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Senate Passes Reconciliation Bill with Obamacare Repeal

By Melissa Attias, CQ Roll Call

December 4, 2015 -- All but two Senate Republicans joined to pass legislation late Thursday that would dismantle large swaths of the Affordable Care Act and cut off federal funding to Planned Parenthood for one year, which the House is expected to clear next week.

The Senate endorsed the package (HR 3762) in a 52-47 vote, with Republicans Susan Collins of Maine and Mark S. Kirk of Illinois breaking ranks. Only 51 votes were required for passage because Republicans moved the measure through budget reconciliation, an expedited process that allows them to bypass the usual 60 votes required to avoid a filibuster. Sen. Bernard Sanders, D-Vt., was the only senator who didn't vote.

Before advancing the package, senators adopted a substitute amendment from Majority Leader Mitch McConnell, R-Ky., that dramatically expanded the scope of the repeal of the health overhaul from the version the House passed in October. The substitute includes provisions that would scrap in 2018 the overhaul's Medicaid expansion, as well as subsidies to help individuals buy coverage through the insurance exchanges.

The Senate also rejected more than a dozen amendments to the package during a nearly seven-hour vote-a-rama, including a proposal that would have stripped out the language cutting federal funding for Planned Parenthood and others on gun control. The votes came after a mass shooting killed 14 people in San Bernardino, Calif., on Wednesday.

Although President Barack Obama has already pledged to veto the legislation, Republicans view the exercise as a way to lay the groundwork for what could be accomplished in 2017 if the GOP wins the White House and establish a clear line between the two parties ahead of the elections. Democrats have spent the week characterizing the bill as a waste of valuable time that could be spent on other issues.

"We will vote for a new beginning, we hope the House will again do the same, and then President Obama will have a choice: He can defend a status quo that's failed the middle class by vetoing the bill, or he can work toward a new beginning and better care by signing it," McConnell said on the floor.

"I hope that once this partisan bill reaches the dead end it has always been headed for, Republicans will finally drop the politics and work with us to deliver results for the families and communities we serve," countered Patty Murray of Washington, the top Democrat on the Health, Education, Labor, and Pensions Committee.

Senate passage came without any major setbacks Thursday, despite a rocky start. GOP Sens. Mike Lee of Utah, Ted Cruz of Texas, and Marco Rubio of Florida had opposed the narrower repeal of health law provisions in the House-passed bill, posing problems for Senate Republican leaders who could only afford three defections from their 54-vote majority. But the trio voted in favor of the expanded Senate plan, which also won over the conservative outside group Heritage Action for America.

The amended measure now volleys back to the House, which is expected to easily send it to Obama's desk rather than create a conference committee to work out the differences between the two versions.

Planned Parenthood Amendment

During the vote-a-rama, senators rejected, 48–52, an amendment by Collins, Kirk and Republican Lisa Murkowski of Alaska that would strike language in the bill to defund Planned Parenthood for one year. Collins argued the funding cutoff would likely result in the closure of several hundred clinics across the country and deprive millions of women's options for care.

Oklahoma Republican James Lankford urged opposition to the amendment, highlighting another provision in the package that would boost funding for community health centers. "Directing increased taxpayer dollars to community health centers provides quality health care, those options to women, without supporting the largest provider of abortion in the country," he said.

While Collins and Kirk ultimately opposed the package, the amendment vote may have given Murkowski some cover to support the legislation that more broadly takes aim at the health care law.

Senators also voted, 54–46, to table a Democratic amendment that would remove the Planned Parenthood funding prohibition and create a new fund for women's health clinic security after last week's fatal shooting at a Colorado Planned Parenthood facility.

But senators overwhelmingly endorsed a proposal from Nevada Republican Dean Heller that would permanently repeal the health law's "Cadillac" tax on high-cost employer plans that is due to take effect in 2018 instead of allowing it to be reinstated in 2025, as the package provided. The sunset was meant to prevent the provision from violating the complicated rules that govern the budget reconciliation process, which bars legislation from increasing the deficit beyond the 10-year budget window.

While the Senate adopted the amendment in a 90–10 vote, the McConnell substitute later displaced the language. In a procedural gambit, Minority Leader Harry Reid, D-Nev., sponsored an amendment to the substitute removing the sunset that was adopted by voice vote, once again making the Cadillac tax repeal permanent.

In addition to delayed repeals of the Medicaid expansion and subsidies, the substitute amendment would scrap a lengthy list of taxes included in the health law and remove the penalties used to enforce the mandates that individuals buy health coverage and large employers offer it to their workers.

Gun Proposals

Senators also turned back an amendment from West Virginia Democrat Joe Manchin III and Pennsylvania Republican Patrick J. Toomey that would expand the federal background check system to include firearms purchased at gun shows and over the Internet. The Senate rejected, 48-50, a motion to waive the Congressional Budget Act with respect to the amendment.

"Our words will offer little comfort to the victims of mass violence everywhere. It is only through our actions that these families and communities across America may find solace," Manchin said in a statement. "I am disappointed this vote failed, but I will continue to fight for common sense reforms that protect law-abiding gun owners and keep guns out of the hands of criminals and those adjudicated mentally ill."

Another Democratic amendment designed to block terrorists from buying guns also failed to advance after senators rejected, 45–54, a motion to waive the budget act for that proposal.

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