(WASHINGTON) — The Senate is in the middle of thick debate, struggling to pass any option for repealing or replacing the Affordable Care Act. After a proposal to only repeal the majority of the law failed Wednesday afternoon, Senate sources said, the Republican leadership’s next move will likely be to introduce a narrower repeal bill that would scrap just portions of the ACA.
This path, dubbed skinny repeal, since it would be limited in scope, is still in the works. The precise, final text has not been publicly released, but according to a draft being circulated by the Senate Majority Leader’s office, it would repeal the individual mandate for health insurance coverage, the crux of Obamacare, as well as the employer mandate and a fund meant for research and development.
Other provisions include defunding Planned Parenthood and giving that money to community health centers, which could turn off moderate Republicans like Sens. Lisa Murkowski and Susan Collins. But it’s still possible that some of those measures don’t end up in the final amendment.
At least four Republican senators have threatened to block the so-called skinny repeal proposal unless they have assurances from House Speaker Paul Ryan that it is only a placeholder and would not be passed in the House and sent to the president’s desk. They, and others, want this to serve a vehicle for the next step of negotiations between the House and the Senate.
“The skinny bill as policy is a disaster. The skinny bill as a replacement for Obamacare is a fraud,” Sen. Lindsey Graham, R-S.C., said. He said he could support the bill, but warned of the dire consequences if it was allowed to become law.
Graham said he has had conversations with Freedom Caucus chair Rep. Mark Meadows, R-N.C., in which Meadows has warned him that House Majority Whip Steve Scalise has apparently been telling “some” people that the House will just take up the skinny repeal and pass it and put it on the president’s desk.
“I need assurances that it will not be the final product,” Sen. Graham went on during a press conference Thursday. Graham said he worried about rumors that House Majority Whip Steve Scalise, who has been recovering from a gunshot wound but was released from the hospital this week, was considering bringing the narrow repeal bill up for a vote as is.
Amid the negotiations Thursday evening, House Speaker Paul Ryan opened the door for the Senate proposal to be considered in a conference committee with House lawmakers, giving the Senate efforts a much-needed boost.
“It is now obvious that the only path ahead is for the Senate to pass the narrow legislation that it is currently considering,” Ryan’s statement read. “Senators have made clear that this is an effort to keep the process alive, not to make law. If moving forward requires a conference committee, that is something the House is willing to do.”
As the possibility of the Senate passing a partial repeal bill loomed Thursday, several patient, hospital and insurance groups put out statements arguing that scrapping even just the mandate that individuals buy insurance could have real consequences for health care marketplaces.
Blue Cross wrote in statement: “A system that allows people to purchase coverage only when they need it drives up costs for everyone.”
America’s Health Insurance Plans CEO Marilyn B. Tavenner echoed their concern, writing in a statement: “We would oppose an approach that eliminates the individual coverage requirement, does not offer alternative continuous coverage solutions, and does not include measures to immediately stabilize the individual market.”
The AARP called it a “wolf in sheep’s clothing.” Citing a recent report from the Congressional Budget Office that predicted repealing even just the individual mandate could lead to 15 million more Americans uninsured in the next decade a 20 percent premium increase for folks buying their own insurance.
This increase in premium costs could lead to some people’s being priced out of plans, or the federal government may aid those people through subsidies and tax credits.
The individual mandate provides social cost savers as well. If people don’t have insurance and get sick, hospitals, taxpayers and local governments end up covering the costs. “In the absence of a mandate, those social costs would probably increase relative to the case under current law,” the CBO said in a report last December.
Sen. Ron Johnson, R-Wis., indicated he would vote for a bare-bones package as long as it kept the process moving forward. “We’ll keep the process going. If we’ve got to do something less than obviously I’d want to keep the process going, we’ll do it,” he said.
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