GOP expected to have hard time replacing Obamacare with sweeping changes

- Where the Senate Republican effort to demolish the Obama health care law ends up is anyone's guess, but early indications are the GOP will have a hard time replacing that statute with any sweeping changes.

Senators planned to vote Wednesday on a Republican amendment repealing much of President Barack Obama's law and giving Congress two years to concoct a replacement. A combination of solid Democratic opposition and Republicans unwilling to tear down the law without a replacement in hand were expected to defeat that plan.

Late Tuesday night, the Senate voted 57-43 to block a wide-ranging proposal by Majority Leader Mitch McConnell replacing Obama's statute with a far more restrictive GOP substitute. Those voting no included nine Republicans, ranging from conservative Mike Lee of Utah to Maine moderate Susan Collins, in a roll call that raised questions about what if any reshaping of Obama's law splintered Republicans can muster votes to achieve.

The rejected amendment - the first offered to the bill - was centered on language by McConnell, R-Ky., erasing Obama's tax penalties on people not buying insurance, cutting Medicaid and trimming its subsidies for consumers. It included a provision by Ted Cruz, R-Texas, letting insurers sell cut-rate policies with skimpy coverage plus an additional $100 billion - sought by Midwestern moderates including Rob Portman, R-Ohio - to help states ease out-of-pocket costs for people losing Medicaid.

GOP defectors also included Sens. Dean Heller of Nevada, who faces a tough re-election fight next year, and usually steady McConnell allies Bob Corker of Tennessee, Lindsey Graham of South Carolina and Kansas' Jerry Moran.

Before that defeat, President Donald Trump and McConnell snatched victory from what seemed a likely defeat and won a 51-50 vote to begin debating the GOP drive against Obama's Affordable Care Act, which sits atop the party's legislative priorities.

In a day of thrilling political theater, Vice President Mike Pence broke a tie roll call after Sen. John McCain returned to the Capitol from his struggle against brain cancer to help push the bill over the top. There were defections from just two of the 52 GOP senators - Maine's Susan Collins and Alaska's Lisa Murkoswki - the precise number McConnell could afford to lose and still carry the day.

All Democrats voted against dismantling the 2010 statute that looms as President Barack Obama's landmark domestic achievement.

Leaders were openly discussing a "skinny bill" repealing unpopular parts of the statute like its tax penalties on people not buying coverage - a tactic aimed chiefly at letting Senate-House bargainers seek a final compromise.

McConnell was practically zen-like in his evaluation of the next steps, saying the Senate will "let the voting take us where it will."

Asked what Republicans would do now that the dog had caught the car - an expression for someone who regrettably achieves a trying goal - Sen. Orrin Hatch, R-Utah, said, "We'll have to see if the car can survive."

Senate Minority Leader Chuck Schumer, D-N.Y., said a final bill negotiated by the two GOP-led chambers would mean "drastic cuts in Medicaid, huge tax cuts for the wealthy, no help for those with pre-existing conditions and tens of millions losing coverage."

Senators started 20 hours of debate on the bill Tuesday, though angry Democrats were burning time - not counted against that total - by requiring clerks to read amendments. At week's end, a "vote-a-rama" of rapid-fire voting on a mountain of amendments was expected before moving to final passage - of something.

"Now we're all going to sit together and we're going to try and come up with something that's really spectacular," Trump told reporters at the White House. He added, "This is the beginning of the end for the disaster known as Obamacare."

That may prove a premature statement.

Internal GOP differences remained over how starkly to repeal the law, how to reimburse states that would suffer from the bill's Medicaid cuts and whether to let insurers sell cut-rate, bare-bones coverage that falls short of the requirements.

While pressure and deal-making helped win over vacillating Republicans to begin debate, they remained fragmented over what to do next. Several pointedly left open the possibility of opposing the final bill if it didn't suit their states.

Even McCain, R-Ariz., who received a warm standing ovation and bipartisan hugs when he returned, said he'd oppose the final bill if it didn't reflect changes to help his state and lambasted the roughshod process his own party was using.

He accused party leaders of concocting a plan behind closed doors and "springing it on skeptical members, trying to convince them it's better than nothing, asking us to swallow our doubts and force it past a unified opposition. I don't think that is going to work in the end. And it probably shouldn't."
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The Senate's days-long debate on health care features a dynamic that's relatively rare on Capitol Hill.
 
   Genuine suspense.
 
