Senate ref flags key parts of GOP health bill plan

Key parts of the Republican health care bill, including defunding Planned Parenthood and barring the use of tax credits for abortion coverage, are not eligible for the fast-track process Republicans are using to prevent a Democratic filibuster, says the Senate’s referee, throwing yet another roadblock in front of President Trump’s attempt to repeal and replace Obamacare this week.

Already, Republican leaders are struggling to gather enough support from the party’s rank and file for their replacement bill or a straightforward repeal of the 2010 law, even though they are leveraging “budget reconciliation” rules to carve Democrats out of the process.

In new guidance, the Senate parliamentarian made their task tougher by saying key parts of the plan should require 60 votes to pass, according to Senate Democrats on the Budget Committee.

“The parliamentarian’s decision today proves once again that the process Republicans have undertaken to repeal the Affordable Care Act and throw 22 million Americans off of health insurance is a disaster,” Sen. Bernard Sanders, Vermont independent, said after detailing Parliamentarian Elizabeth MacDonough’s findings on Friday.

Conservatives and advocates have insisted on pro-life language in whatever plan emerges, yet Democrats will not help them get the votes they would need to strip Planned Parenthood of Medicaid funding for a year or endorse certain policy changes, such as a continuous coverage provision to replace Obamacare’s “individual mandate.”

Some conservatives argue that Vice President Mike Pence, as president of the Senate, can overrule the parliamentarian while presiding over the chamber, though many Republicans are leery of making such a bold move.

The office of Senate Majority Leader Mitch McConnell, Kentucky Republican, said the parliamentarian’s guidance is not a ruling and there is time to tweak the language, though the roadblock further clouds plans to vote Tuesday to take up a House-passed bill, work through amendments and reach for final passage.

A push to debate the latest version of Mr. McConnell’s replacement bill ran into opposition from four senators last week, and then three moderate Republicans balked at reviving a 2015 bill that would gut Obamacare but delay its full effect for two years, buying Congress time to come up with an overhaul.

It’s unclear whether enough senators will take leadership’s advice and vote to act on the bill this week or risk pushing members of the Republican base to link arms with Democrats to block debate.

With Sen. John McCain of Arizona absent because of his sudden cancer diagnosis, Republican leaders cannot afford more than one defection and still proceed with the bill or pass a plan.

“We are going to vote this week, and I think until the vote is actually on the floor of the Senate, some people may not tell you what they’re actually going to do,” Sen. John Barrasso, Wyoming Republican, told CBS’ “Face the Nation. “We all got elected to legislate, and that’s why we’re here.”

The White House is imploring senators to start debate so they can throw Obamacare into the dustbin, saying they are just a few votes shy of fulfilling their seven-year promise.

“ObamaCare is dead and the Democrats are obstructionists, no ideas or votes, only obstruction. It is solely up to the 52 Republican Senators!” Mr. Trump said on Twitter.

Some moderate Republicans are calling for a do-over, saying it’s best to rope in Democrats as they struggle to pass the replacement bill, which leaders wrote behind closed doors.

Sen. Susan M. Collins, Maine Republican, said senators don’t even know which path will take precedent if they take up the bill to repeal Obamacare and begin a marathon round of amendments.

“We don’t know whether we’re going to be voting on the House bill, the first version of the Senate bill, the second version of the Senate bill, a new version of the Senate bill or a 2015 bill that would have repealed the Affordable Care Act now and then said that somehow we’ll figure out a replacement over the next two years,” she told CBS. “I don’t think that’s a good approach to facing legislation that affects millions of people and one-sixth of our economy.”

From the sidelines, senior Democrats warned Republican leaders not to try to buy off wavering moderates after the parliamentarian raised the vote threshold for the “Buffalo bailout” — a part of the House bill that limited New York state’s ability to force counties to contribute to the Medicaid program. The measure pulled in votes from moderate House Republicans in upstate New York.

“This will greatly tie the majority leader’s hands as he tries to win over reluctant Republicans with state-specific provisions. We will challenge every one of them,” said Senate Minority Leader Charles E. Schumer, New York Democrat.

The biggest political victims of the scrubbing process, or “Byrd bath,” were defunding Planned Parenthood and the prohibition on using tax credits to buy plans that cover abortion. Stripping out the pro-life language would be a major sticking point and could imperil passage, particularly when the House revisits the plan.

Ms. MacDonough also flagged a provision that would lock consumers out of the market for six months if they experience a significant lapse in coverage and want to buy health insurance again, Mr. Sanders said.

Republicans included the provision to replace Obamacare’s individual mandate, which requires Americans to have coverage or pay a tax and serves as the main prod to get healthy people into the marketplace.

Ms. MacDonough said other aspects of the Republican plan, including work requirements for Medicaid recipients and the repeal of “cost sharing” reimbursements in 2020, could pass on a majority-line vote.

Other provisions in the Republican plan, such as one that would allow states to waive certain Obamacare regulations for insurers, remain under review.

The parliamentarian did not vet a plan by Sen. Ted Cruz, Texas Republican, that would let insurers offer plans that do not comply with Obamacare’s coverage requirements as long as they also sell plans that do, presumably because the Congressional Budget Office has not yet scored the plan.

Mr. Cruz and Sen. Mike Lee, Utah Republican, argue that including a version of the “freedom” amendment would drive down premiums for healthier consumers, though analysts say the idea would segment the marketplace, driving up costs for sicker consumers.