back approach came as the Senate rejected a straight repeal of Obamacare in a 45-55 vote Wednesday. The night before, senators turned aside a comprehensive replacement plan that had been crafted by Senate Majority Leader Mitch McConnell. The roll calls were the latest reminders that GOP leaders’ best hope at this point is just to get something — anything — through the chamber with a bare majority and into a conference with the House.
“Sure. There’s plenty we agree on,” said Senate Majority Whip John Cornyn (R-Texas) late Wednesday when asked if he can get 50 votes. One challenge for GOP leaders is “trying to explain the concept that we need to it this way as opposed to solving all the problems in a Senate bill now.”
Cornyn said broader negotiations on Medicaid reforms and other divisive issues would likely reemerge in bicameral negotiations with the House. But some Republicans are worried that those talks would revive efforts to wind down a Medicaid expansion that’s benefited their states.
Centrist Sens. Rob Portman (R-Ohio) and Shelley Moore Capito (R-W.Va) were undecided on the so-called “skinny repeal” Wednesday. Another senator from an expansion state, Sen. Dean Heller (R-Nev.) indicated he would back it.
“We’ll see at the end of the day what’s in it but overall I think I’d support it,” Heller said. He said slashing Obamacare’s Medicaid expansion or its growth rate should be a non-starter.
Conservatives could be another matter.
“I don’t like it,” said Sen. David Perdue (R-Ga.). “Because I don’t know where we end up. This whole [health care system] holds together or falls apart in totality. We’ve got a system that is collapsing.”
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 said he would only vote for the slimmed-down plan if House and Senate lawmakers use it to go to conference and come up with a fuller replacement.
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 (Obamacare insurance mandate) 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) can back a trimmed-down proposal “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,” Paul (R-Ky.) said 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.
Many Republicans are in the dark about the emerging proposal. And aides said senators were still focused on amendment votes, floor tactics and the chaotic atmosphere, making it difficult to tell what can clinch 50 votes.
“I don’t know what would be in the skinny repeal,” said Sen. Susan Collins (R-Maine.) “Until I see what’s in it I’m not ruling it out because I don’t know what it would be.”
The Senate also rejected on Wednesday an attempt to send their repeal effort to congressional committees for several days.
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 known as “vote-a-rama,” which is expected to begin sometime Thursday.
In the final bill, 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 (eliminating) the medical device tax,” 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. They may be able to do so because slashing the mandates means millions would drop insurance coverage – and the subsidies that come with it.
In the end, Senate leaders would want the House to either take up their bill or go to conference and hammer out a compromise 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 (be in) 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.”