Senate Health Bill Prospects Worsen After Procedural Setback

The Senate parliamentarian issued a preliminary finding that key parts of Republicans’ health-care proposal don’t qualify for a fast-track procedure being used by the GOP, dramatically complicating Majority Leader Mitch McConnell’s already slim prospects of passing a bill next week.

Democrats on the Budget Committee Friday released a summary of the parliamentarian’s findings on a June 26 draft of McConnell’s proposal to replace Obamacare. The majority leader plans a test vote early next week on the repeal effort.

Two anti-abortion provisions are among the dozen the parliamentarian concluded would require 60 votes rather than the simple majority the GOP seeks to use under the fast-track procedure. One prohibits Planned Parenthood from receiving Medicaid funds for one year, and the other would prevent tax credits for insurance premiums from being used to buy policies that cover abortion.

"The parliamentarian’s decision today proves once again that the process Republicans have undertaken to repeal the Affordable Care Act and throw 22 million Americans off of health insurance is a disaster," said independent Senator Bernie Sanders of Vermont, the top Democratic caucus member of the Budget Committee.

McConnell spokesman Don Stewart cautioned in an email that the parliamentarian’s findings were "guidance on an earlier draft" of the majority leader’s proposal, "which of course helps inform subsequent changes."

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Republicans control the Senate 52-48, and Democrats are united against the GOP drive to replace Obamacare.

The loss of Planned Parenthood defunding and new anti-abortion restrictions on tax credits would be sure to cause howls of protest from conservatives. Representative Trent Franks, an Arizona Republican, said in an interview that failing to ensure that federal dollars won’t support abortion "really blows a hole" in the chances the Senate measure would pass in the House.

Other provisions that would be stricken without Democratic support include a New York-specific clause that was key to passing an Obamacare replacement in the House in May, and a provision to end the requirement that state Medicaid alternative-benefit plans cover certain health benefits deemed essential.

Cost-sharing subsidies for two years were also put in doubt by the parliamentarian, who said they duplicated current law.

Also put in doubt would be a key piece of the replacement plan that bars people who go without insurance for about two months from buying coverage for six months. That provision is intended to encourage people to maintain continuous coverage and replace Obamacare’s requirement that most individuals obtain insurance.

Tough Odds

The drive for a GOP-only Obamacare replacement is already facing tough odds. Republican leaders had planned to shelve it after a revised version — which included deep cuts to health expenditures and repealed some key Obamacare tax increases — failed to get enough support among the chamber’s 52 Republicans. 

McConnell said earlier this week the Senate instead would vote on a simple repeal of Obamacare with a two-year delay — but that also has enough GOP opposition to block it.

President Donald Trump on Wednesday called Senate Republicans to the White House to personally ask them to continue trying to build consensus. Earlier this month, he said in a television interview that he would be "very angry" if the Senate didn’t pass a health-care bill.

Parliamentarian Elizabeth MacDonough is the Senate’s adviser on the interpretation of rules and procedures.

Senator Ted Cruz of Texas has championed a way to override or ignore the parliamentarian. Under Senate rules, the presiding officer — potentially Vice President Mike Pence — could make such a ruling. But that would violate Senate norms, and senior Republicans, including John Cornyn of Texas, have said they don’t plan to go that route.

The parliamentarian hasn’t yet made findings on some provisions in the legislation that could still be crucial. They include providing states with more flexibility to run their own insurance markets, a provision often touted by the administration, and a change in setting insurance premiums that would make them cheaper for young people and more expensive for older people.

The parliamentarian also still has to rule on a provision creating a new type of small business plan, and another that would allow state Medicaid funds to be provided as a block grant.

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