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 McConnellCompromise is the key to moving forward after Trump's first 100 days Juan Williams: Trump's 100 days wound GOP Judd Gregg: Trump gets his sea legs 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 CruzWeek ahead in tech: Trump's antitrust pick heads before Senate Week ahead: Senate panel to vote on Trump's FDA pick Warren builds her brand with 2020 down the road MORE (R-Texas) and Marco RubioMarco RubioTop Trump officials push border wall as government shutdown looms Rubio defends Trump: 'This whole flip-flop thing is a political thing' Rubio: Shutdown would have 'catastrophic impact' on global affairs MORE (R-Fla.), joined by Sen. Mike LeeMike LeeTrump should work with Congress to block regulations on prepaid cards Sweeping change at DOJ under Sessions Executive orders alone can't create sustainable deregulatory change 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 KirkThe way forward on the Iran nuclear deal under President Trump ObamaCare repeal bill would defund Planned Parenthood Leaked ObamaCare bill would defund Planned Parenthood MORE (Ill.), Susan CollinsSusan CollinsCollins: I'm not working with Freedom Caucus chairman on healthcare Mexico: Recent deportations 'a violation' of US immigration rules White House denies misleading public in aircraft carrier mix-up MORE (Maine), Lisa MurkowskiLisa MurkowskiTrump’s Army pick faces tough confirmation fight Republican Sen. Collins considering run for Maine governor in 2018 Alaska senators push bill to allow Arctic drilling MORE (Alaska) and Kelly AyotteKelly AyotteHow Gorsuch's confirmation shapes the next Supreme Court battle THE MEMO: Trump set to notch needed win with Gorsuch Gorsuch sherpa: Dems giving GOP ‘no choice’ on nuclear option 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.