Three months after their defeat at the Supreme Court, Republicans see a long road ahead for repealing ObamaCare.
“Nobody’s kidding themselves that there will be a repeal bill signed by this president while he’s in office,” House Budget Committee Chairman Tom Price (R-Ga.) said in an interview.
That pessimism is shared by even ObamaCare’s biggest foes, many of whom were swept into office by the 2010 backlash over the healthcare law’s passage.
While 2015 was supposed to be the year that saw the demise of ObamaCare, the new GOP majority has so far failed to send a single repeal bill to the president’s desk.
But there is one last hope before the 2016 elections: repealing some of the most controversial pieces of the law using a rare budget procedure known as reconciliation. Using that tool, the GOP-led Congress can push legislation through the Senate with just 51 votes.
So far, creating the gameplan for reconciliation has been messy. Talks have been underway for months, and little has emerged publicly about the plan.
‘Very, very complex’
Republicans’ biggest hurdle in using reconciliation will be keeping track of the rules.
“Reconciliation is a very, very complex and mysterious thing that I think not a single person has complete understanding of,” Rep. John FlemingJohn Calvin FlemingLobbying world Trump wants Congress to delay Census deadlines amid pandemic Meadows sets up coronavirus hotline for members of Congress MORE (R-La.) said.
Discussions have, so far, been kept between the House and Senate budget committees as well as the handful of committees with jurisdiction over healthcare.
The Senate parliamentarian will have perhaps the largest role, ensuring that lawmakers follow the chamber’s Byrd Rule. Under the rule, reconciliation bills cannot increase the deficit, and all provisions must directly relate to spending or revenue. That disqualifies some pieces of ObamaCare, like the mandatory benefits packages, Price said.
“What we’ve been working with our colleagues in the Senate is to try to identify all the things that are able to be repealed, that are possible through reconciliation through the Byrd rule,” Price said. He maintains that they have a lot of options.
“The array of things that are available to us are very broad,” he said, though declined to offer details.
Sen. John BarrassoJohn Anthony BarrassoSenate appears poised to advance first Native American to lead National Park Service Sunday shows preview: Senate votes to raise debt ceiling; Facebook whistleblower blasts company during testimony The Hill's Morning Report - Presented by Facebook - After high drama, Senate lifts debt limit MORE (R-Wyo.), one of the Senate’s major players in the ObamaCare replacement debate, said he and others believe both the individual and employer mandates for insurance can be included in a reconciliation bill. He also pointed to unpopular pieces of the law such as the “Cadillac tax” goinginto effect next year and the Medicare cost-cutting panel known as the Independent Payment Advisory Board.
“I think reconciliation is the best way to get rid of the most egregious parts of the healthcare law,” he said, which he said would include “absolutely every part of the healthcare law that is reconcilable.”
The process has already been delayed. Price said he had planned to finish the talks before August break. Now, he says his goal is “sooner rather than later.”
Risks of reconciliation
Barrasso, and others, acknowledged that in the end, reconciliation is a chance to boost the party’s chances in future elections. If a reconciliation bill passes this fall, it tees up the healthcare law for the 2016 presidential debates — the arena where most Republicans believe the next ObamaCare fight will play out.
“It’s much more of a political vote than it is a policy vote because we know the president’s position,” Barrasso said.
Reconciliation is still risky politics. For one, the bill needs a substantial level of support in the Senate at a time when intraparty battles on ObamaCare are still common.
“Even a 51 vote threshold means you can only lose a few of them, you’ve got so many running for president themselves, they might not want to show about that,” Rep. Michael BurgessMichael Clifton BurgessOVERNIGHT ENERGY: Supreme Court rules that pipeline can seize land from New Jersey | Study: EPA underestimated methane emissions from oil and gas development | Kevin McCarthy sets up task forces on climate, other issues Texas Republicans condemn state Democrats for response to official calling Scott an 'Oreo' Americans have decided to give professionals a chance MORE (R-Texas) said.
Using reconciliation for ObamaCare also threatens to use up an extremely valuable tool that some Republicans say should be used for something the president would sign.
“I want reconciliation to be used for something that’s going to be passed, I mean ultimately passed,” said Rep. Brendan Byrne (R-Ala.), who drafted the only repeal bill to pass the House this year. “If we use reconciliation for ObamaCare repeal, it would get a veto.”
“You’ve got one shot at it, so you’ve got to make it you utilize it well,” Rep. Marsha BlackburnMarsha BlackburnSenator asks Facebook's Zuckerberg to testify at hearing on kids' safety TikTok, YouTube, Snapchat executives to testify at Senate hearing on kids' safety Buttigieg hits back after parental leave criticism: 'Really strange' MORE (R-Tenn.), another fierce ObamaCare opponent, added.
Chipping away at the law
Meanwhile, lobbyists from all sides of the healthcare debate say they are gaining momentum on repealing smaller pieces of ObamaCare, but have been stymied by GOP leaders when seeking to get the bills up for a vote.
Many of the bills have Democratic cosponsors, including a repeal of the so-called Cadillac tax on high-cost insurance plans and the new 30-hour workweek threshold for full-time employment.
Even with some Democrats on board, GOP leaders see little benefit of calling votes on bills that are likely to be vetoed. While several bills, including a repeal of the medical device tax, have already passed the House, they’ve received a lukewarm reception in the Senate.
Some rank-and-file members are also skeptical about piecemeal repeal.
“I think the vast a majority of us want a straight repeal. We’re not necessarily opposed to repealing smaller provision of the law,” Byrne said. “We just see that as being a distraction.”
Most doubt whether the Obama administration would be willing to support any changes to the law.
“The president is living out there in La-La Land thinking the ObamaCare law is working so well,” Cassidy said. “He is not going to accept significant change. It is his legacy, he loves it.”
“At this point, his end game is preserving the law,” he said.