On Thursday afternoon, the Senate is expected to vote on what’s been dubbed the “skinny repeal,” a stripped down version of the full Obamacare repeal that failed to pass on Wednesday afternoon.
It remains unclear what precisely is in the “skinny” repeal bill, but a report from Axios indicates that its key provisions include a full repeal of the individual mandate, a partial repeal of the employer mandate, and a one-year defunding of Planned Parenthood. The bill might also expand funding for community health centers and changes to the Affordable Care Act’s 1332 innovation waivers. Under the ACA, section 1332 allows states to apply for waivers to modify some of the ACA’s central provisions like essential health benefits “so long as health coverage is not jeopardized and federal deficits not increased.” The innovation waivers are already flexible under the ACA and, as Axios reports, it’s unclear how the provision would change their current implementation.
Still, the contents of this “skinny” repeal bill remain a mystery. Axios’s report is sourced to “two senior GOP aides” but no one other than Senate Republican leadership has apparently seen the full bill. On Wednesday, minority leader Chuck Schumer criticized Mitch McConnell for his opaque approach to passing legislation that would affect the health of millions. Schumer said that Democrats would no longer offer amendments until the full bill was shared with the Senate. (After passing the motion to proceed on Tuesday, the Senate moved to 20 hours of debate. Debate ends this afternoon and the Senate will move to a vote-a-rama where they can offer an unlimited number of amendments and then vote immediately on them without debate. It’s a nightmare process with an appropriately ridiculous name.) “We ought to see it soon, in broad daylight, not at the 11th hour,” Schumer said of the “skinny” repeal under consideration.
In another effort to kill the skinny repeal, Democrats submitted a draft of what they expect to be in the bill to the Congressional Budget Office. On Wednesday the CBO scored the expected bill and found that the number of uninsured people would rise by 16 million by 2026 (that’s in addition to the 28 million expected to be uninsured under the current law). The CBO also estimates that insurance premiums would rise across the board. Again, the CBO score is on a possible, phantom, invisible bill (the CBO score includes the elimination of the medical device tax and Axios reports that the tax elimination is not in the bill) but it’s clear that eliminating Obamacare’s insurance mandate would be a disaster. As Sarah Kliff at Vox notes,
Skinny repeal is, simply put, a misnomer. This is a bill that would cause millions of Americans to lose coverage, individual market premiums to rise, and the size of that market to shrink. There is nothing skinny about that.
It’s likely that the Senate will vote on this last ditch repeal option today, but that’s not a certainty. Also uncertain is whether or not sections like the one-year-defunding of Planned Parenthood would run afoul of congressional rules and require more than a simple majority to pass (a la the BCRA). As Mike Pence told NBC, “It’s going to be a big day.”
Update, 5:00 p.m.: Senate parliamentarian said that the waiver provision violated the Senate’s rules of fast-tracking. In addition, it is becoming increasingly unclear whether or not McConnell has enough votes to pass this repeal. Senators seem unsure about the majority leader’s promise that, once passed, the bill would be sent back to House where further details would be worked out in conference. Some Republicans are worried that the House wouldn’t flesh out the bill in conference but rather pass it as is.
Update, 5:30 p.m.: During a press conference that can only be described as the ne plus ultra of the Republican leadership’s dysfunction, Senators Lindsey Graham, Ron Johnson, and John McCain spoke about their “increasing concern” that the skinny repeal that they are willing to pass in the Senate might be passed by the House. Put plainly, despite Graham’s description of the bill as “terrible policy and horrible policy,” the Senators seemed to be seeking assurance that the “skinny repeal” would not pass the House as is but rather go to conference for further work. They were joined mid press conference by Senator Bill Cassidy. I guess everyone has lost Paul Ryan’s phone number. Also, they will all vote for this bill despite this fun charade.
Update, 9:50 p.m.: Mitch McConnell just introduced the full text of the bill, called the Health Care Freedom Act. The bill includes much of what Axios reported earlier today, including repealing the individual and employer mandates and defunding Planned Parenthood for a year (the bill prohibits funding for “community providers” that provide abortion with exceptions for rape, incest or “danger of death”). It also repeals the medical device tax and increases tax-free contribution limits for Health Savings Accounts. In addition, it keeps the 1332 waivers allowing states to potentially opt-out of many of the Obamacare requirements (this section was rewritten so it now passes the Senate parliamentarian’s rules). This bill is practically a full repeal of Obamacare. If there’s a silver lining, it’s barely visible, but the extensive Medicaid cuts that were in the BCRA are absent here—that, of course, could change once the bill goes back to the House. The Senate will vote at midnight.
Update, 11:05 p.m.: The Congressional Budget Office’s score is out. According to the CBO, the Health Care Freedom Act would leave 16 million more uninsured by 2026.
Update: The bill has failed to pass the Senate. Republican Senators Lisa Murkowski, Susan Collins, and John McCain diverged from their party and voted “no” on the bill.