Sunday, July 23, 2017

As health-insurance vote looms, McConnell's path to immediate success is narrowed

Kentucky Health News

UPDATE, 3:08 p.m. July 25: The Senate voted 51-50, with Vice President Mike Pence breaking the tie, to open debate on health insurance, via the bill passed by the House. After the vote, Senate Majority Leader Mitch McConnell introduced an amendment as a substitute to the House bill, to be titled the Obamacare Repeal Reconciliation Act. (UPDATE, 11 p.m.: That measure failed, 57-43, which was 17 votes short of the 60 it needed to pass.)

Republican Sens. Susan Collins of Maine and Lisa Murkowski of Alaska voted no and were the exceptions to the party-line vote. Kentucky Sen. Rand Paul, who had been a holdout with them, voted with the majority. Paul had tweeted earlier, “This morning, @SenateMajLdr informed me that the plan for today is to take up the 2015 clean repeal bill as I’ve urged,” Paul this morning. “If that is the plan, I will vote to proceed to have this vote. I also now believe we will be able to defeat the new spending and bailouts.”

As Senate Majority Leader Mitch McConnell moved toward a climactic vote Tuesday on health insurance, the Senate parliamentarian made it more difficult for him to maneuver by saying that some measures would require more votes to pass.

Sen. Mitch McConnell (Photo
by Brendan Smialowski, Agence
via Getty Images)
McConnell is trying to pass a bill under budget-reconciliation rules, which disallow the filibusters that require 60 votes to stop. His goal is 50 votes and a tie-breaking vote by Vice President Mike Pence. But the parliamentarian has ruled that several points don't qualify under reconciliation because they aren't related to the budget, taxes or spending.

"In a blow to the insurance industry, the parliamentarian has advised that two key market-stabilization provisions in the bill would be against the rules," Nathaniel Weixel of The Hill reports. "First, the legislation can't appropriate the cost-sharing reduction subsidies insurers rely on to keep premiums and deductibles low; it can only repeal them. Additionally, a 'lockout' provision requiring consumers with a break in coverage to wait six months before buying insurance also violates the rules, according to the guidance." Also nixed was a repeal of the law limiting insurance company profits.

The cost-sharing subsidies have been in doubt because Congress has not specifically appropriated money for them, and the Trump administration has suggested that it might stop them -- a move that could further destabilize insurance markets.

Other provisions found wanting "include policies important to conservatives, such as restrictions on tax credits being used for insurance plans that cover abortion," The Hill reports. "Language in the bill defunding Planned Parenthood for a year also violates budget rules, according to the parliamentarian. That guidance is sure to anger anti-abortion groups who backed the bill specifically because of those provisions."

McConnell could revise the language to get it approved, or conservatives could ask the Senate to overrule the parliamentarian, but in the past McConnell has thrown cold water on that idea.

"The parliamentarian has also not yet ruled on a controversial amendment from Sen. Ted Cruz (R-Texas) that would allow insurers to sell plans that do not meet Obamacare regulations," The Hill reports. "If that provision were struck, conservative support for the bill would be in doubt."

The parliamentarian could also complicate any McConnell efforts to get votes by inserting special funding that would help states represented by holdout senators.

American Health Policy Institute President Tevi Troy, a former deputy HHS secretary in the George W. Bush administration, told The Wall Street Journal that Republican leaders' work on the legislation is "entirely political," about what can get enough votes to pass, not about what the best policy would be.

It remains unclear whether McConnell can even get the votes to take up a bill, much less pass anything resembling the one he has been trying to pass without success.

Sen. Rand Paul (Getty Images)
His more conservative Kentucky seatmate, Rand Paul, said on CNN's "State of the Nation" Sunday that he would not vote to take up McConnell's bill, which he called a "monstrosity" with a "pork fest" of subsidies for insurance companies.

Paul said he would vote to take up a "clean repeal" bill, which McConnell has offered as an alternative. That measure would not become effective for two years, giving Congress time to figure out a replacement for the 2010 Patient Protection and Affordable Care Act.

Either bill could be a vehicle to pass something different, perhaps even a limited, bipartisan measure to stabilize insurance markets. McConnell said last month that would be the alternative if Republicans couldn't pass a bill on their own, but more recently has cast doubt on that option.

"In the absence of internal consensus on health reform, other GOP lawmakers are leaning toward a more bipartisan approach," Brianne Ehley reports for Politico.

McConnell told reporters at the White House following a lunch with President Donald Trump and almost all of the Republican senators, "I think we have two options here. I think we all agree it's better to both repeal and replace. But we could have a vote on either, and if we end up voting on repeal only, it will be fully amendable on the Senate floor and if it were to pass without any amendment at all there's a two-year delay before it kicks in . . . so the takeaway from what I'm telling you is no harm is done from getting on the bill."

If no bill is taken up, "We’ll go back to the drawing board and get a bill up,” Senate Republican Conference Chair John Thune of South Dakota said on "Fox News Sunday." “We are going to vote to repeal and replace Obamacare. It’s not a question of if, it’s a question of when.”

Paul agreed, telling CNN's Jake Tapper, “We can do this for quite a while.”

Meanwhile, Trump criticized Paul for his frequent TV appearances. Privately, White House officials criticized McConnell for not getting the votes for a bill that Trump and Republicans have long promised, while Republican senators "say Trump failed to provide any meaningful political momentum for the prized measure," Alex Bolton reports for The Hill. "Tensions between Trump and Senate Republicans have been a theme of the months-long effort to win passage of the healthcare legislation." Trump has been sending mixed messages lately, The Associated Press reports.

McConnell "is getting pummeled in the press," Fox News media reporter Howard Kurtz writes, rounding up much of the critical coverage and commentary. But he says McConnell "was essentially put in an impossible position" that even "Master of the Senate" Lyndon B. Johnson couldn't have played well.

"I doubt that even LBJ, in his Senate arm-twisting days, could have pushed through a bill so unpopular with the public and such anathema to two competing factions," Kurtz writes. "It’s easy to blame tactics when everyone does their tick-tocks, and the Kentucky senator may have made some missteps. But the bill ultimately failed because of the substance: it was too weak at changing Obamacare for the most conservative GOP senators and too draconian in reducing coverage for the most moderate ones. And the majority, with 52 members, could afford to lose just two votes against united Democratic opposition. . . . There’s a reason the Republicans don’t have the votes, and it’s not Mitch McConnell."

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