Senate GOP’s endgame on health care: the lowest common denominator

Liz Goodwin and Andrew Bahl
Senate Majority Leader Mitch McConnell walking to his office on Wednesday. (Photo: Justin Sullivan/Getty Images)

WASHINGTON — Senate Republicans are scaling down their ambitions to repeal and replace the Affordable Care Act, instead hoping they can get 50 of their members to vote for the plan that faces the least resistance within their caucus: a so-called skinny repeal of just a handful of aspects of current law.

Republicans are aiming for the “lowest common denominator” that can get 50 votes, Health and Human Services Secretary Tom Price said in a CNBC interview Wednesday.

“What gets us to 50 votes so that we can move forward on a health care reform legislation, … that’s what needs to happen,” Price said.

On Tuesday, Senate Majority Leader Mitch McConnell, R-Ky., convinced his reluctant caucus to vote to begin a floor debate on the House bill that would repeal and replace the Affordable Care Act, better known as Obamacare. But McConnell’s move to replace the House bill with the Senate’s compromise version failed with nine Republican defections. And an amendment to repeal Obamacare entirely — and then spend two years finding a replacement for it — failed Wednesday with at least seven GOP senators voting against it.

That’s left Senate Republicans grasping for a narrower solution. They’re now talking about passing a bill to repeal Obamacare’s individual and employer mandates that require insurance coverage, as well as one or two of the law’s taxes, and sending that stripped-down bill to a conference committee. The committee would then try to reconcile differences between it and the House’s comprehensive repeal-and-replace bill. And then later, the House and Senate would have to approve that compromise.

Sen. John Cornyn arrives for work on Capitol Hill on Tuesday. (Photo: Mark Wilson/Getty Images)

“I think all we’re looking at is a way to get to that conference quick so we can find a way to have those discussions,” Sen. John Cornyn, R-Texas, told reporters Wednesday.

Some Republican senators do not seem focused on the details of what they pass, trusting it will all get worked out in the committee. “At the end, you end up in a situation where you vote on the lowest common denominator,” Sen. Bob Corker, R-Tenn., told reporters after Tuesday’s vote, according to Talking Points Memo. “There’ll be enough votes for something.”

Cornyn, the No. 2 Senate Republican, said portions of his chamber’s repeal-and-replace bill could be added back to “skinny” repeal in conference, including provisions to allow insurers to sell stripped down plans on the exchanges and money to offset Medicaid cuts. But there’s no guarantee. The House could simply pass the Senate’s “skinny repeal” and it would become law, bypassing committee. The could cause death spirals in the individual markets, worsening the problem of high premiums the senators say they want to fix.

Senate Minority Leader Chuck Schumer, D-N.Y., compared the GOP strategy to an elaborate game of “hot potato” — in which the House and Senate continue to shift responsibility for the bill from one to the other.

“Of course it’s likely that a conference would produce no agreement at all, keeping the incredibly toxic and unpopular Trumpcare bill the topic of conversation … and in the end getting nothing done,” Schumer warned.

Key senators are lining up behind the approach, however, including Sen. Dean Heller, R-Nev., and Sen. Rand Paul, R-Ky., who both told Politico they’re open to it. “Starting small and getting bigger is a good strategy,” said Paul, who’s often an ideological holdout among Senate conservatives.

Senate Minority Leader Chuck Schumer speaks to reporters during a news conference on Capitol Hill following a procedural vote on the GOP health care bill. (Photo: Justin Sullivan/Getty Images)

Sen. Lindsey Graham, R-S.C., told reporters he didn’t think “skinny” repeal was better than the status quo. But he said he’d probably vote for it to get the process of repeal started. That seems to be the view of many Republican senators, though some — including Sen. Shelley Moore Capito, R-W.Va. — said she needed to see the text before deciding her vote.

Even senators who are critical of McConnell’s process of crafting this bill entirely behind closed doors say they would probably vote for the skinny repeal, including Sen. Ron Johnson, R-Wis.

“I’m concerned … that we’re not fixing this problem when we had an opportunity to do so,” Johnson said. “We just don’t have the courage and really the intestinal fortitude to suck it up, do the root cause analysis and do what’s right.”

Only two Republican senators can object to the plan in order for it to pass the Senate at the end of the week.

Voting to end the most unpopular part of Obamacare, the mandate that requires people to purchase insurance or pay a fine, without touching the trickier and more divisive area of Medicaid might be the only way Republicans can agree on a bill. They could also go home over August recess and argue to their constituents they had moved the ball forward, if only slightly. But experts have warned that removing the mandate would result in fewer healthier people buying insurance, projecting higher care costs for people who remain insured. (The bill’s supporters, however, could argue that “skinny repeal” itself won’t become law after the conference tweaks it.)

The strategy also has its political risks. Democrats plan to offer several amendments that order the bill be returned to committee for three days to look into how the legislation would affect people with disabilities, or people on Medicaid. When Republicans vote those amendments down, they would likely later be confronted with campaign ads that say they voted against protecting vulnerable constituents. These kinds of amendments will continue to dog them through the entire process of the “vote-a-rama” likely beginning Thursday afternoon and stretching into the early hours of Friday.

“These votes, frankly, are a lot tougher for them than for us,” Schumer said Tuesday.

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