   Debate kicked off Tuesday without an obvious endgame. Several Republicans voted to start debate but said the bill will have to be changed for them to vote to actually pass the legislation later this week. The amendment process promises to be extensive and freewheeling. And victory for Republicans and President Donald Trump is not guaranteed.
 
   The Senate has started off by taking up the House-passed bill -- which doesn't have enough support to pass the Senate -- and it'll take near-unanimity among Republicans for them to alter the measure. Right now, they're deeply divided.
 
   "We obviously don't have consensus on where we ought to go," said Sen. Ron Johnson, R-Wis. "No matter what we pass it's not going to fix the whole problem."
 
   Here's a primer on how to watch this week's Senate debate on repealing and replacing the Obama health law.
 
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   FAST-TRACK PROCESS
 
   First, the legislation is being debated under fast-track budget rules that allow it to pass on a simple majority instead of having to clear the 60-vote filibuster threshold required of other legislation. Debate is limited to 20 hours. Amendments, generally speaking, are unlimited -- and can be offered after debate time has expired in a Washington ritual known as "vote-a-rama." That's when amendment after amendment is voted on in what could be an all-night session on Thursday.
 
   The first amendments get up to two hours of debate. During the voting marathon, debate is typically just two minutes.
 
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   AMENDMENTS GALORE
 
   Unlike other bills, which typically are debated in ways that limit senators' rights to offer changes known as amendments, the current bill is wide open.
 
   "I suspect there will be literally hundreds of amendments," said Sen. John Cornyn of Texas, the No. 2 Republican in the Senate.
 
   The first amendment was offered by GOP leader Mitch McConnell of Kentucky. It is virtually identical to the version that passed the Senate in late 2015 that would repeal much of Obamacare and leave replacing it for later. It's sure to lose, even though it passed less than two years ago -- when skeptics of repealing the law without a clear plan for replacing it were assured of former President Barack Obama's veto.
 
   Another McConnell amendment, likely to be swatted down by a parliamentary challenge by Democrats, includes the Senate's most recent "repeal and replace" bill -- scuttled last week for lack of support -- along with separate provisions from Sens. Ted Cruz, R-Texas, and Rob Portman, R-Ohio.
 
   Democrats are poised to offer dozens of amendments of their own. For instance, they could try to eliminate tax cuts rewarding investors and upper bracket earners, just for starters.
 
   One problem: Senators don't necessarily know how to draft amendments because they're unsure which bill they'll ultimately be amending.
 
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   PARLIAMENTARY PUZZLE
 
   The special fast-track process, called reconciliation in Washington-speak, comes with tricky rules. Amendments that are carefully crafted and fit within the rules can pass on a simple majority vote. But many amendments run afoul of the Senate's byzantine rules, which mean they can require 60 votes and effectively be blocked by Democrats.
 
   Among them is the so-called Byrd rule, named after former Sen. Robert Byrd, D-W.Va. It's complicated, but the Byrd rule disqualifies some of the GOP's ideas, such as a provision in the pending bill aimed at lowering premiums paid by younger, healthier consumers by allowing insurance companies to increase premiums paid by seniors. 
 
   The Byrd rule generally blocks provisions that don't affect the federal budget -- and blocks provisions whose changes to spending or taxes are "merely incidental" to a larger policy purpose. If such provisions are inserted despite the Byrd rule, any individual senators can knock them out with a point of order.
 
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   MCCONNELL'S LAST OPTION
 
   At the very end of the debate, after dozens of votes on amendments and parliamentary challenges, majority Republicans can offer one, final substitute amendment. McConnell would probably be the author and it could represent one final grasp at consensus among fractured Republicans. 
 
   McConnell's last gambit could offer Republican senators a difficult choice since rejecting it would probably doom the whole effort. But consensus among Republicans has eluded McConnell for weeks, so there are plenty of reasons to be skeptical he can succeed now.
 
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   BACK TO THE HOUSE -- OR INTO CONFERENCE?
 
   If the Senate should manage to maneuver its way through this week's legislative labyrinth, the resulting bill could go back to the House for a vote that would send it directly to Trump for his signature.
 
   The other alternative would be to send the measure into official House-Senate negotiations known as a conference committee. Conference talks, insiders fear, could be a nightmare and invite balkanized Republicans to feud even more. In particular, tea party House Republicans and the Senate's more pragmatic GOP wing could be in for a fight.
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