Route to health law repeal
Senate GOP’s stripped-down bill seen as path to deal with House
WASHINGTON — Amid all the confusion, division and near-death experiences of the Republican effort to repeal the Affordable Care Act, party leaders emerged this week with a narrow but visible path to fulfilling their seven-year vow to revoke the law they call Obamacare.
A razor-thin Senate vote Tuesday to begin the health care debate gave Republicans an opening to pass a strippeddown “skinny repeal” by the end of the week that would repeal mandates in the current law on individuals to buy insurance and most employers to provide it, and a tax on the sale of some medical devices.
Health and Human Services Secretary Tom Price described the approach as finding the “lowest common denominator” of what Senate Republicans can pass with the 50 votes they need, along with a tie-breaking vote from Vice President Mike Pence. Such a bill, still not in written form as of Wednesday,
would provide a legislative vehicle to enter negotiations with the House on a potentially much larger repeal bill, analysts said.
“I think we’re in territory where millions of families are at risk of losing their health coverage,” said Andy Slavitt, former acting administrator in the Obama administration of the Centers for Medicare and Medicaid Services, the agency that runs the government’s health care programs.
In House and Senate negotiations, known as a conference, House Speaker Paul Ryan, R-Wis., and Senate Majority Leader Mitch McConnell, R-Ky., could write a repeal bill that melds a House version that passed in May and whatever the Senate comes up with.
The final product then would have to be passed again by both chambers, with no amendments.
Senate Majority Whip John Cornyn, R-Texas, said he was not certain the Senate could even pass a stripped-down bill. “We’ll find out,” Cornyn said. “This is a high-wire act — the whole thing.”
But given the pressure President Trump has put on Republicans to deliver on their campaign promise, many analysts believe that Republican lawmakers could ultimately take whatever comes out of the conference negotiations and deliver a version of the House bill to the White House.
The House legislation, the American Health Care Act, would slash Medicaid, cut subsidies for people buying insurance individually, strip protections for people with pre-existing medical conditions such as cancer or diabetes and cut taxes for wealthy people and the medical industry.
The Congressional Budget Office, the nonpartisan agency that analyzes the effect of legislative proposals for Congress, said that bill would lead to 24 million people losing their insurance.
But first the Senate has to pass a bill, and the “skinny repeal” — which Senate Minority Leader Chuck Schumer called a Trojan Horse designed to get the House and Senate into conference — seems to be the preferred choice.
Health policy analysts said that option, should it become law, would make the problems in the current law that Republicans complain about — high premiums and a dearth of insurers — much worse.
Freed from the mandate, fewer young, healthy people would buy coverage, leaving sicker, costlier patients in the state insurance exchanges. Insurers would flee the markets, especially in rural areas, where there is already a dearth of offerings, and premiums would spike. Based on past estimates of similar legislation by the Congressional Budget Office, 15 million people would lose their insurance, and premiums would spike by 20 percent.
“The mantra from Republicans throughout this debate has been to lower premiums, and a bill like this would do just the opposite,” said Larry Levitt, a senior adviser at the Kaiser Family Foundation, a health care think tank.
But the “skinny repeal” is probably not the objective, analysts said.
“The notion that skinny repeal itself is the end game is laughable,” said Sam Berger, a former Obama administration health official now at the liberal Center for American Progress. “The right way to look at this is a vote for skinny repeal is a vote for the House bill.”
“This is really about the House bill,” Slavitt said.
On Thursday, the Senate will begin debate and a long series of votes on amendments from both parties that could continue into the early hours of Friday morning. The Senate is expected to cast its decisive vote on the stripped-down repeal bill sometime Friday afternoon.
If that passes, the door would be opened to the conference committee. Legislation that emerges from that would have to be passed by both chambers on an up-or-down vote with no amendments.
At that point, Slavitt said, pressure on Republicans would be intense. Trump has already exerted pressure on Republicans to deliver a bill to his desk.
“You no longer have any leverage offering amendments,” he said, “and McConnell can cast it as, ‘I hate the Affordable Care Act, or I love the Affordable Care Act. Which way do you go?’ ”