After a chaotic and tumultuous week, the Senate appears to be slowly, painfully congealing around a plan it can agree on to repeal parts of the Affordable Care Act (Obamacare). But that plan itself is still something that nobody, including the Senators who will probably vote on it, has seen the text for. And even if the Senate does vote to pass it, is that really the bill we’re going to get?
If you’re confused by all this, you’re not alone. The entire internet at this point is full of experienced healthcare experts and Congressional reporters who have no clue what’s going on behind closed doors on Capitol Hill. But as support for the “skinny repeal” seems to be solidifying, watchers are starting to ask if repeal is actually the plan — or if the end goal is to create a backdoor to pass the House version of repeal, that the Senate basically already rejected.
A busy couple of days
On July 25, the Senate voted 51-50 to open debate on a healthcare bill.
That bill was the House’s American Health Care Act, but it was used effectively as a placeholder text while the Senate crafted its own plan to repeal and/or replace the ACA.
The rules the Senate is moving to pass a repeal under grant 20 legislative hours of debate, so Tuesday’s vote set the clock ticking.
The first Senate alternative to come to a vote was basically the Better Care Reconciliation Act (BCRA) — the bill that was basically deemed too dead to vote on merely a week earlier. It did indeed fail, 57-43.
On Wednesday, the Senate then moved on to its next option, which was essentially the Obamacare Repeal Reconciliation Act (ORRA) — a straight “repeal” plan. That, too, failed to advance, only securing 45 of the necessary 51 votes.
However, that 20-hour clock is now, two days later, starting to run down. And so the Senate is moving to come up with something that can garner 51 votes before time runs out. Sources report that support is beginning to coalesce around a last-ditch option that’s being called the “skinny repeal.”
What’s in the “skinny repeal” option?
The proposal has been given the nickname “skinny repeal” because it’s not a full repeal of the entire ACA. Instead, it proposes to roll back a few key provisions that Republicans in Congress have objected to.
Most notable among these is the individual mandate. That’s the rule that requires everyone to have insurance or pay a penalty. Without it, the thinking goes, the individual insurance market would become overburdened with high-cost patients as more-or-less healthy individuals dropped out. That would cause premiums and policy costs to rise, which would in turn cause fewer people to be able to purchase insurance, so fewer insurers would sell policies, and the market would basically nosedive into a death spiral.
(As NPR reports, several states tried extremely similar legal maneuvers in the late 1990s and it did indeed drive insurers out of the market, leaving fewer and less-affordable plans for consumers.)
As Vox notes, although the Congressional Budget Office hasn’t given the proposal a formal score yet (as no actual bill text yet exists), it estimates that enacting it would still cause 15-16 million Americans to lose insurance they currently have, while also driving premiums up by 20%.
Other provisions, like letting states waive Essential Health Benefits, have come up as features of the skinny repeal. However, some of those don’t meet the standard for things that can be included in a budget resolution and would need 60 votes in order to pass. That means they won’t, so they’ll have to be dropped if McConnell wants the plan to advance.
Our colleagues down the hall at Consumers Union, the policy and mobilization arm of Consumer Reports, slammed the plan.
“Senate leaders are using smoke and mirrors to make it seem as if this latest proposal is somehow different or better than the ones just voted down in the Senate,” Betsy Imholz, special projects director, said in a statement. “This so-called ‘skinny repeal’ would not only still leave millions uninsured, destabilize the insurance markets further, and trigger skyrocketing premiums, but is also an attempt to try to breathe new life into the harmful ideas in both the American Health Care Act and the Better Care Reconciliation Act — both hugely unpopular proposals that have been rejected by Senators repeatedly.”
Read More: Insurance companies, actuaries, and physicians warn against repeal of the individual mandate
Is the Senate actually going to vote for it? When?
This is where it starts to get complicated. Or just gets even more complicated, really.
The Senate is pretty close to running out its 20-hour debate clock. When it does, they will move on to something called the vote-a-rama. That’s a marathon session — most Hill-watchers expect it to start Thursday evening and stretch until the wee small dawn hours of Friday morning — in which Senators offer and vote on amendments rapid-fire.
At the end of that process, Senate Majority Leader Mitch McConnell (KY) is expected to basically ignore all of those and instead offer the final bill, the skinny repeal, for a vote. But how likely the Senate is to go for that depends on which source you ask, at this point.
Republican Senators have been divided all along on a repeal and replace plan. Basically, they’re in two rough camps: The “this goes too far” group and the “this doesn’t go far enough” one. As a result, the skinny repeal is as minimalist and bare-bones as McConnell feels is possible, in order to shepherd all the Republicans together.
Even so, a number of Senators have said that they aren’t terribly keen on the planned bill. Right now, Politico describes the situation as, “Senate Republicans hope their own Obamacare repeal won’t become law” — but that headline has changed a half-dozen times in recent hours, as many of them are likely to vote for it anyway, on the basis that it’s the only way to keep moving forward.
Who’s planning to vote which way isn’t exactly in line with the two camps we got used to from earlier stages of the process. The Republican Senators are, basically, all over the map, with some voicing full-throated support of just doing anything and others voicing indecision since there’s no actual bill.
But what process is McConnell trying to get them to move forward to, you may ask?
Conference
At this exact moment in time, the goal for McConnell is not to craft and pass a final bill. It’s to pass something — anything — to make the process survive to the next stage.
In this case, the next stage is “conference.”
Although this entire process has been a confusing, chaotic mess, entirely unlike the way Schoolhouse Rock taught us it would be, one old-school fact still holds: The House and Senate both have to agree on a final draft of something before the President can sign it.
That’s where the conference committee comes in. A group of Representatives and Senators come together and hammer out something they can agree on — a final, unified draft that can come before a final vote in both chambers.
But if the Senate votes this week on what is effectively a placeholder that nobody wants, that just kicks the can of fundamental disagreement down the road into conference, where the same cracks will surface yet again.
That brings us back to the House, which last voted on its own repeal plan back in May.
Politico reports that House Majority Leader Kevin McCarthy (CA) has just instructed Representatives not to leave town for their planned August recess, anticipating the need for the House to take action on a Senate bill of some kind.
Does the House want “skinny repeal” too?
It is, at this point, anyone’s guess what the House and Senate would do together in conference.
Washington Post reporter Mike DeBonis Tweeted earlier today that Republican members of the House said it’s a “definite possibility” that the skinny repeal could pass the House intact, as-is (whatever it is) if the House freedom caucus (i.e. the most conservative, “tea party” wing) rallies around it.
Sen. John Cornyn (TX) likewise told reporters recently that it’s entirely possible that the House could just take whatever the Senate passes and send it right on up to the White House without conference.
But again, not everyone agrees.
Sen. John McCain (AZ), who flew back from his home state days after brain surgery for a dramatic entrance to vote on Tuesday’s motion, told reporters that he was “very worried about it, and I would be worried about the product” of the House adopting the skinny repeal — if, indeed, that is even what the Senate votes to do tonight.
Alternatively, however, the situation could go the other way: the Senate could adopt the House’s version, instead of the House adopting the Senate’s.
That would likely go over well with the Representatives at the conference, because the House has already passed that bill. But that could be a harder sell in the Senate: The House bill’s language is nearly the same as the BCRA that failed to garner support or to advance in the Senate twice already.
by Kate Cox via Consumerist
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