Is the “skinny repeal” of the Affordable Care Act that is nearing a vote in the Senate a means to an end, or the end itself?
That is the crucial question that GOP senators are facing as they consider Majority Leader Mitch McConnell’s latest—and likely final—proposal for rolling back Obamacare. According to an email McConnell sent to Republicans, shared with me by a Senate aide, the current plan under discussion—dubbed the “Freedom Bill” by the White House—would repeal the ACA’s individual insurance mandate permanently and its employer mandate for six years, defund Planned Parenthood for a year, and allow states at least some flexibility to opt out of Obamacare’s requirement that insurers cover certain essential health benefits.
Not many Republican senators like this plan. It doesn’t fully or even broadly repeal Obamacare. It certainly doesn’t replace the law with a new health-care system. It contains none of the cuts to Medicaid that many of them prize. And on its own, according to the Congressional Budget Office, it would still leave somewhere close to 16 million more people uninsured over a decade and increase premiums immediately. As with previous GOP proposals, it has drawn fierce opposition from a bipartisan group of governors and just about everyone connected to the health-care industry—among them insurers, doctors, the American Cancer Society, and the AARP. Republican Senator Lindsey Graham of South Carolina called the idea “a political punt”; his colleague Ron Johnson of Wisconsin said it was “very sad.”
Yet despite all of this, 50 Republican senators might still vote to pass this proposal in the wee hours of Thursday night or Friday morning, after lawmakers conclude an all-night session of largely symbolic amendment votes known as the “vote-a-rama.” And many of them might support this skinny repeal for contradictory reasons.
A few, like Senator Rand Paul of Kentucky, would vote for it on the assumption that the House would pass it without amendments, and it would become law as soon as President Trump signs it. Paul now believes that a partial repeal of Obamacare is better than none at all, and that it is better than the GOP trying to replace the law with another government-backed program.
Many other Republicans, however, have said they would only support it with assurances that the House would not pass the bill as is, but would instead enter into a conference committee with the Senate to hash out a compromise on a broader health-care bill. The senators in this group, according to various reports, include Graham, John McCain of Arizona, and Bob Corker of Tennessee. In a statement, Senator Rob Portman of Ohio said he’d “support support legislation to move this process to a House-Senate conference.” He made no mention of the underlying policies in the skinny repeal, nor of the possibility that it might be the GOP’s final answer on health care. In other words, some Republicans would be voting for a bill in the hopes that it would become law, while others would be voting for the same bill on the condition that it would not.
This is a risky strategy. Unlike previous votes Republicans have taken during this lengthy, at times chaotic health-care debate, GOP senators would have no guarantee of getting another shot to amend or stop the bill. House leaders have, as of yet, issued no public promises that they won’t simply bring up the Senate’s skinny-repeal bill rather than go to a conference. In fact, they have advised lawmakers to “remain flexible in their travel plans” in the coming days in case they need to act on health care. And even if the House and Senate do form a conference committee to reconcile the differences between their two proposals, the House would, at any time, have the option of passing the Senate bill if the two chambers can’t reach an agreement.
“If this Trumpcare bill goes thru & conference starts w the House, every Senate R who votes for it is OK sending it straight to the president,” a leading Senate Democrat, Patty Murray of Washington state, warned on Twitter.
The Senate’s passage of a skinny repeal is far from a done deal. There is no bill text, no final score from the CBO, and McConnell appears still to be short of the 50 votes he needs to pass it. It’s not clear whether all of its provisions will comply with the Senate’s budget reconciliation rules. The demands of McCain, Graham, and other holdouts could still scuttle the whole thing.
Yet the Senate is barreling toward a dramatic conclusion of a years-long health-care fight in a matter of hours, and Republicans appear to be voting blind.
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