GOP seeks to meet referee’s rules on healthcare repeal

GOP seeks to meet referee’s rules on healthcare repeal
© Greg Nash

Ahead of a crucial vote Tuesday, Republicans are working to revise their ObamaCare repeal-and-replace bill after the Senate parliamentarian said some provisions would need 60 votes in order to be included in the measure.

These provisions include language that defunds Planned Parenthood for a year, a lockout provision aimed at ensuring people don’t just sign up for insurance plans when they’re sick and a ban on tax credits going toward plans that cover abortion. 

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Sen. John ThuneJohn Randolph ThuneSenate panel approves GOP tax plan Republicans see rising Dem odds in Alabama Overnight Health Care: Nearly 1.5M sign up for ObamaCare so far | Schumer says Dems won't back ObamaCare deal if it's tied to tax bill | House passes fix to measure letting Pentagon approve medical treatments MORE (R-S.D.) said changes are being made to the bill to meet the requirements. “And that happened last time,” he said. “Some of it is just restructuring stuff, getting feedback and interacting with the parliamentarian to find out what’s the best way of doing it.”

He acknowledged the abortion language is particularly important.

The guidelines from Senate Parliamentarian Elizabeth MacDonough, a referee of sorts over Senate rules, mean senators need to tweak certain provisions of the bill in an effort to get them to comply with the strict rules of reconciliation, the fast-track budget maneuver Republicans are using to avoid a Democratic filibuster.

That’s because it’s almost certain Democrats will vote against allowing these measures to stay in the bill if they’re subject to a 60-vote threshold.

But without them, it could further complicate support from organizations, industry and some lawmakers.

It’s a complicated task because provisions passed under reconciliation must have a direct impact on the budget and cannot be primarily oriented toward making policy changes.

Republican leadership is barreling toward a vote to debate healthcare Tuesday. It’s unclear if enough senators will support a motion to proceed to the bill — and as of early Monday evening, Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellAlabama election has GOP racing against the clock McConnell PAC demands Moore return its money Klobuchar taking over Franken's sexual assault bill MORE (R-Ky.) hadn’t announced if the first amendment will be a vote on a clean repeal of ObamaCare with a two-year delay or the repeal-and-replace bill that has lead to deep divisions in the Senate GOP conference.

One conservative aide wrote in an email that leaders will need to ensure the bill defunds Planned Parenthood or the bill won’t pass the upper chamber.

Anti-abortion groups, such as the Family Research Council and the Susan B. Anthony List, have also threatened to oppose the bill if it doesn’t defund Planned Parenthood and prohibit financial assistance from going toward plans covering abortions. Yet they seemed optimistic Republicans will find a workaround.

“The news from the parliamentarian was another dip in the roller coaster ride,” SBA List President Marjorie Dannenfelser told The Washington Post over the weekend. “We have been reassured the problem can be fixed, so are in a tentative support mode still.”

Senate GOP aides say tweaking the bill to comply with the parliamentarian’s guidance is part of the process and was done when Republicans hammered out the legislation repealing ObamaCare in 2015.

At that time, the parliamentarian initially said eliminating the individual and employer mandates needed 60 votes to be included in the bill, but the measure’s language was later modified to comply with reconciliation rules.

David Christensen, vice president for government affairs at the Family Research Council, said they’re hopeful Republicans can find a workaround to keep the abortion-related provisions in the bill.

“We think that the news on the ruling raises some concerns, but I think we’re hopeful that pro-life senators are working through ways to ensure that funds don’t continue to be used in the mandatory programs for abortion providers like Planned Parenthood … and trying to think through ways to ensure that tax subsidies are not going to be subsidizing abortion coverage,” he said.

Christensen said there might be a way to redirect funding for the ObamaCare subsidies through programs that already restrict abortion services, like Medicaid or the Children’s Health Insurance Program.

While the parliamentarian OK’d the Planned Parenthood language in the 2015 repeal bill, it didn’t pass the test this time, even though the language is identical. An aide to Sen. Bernie SandersBernard (Bernie) SandersDe Blasio headed to Iowa to speak at political fundraiser Yes, spills happen — but pipelines are still the safest way to move oil Why sexual harassment discussions include lawmakers talking about Bill Clinton’s past MORE (I-Vt.), ranking member of the Budget Committee, said his understanding is that Republicans haven’t been able to show that Planned Parenthood isn’t being singled out in the legislation.

“It passed last time because there was at least a question that other entities could be affected by the language,” the aide told The Hill.

“In the interim, Republicans have not been able to show that any entity other than Planned Parenthood is affected, and the new CBO score confirms that.”

The current language blocks Medicaid reimbursements for a year for entities that had expenditures that exceeded $350 million in fiscal 2014, but a CBO analysis from earlier this year concluded that would only apply to Planned Parenthood and its affiliates and clinics.

If Republicans can rewrite that language so it includes more abortion providers and generates more budget savings, as is required under reconciliation rules, that might be an adequate workaround, sources say.

Tim Head, executive director of the Faith & Freedom Coalition, said he is in regular contact with GOP leaders over the matter and is optimistic the abortion language will stay in.

“The workaround is in play. That’s the reason we’re optimistic that we can get the bill passed and still include this language that will make sure the pro-life community is satisfied,” he said.

Another item of concern is the bill’s continuous coverage provision, which requires consumers who had at least a 63-day break in healthcare coverage to wait six months before buying insurance. The parliamentarian advised this provision, as written, doesn’t fit within reconciliation’s parameters.

Leadership initially didn’t include the lockout provision in its first version of the Better Care Reconciliation Act, though aides quickly said they were working behind the scenes to add it and make sure it complied with the rules. Experts warned that, with the repeal of the individual mandate and without an incentive to keep insurance coverage, only the sickest would sign up for plans, leading to very high premiums.

America’s Health Insurance Plans, the industry’s main trade group, has told Congress of the need for a continuous coverage provision.

“If the tax penalties associated with the individual requirement are eliminated, any new legislation must include alternatives to incentivize continuous coverage,” the group wrote in a May 23 letter to Senate Finance Committee Chairman Orrin HatchOrrin Grant HatchProminent conservative passes on Utah Senate bid Republicans offer this impossible choice: Tax cuts or senior care Senate GOP running out of options to stop Moore MORE (R-Utah).

Additionally, the parliamentarian advised the legislation can’t fund critical payments to insurers compensating them for lowering the out-of-pocket costs for certain enrollees. The industry has been pleading for certainty they’ll continue to receive this money, which totals about $7 billion for fiscal 2017.

A document released by Sanders detailing the parliamentarian’s ruling also mentions provisions that can be included in the bill because they’re subject to a simple majority and others that are “still under review.”

The parliamentarian reviewed the June 26 bill, which doesn’t include a controversial measure from Sen. Ted CruzRafael (Ted) Edward CruzTexas Republicans slam White House over disaster relief request Dem rep: Trump disaster aid request is 'how you let America down again' Moore endorsements disappear from campaign website MORE (R-Texas) that lets insurers opt out of ObamaCare regulations as long as they sell an ObamaCare-compliant plan.

The inclusion of this amendment is crucial to Cruz’s support for the repeal-and-replace bill, but there’s been uncertainty on whether or not it meets reconciliation’s guidelines. The parliamentarian has not ruled either way.