On July 25, 2017, the United States Senate began its long-awaited debate on repealing the Affordable Care Act. At around 2 in the afternoon, Senate Majority Leader McConnell called up a motion to proceed on consideration of the American Health Care Act, which the House of Representatives had passed on May 4, with a 217 to 213 vote. A motion to proceed on a budget reconciliation bill needs only to pass by a bare majority, but the Republicans hold only 52 of the chamber’s 100 votes, and Republican Senators Collins (ME) and Murkowski (AK) voted against proceeding.
What’s Happened So Far
There was high drama as Senator McCain (R AZ), who had surgery for a blood clot and was diagnosed with brain cancer the week before, arrived to vote yes. Senator Johnson (R WI) huddled with Senate leadership for some time before casting a yes vote to bring the tally to 50 to 50, with protesters in the gallery shouting “Kill the bill, don’t kill us” and “Shame” until they were taken away. With the vote evenly divided at 50 to 50, Vice President Pence, the President of the Senate, cast the deciding vote and the motion to proceed succeeded.
After an emotional speech by Senator McCain calling on the Senate to regain its stature as a deliberative body, Speaker McConnell moved to amend the House bill to substitute amendment 267. This was basically the Senate’s Obamacare Repeal Reconciliation Act, which was in turn the repeal and delay bill that was passed by the Senate in 2015 with a few added features, such as the funding of the cost-sharing reduction payments and the ban on tax credits for plans covering most abortions. The abortion coverage ban was crossed out in the version submitted; in addition, in the section defunding Planned Parenthood, the amount of federal and state funds that the organization would have had to receive in fiscal year 2014 to be covered by the funding prohibition was reduced from $350 million to $1 million, apparently to satisfy the Senate Parliamentarian’s concern that the section was written too specifically to cover only one organization.
The Democrats forced the reading of the entire 18-page bill and then made a couple of speeches against it, but at that point Speaker McConnell moved amendment 270 to amendment 267. This was a third version of the Better Care Reconciliation Act, incorporating the Cruz (R TX) amendment to allow the sale of skinny plans. At the prompting of Senator Portman (R-OH), the new BCRA version also included language providing an additional $100 billion over seven years for states to help reduce cost-sharing obligations of low-income consumers, and further permitting states to use Medicaid funds to help low-income individuals with cost-sharing payments.
The Democrats demanded that the 178-page bill be read, a not unreasonable request given the fact that none of them had seen it before, but were willing to end the reading at the request of Senator Enzi (R WY) after the clerk had read well over 100 pages. At that point debate resumed and several Senators spoke on both sides, including Senators Cruz and Portman.
Senator Murray then raised a point of order, asking that Amendment 270 be stricken for failure to comply with budget reconciliation rules. It is reported that her objection was that the newest BCRA version with the Cruz and Portman amendments had not been scored by the Congressional Budget Office and thus could not be adopted through reconciliation. A number of the provisions of the BCRA, however, had reportedly also been questioned by the Senate Parliamentarian, who suggested they could not be included in reconciliation legislation. It was further reported on July 25, that the Parliamentarian had held two other provisions of the BCRA to be objectionable, including the change in the age rating ratio from one-to-three to one-to-five and the small business association health plan provisions. The budget challenge presumably did not include these provisions, but it was not wholly clear.
Senator Enzi moved to overrule the point of order, a motion that would have needed 60 votes to succeed. In fact, nine Republicans, Senators Collins, Corker, Cotton, Graham, Heller, Lee, Moran, Murkowski, and Paul, joined all 48 Democrats to uphold the point of order 57 to 43.
At that point, Senator Enzi moved to bring Senate Amendment 271 to the floor. This is the ORRA, including language prohibiting tax credits for plans that cover abortions but replacing the $350 million with $1 million for the amount of FY 2014 federal funding an organization meeting certain conditions (read Planned Parenthood) would have had to receive to be barred from funding. A motion to waive budget rule objections to this bill will receive a vote on the morning of July 26. July 26 will also bring a vote on a motion by Senator Donnelly (D IN) to recommit the bill to the Senate Finance Committee to remove all provisions that would cut Medicaid, end the Medicaid expansion, or shift costs to the states.
What Comes Next?
The repeal and delay ORRA will very likely be voted down—the CBO scored it as causing 32 million people to lose coverage if no replacement were adopted before the repeal went into effect in two years, and no one should reasonably assume that this Congress could adopt and implement a replacement plan in two years.
It is unclear what will come then—perhaps another vote on a stripped down BCRA, or perhaps another bill. There is talk of the Senate ending up with a skinny bill that would simply repeal the individual and employer mandates and the medical device tax. The CBO has already scored pieces of this and it is possible that it would score such legislation as meeting mandatory deficit reduction goals. The bill would then go to conference with the House in secret and be brought back to the Senate floor for a final vote. Who knows what the final bill would do.
As July 26 begins, there are many hours of debate and many votes ahead of us, including votes on points of order to strike provisions that may come before the Senate in various bills for failure to comply with budget reconciliation rules. As the end will come a vote-a-rama, when both parties can offer unlimited amendments with only a minute to debate each amendment. These could include a substitute amendment by Republican leadership completely changing the legislation. The whole show should end up by Friday, July 28, and we will see what remains then. Just about the only certainty is that any children who have learned the legislative process though Schoolhouse Rock will be very confused.
from Health Affairs BlogHealth Affairs Blog http://ift.tt/2uWXVwr
No comments:
Post a Comment