The Senate is heading toward a final vote to repeal the Affordable Care Act. And Republican leadership unveiled their final legislative offer just hours before it was set to take place.
The Senate narrowly voted Monday to proceed with debate on health care legislation and is currently concluding a 20-hour debate on what should be included in the final outcome. So far, the Senate has voted down an amendment that would have, in keeping with a 2015 bill that passed the Senate, fully repealed parts of Obamacare, and another amendment that incorporated the Better Care Reconciliation Act, the reform version the Senate revealed last month.
With those two options essentially off the table, another version of reform — “skinny repeal” — was floated around as a possible version of legislation with a chance to pass the Senate. The full text of the bill was released at 10 p.m., approximately two hours before the Senate was set to vote on it. Called “the Healthcare Freedom Act,” the bill, in keeping with earlier reports repeals the more unpopular parts of Obamacare, such as the individual and employee mandates for health insurance, and largely leaves Medicaid untouched.
No Senators seem to have expressed enthusiasm about the bill, explaining instead that voting on it would merely be a procedural mechanism to begin coordinating with the House of Representatives.
“The skinny bill as policy is a disaster,” said South Carolina Senator Lindsey Graham. “It is a vehicle to getting Congress to find a replacement.”
Although the full text was unveiled, it’s unlikely that will be the final version that makes its way to President Trump’s desk. After the 20 hours of debate concludes, the Senate is set to begin a “vote-a-rama” where they will vote on a series of amendments that could be included in the bill if they pass.
Here’s what you need to know about the latest iteration of a repeal bill — and what would happen if it passed.
What do we know about skinny repeal?
Up until the draft was revealed Thursday night, much of what we know is through what we have been told by GOP Senate aides, and what has been in other reports. The bill would repeal the individual mandate in Obamacare, which stipulates that most people pay a monthly penalty for not buying insurance, as well as the employer mandate, which imposes the same penalty on companies with more than 50 people.
GOP Senators hashed out more details at their lunch on Thursday. Earlier in the day, when asked if the bill would include a prohibition on using Medicaid funds for Planned Parenthood for one year, one of the more controversial measures that weakened support among some moderate GOP Senators, a GOP source said this was among the components up in the air. The bill does include this provision.
The bill would also repeal the tax on medical devices, which wouldn’t kick in until 2021, and enable states to apply for waivers on regulations from Obamacare. Under current regulations, states can waive provisions if they retain the same number of people on health insurance. The language in this bill would likely end up loosening those restrictions.
The nonpartisan Congressional Budget Office released a report Wednesday night estimating that, based on what they knew of the bill, it would result in an additional 16 million being uninsured in 2026, as opposed to current law. If the Affordable Care Act remained as is, 28 million Americans under the age of 65 would be uninsured in 2026. Should the Affordable Care Act be replaced with “skinny repeal” 43 million Americans would be uninsured in 2026. Per a senior Senate Democratic aide, the CBO has also told Democrats premiums could rise 20% higher each year under the skinny repeal law.The estimates were based on provisions sent to the CBO from Senate Democrats, and included portions they think would be included in the bill, like a repeal of the individual and employee mandates. Those portions were included in the bill The CBO released a second score after Republicans unveiled their legislation but the figures regarding the numbers of uninsured were the same, as were the premium increases.
Where does the skinny repeal vote stand?
Like many parts of this process, it was not entirely clear, because Senate Republican leadership did not unveil the actual text of the bill until late Thursday. If the bill retains the Affordable Care Act’s Medicaid expansion, that could satisfy moderate senators like Nevada’s Dean Heller and West Virginia’s Shelley Moore Capito.
However, the governor of Heller’s home state, Brian Sandoval, was among the bipartisan group of ten governors to sign a letter opposing skinny repeal.
Graham, along with his Senate colleagues Ron Johnson and John McCain, held a press conference Thursday evening announcing they were skeptical of the bill and would only vote for it if the House does not immediately pass it into law but instead proceeds to a conference committee.
The parliamentarian will also need to rule if anything in the bill violates the Byrd Rule and falls outside the budgetary process. If the parliamentarian rules that it does, Democrats would likely raise a point of order. If that happens, Republicans would need 60 votes to pass the bill, which they wouldn’t get because there are only 52 of them and all Democrats are opposed. But if the bill remains within budgetary constrictions, they could pass with a simple majority, which means only two can defect.
What would happen if skinny repeal passed? Does it become law?
Not yet, and probably not in that form. Should the bill pass the Senate under budget rules, it would go back to the House for approval before going to the White House. But if the House raises objections the two chambers would likely convene in the form of a conference committee. As described by the Congressional Research Service, the committee would be comprised of members from the House and the Senate. If and when the differences are worked out, the members of the committee would sign a report, but that report would have to be approved by both chambers before heading to Trump’s desk.
Its unclear, however, if the House would raise objections — and that’s what’s causing Graham, Johnson and McCain uncertainty on their votes. They need assurance, they said, from House Speaker Paul Ryan that the House would raise objections and form a conference with the Senate.
Ryan said in a statement Thursday that the House would be “willing” to conference with the Senate, but indicated it was ultimately the Senate’s responsibility. “The burden remains on the Senate to demonstrate that it is capable of passing something that keeps our promise, as the House has already done,” Ryan said. “Until the Senate can do that, we will never be able to develop a conference report that becomes law.”
When asked what constituted that assurance from Ryan, Graham responded, “It’s like pornography. You’ll know it when you’ll see it.”