Senate Republicans are plunging into a difficult debate over ObamaCare as they seek to take up legislation before the Thanksgiving holiday that would repeal most of President Obama’s signature law.
The fight puts Majority Leader Mitch McConnellMitch McConnellTrump taps NY Jets owner to be UK Ambassador Trump applauds congressional allies as he kicks off inaugural festivities Senate to vote Friday on Trump's defense picks MORE (R-Ky.) in a difficult spot, between conservatives who are eager to send the repeal bill to the White House and centrists — including a senator vulnerable in 2016 — who are ready to defect over language in the House-approved bill.
But Senate Republican sources say the House bill cannot pass the upper chamber without significant changes, with McConnell short of the votes he needs.
“The House opted to go a certain way. We don’t have to go that way. We have members here who may have different views on things,” said a senior Senate Republican aide. “If it’s not the exact same as what the House did, that’s OK.”
The reconciliation process allows Senate Republicans to bypass a Democratic filibuster. GOP leaders earlier this year promised the tactic would be used to get an ObamaCare repeal bill through Congress, forcing the president to defend the law with a veto.
But the package passed by the House has created two problems for McConnell.
For one, a pair of presidential hopefuls, Sens. Ted CruzTed CruzCaitlyn Jenner to attend Trump inauguration: report Trump’s UN pick threads needle on Russia, NATO Haley slams United Nations, echoing Trump MORE (R-Texas) and Marco RubioMarco RubioTillerson met with top State official: report McCain ‘very concerned’ about Tillerson Top Dem: Don’t bring Tillerson floor vote if he doesn’t pass committee MORE (R-Fla.), joined by Sen. Mike LeeMike LeePaul, Lee call on Trump to work with Congress on foreign policy Right renews push for term limits as Trump takes power Conservatives press Trump on Supreme Court pick MORE (R-Utah), are vowing to oppose any bill that stops short of repealing the Affordable Care Act in its entirety — something that could be exceedingly difficult to accomplish under reconciliation rules.
“Each of us campaigned on a promise to fully repeal ObamaCare and a reconciliation bill is the best way to send such legislation to President Obama’s desk,” Cruz, Rubio and Lee said in a statement.
“If this bill cannot be amended so that it fully repeals ObamaCare pursuant to Senate rules, we cannot support this bill.”
Without those three votes, McConnell would have just a bare majority of 51 for the reconciliation package — but that’s only if he can hold the rest of his conference together.
Several Republican centrists are already on record opposing the defunding of Planned Parenthood, a key piece of the House package that was included to win over conservatives.
GOP Sens. Mark KirkMark KirkGOP senator: Don't link Planned Parenthood to ObamaCare repeal Republicans add three to Banking Committee Juan Williams: McConnell won big by blocking Obama MORE (Ill.), Susan CollinsSusan CollinsGOP rep faces testy crowd at constituent meeting over ObamaCare DeVos vows to be advocate for 'great' public schools GOP senators introducing ObamaCare replacement Monday MORE (Maine), Lisa MurkowskiLisa MurkowskiWhat we learned from Rick Perry's confirmation hearing Perry regrets saying he would abolish Energy Department Trump education pick to face Warren, Sanders MORE (Alaska) and Kelly AyotteKelly AyotteTen rumored Trump Cabinet picks who didn't get a job Sasse, Perdue join Armed Services Committee Avid pilot among GOP senators joining Transportation committee MORE (N.H.) have all either voted against efforts to defund Planned Parenthood or stated they opposed them. Kirk is considered one of the most vulnerable Senate incumbents in the country this cycle.
The tug-of-war between centrists and White House hopefuls means November will be a tough month for the Senate majority leader, after having dodged the bullet of a federal default and government shutdown with the October budget deal.
“If you move it to the right to placate those guys running for president, you make it a worse vote for people running in purple and blue states in 2016. McConnell’s between a rock and a hard place,” said a Senate Democratic leadership aide.
Changing the legislation could be contingent on favorable rulings from Senate Parliamentarian Elizabeth MacDonough, who will decide whether provisions in the legislation conform to the rules of reconciliation.
Some Senate conservatives are pushing for their chamber’s reconciliation package to include a one-sentence repeal of the entire law, but there’s an internal argument over whether such a blanket move would pass the procedural litmus test known as the Byrd Rule.
The Senate parliamentarian has provided early indications that the entire healthcare law — including parts that do not directly affect the deficit, such as the requirement that young adults be allowed to stay on their parents’ health plans until age 26 — cannot be repealed through reconciliation.
But she has not delivered a final judgment on the matter after hearing arguments from all sides, according to Senate sources.
The parliamentarian’s rulings could generate significant controversy, especially if Republicans are thwarted in their attempts to roll back parts of the law.
Cruz earlier this month said Republicans should not let the parliamentarian stand in the way of getting rid of ObamaCare.
“At the end of the day, the Senate parliamentarian is an employee of the Senate. Virtually every Republican campaigned promising full repeal,” the Texan said.
The House reconciliation bill takes a targeted approach to repeal, abolishing the employer and individual mandates for insurance as well as the “Cadillac tax” on expensive employer-provided health plans. The House bill also repeals the law’s excise tax on medical devices.
But Senate conservatives complain that it leaves the core of ObamaCare — primarily its hundreds of billions of dollars in subsidies — intact, as well as many of the law’s new taxes.
“Many of the ObamaCare tax increases aren’t included in the House bill,” said one Senate aide. “It doesn’t include a repeal of the Medicaid expansion or the subsidies provided by the healthcare exchanges, which are certainly reconcilable.”
But repealing the subsidies, which help offset the cost of insurance for people under certain income limits, could be a tough vote for endangered Republican incumbents in battleground states.
Vulnerable members could also balk at rolling back some popular parts of the healthcare law, including the ban on insurers denying people for pre-existing conditions and the provision that allows young adults to stay on their parents’ plans until age 26.
“Why in the world are we here on the floor of the House of Representatives passing legislation that’s going to take away affordable healthcare to 15 million Americans, including 3 million children?” Rep. Chris Van Hollen (D-Md.), who is also running for Senate, said when the reconciliation bill passed the House last month.