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Republicans Mull Two Options for Obamacare Repeal

By Melissa Attias, CQ Roll Call

July 24, 2015 -- While the Republican budget agreement was geared toward using reconciliation for repealing the health care overhaul, another approach under consideration would involve surgically striking portions of the law—including the mandate that individuals obtain coverage or pay a fine. Such a selective repeal package could more easily comply with the restrictions of the special budget mechanism.

Texas Republican Kevin Brady, chairman of the House Ways and Means Health Subcommittee, said the discussion about how to proceed is occurring at a "higher level," but that one approach is to identify specific provisions and move them to the Senate using reconciliation. Targets could include repealing the individual mandate, a similar requirement that employers offer coverage or pay penalties and "some of the worst parts of the taxation," he said.

The other route would be to repeal as much of the 2010 law as possible under the complicated rules governing reconciliation, including a requirement in this year’s instructions that the legislation decrease the deficit over the next decade. The expedited reconciliation procedure allows legislation to move through the Senate with a simple majority, sidestepping the usual 60-vote requirement for consideration.

Under the fiscal 2016 budget resolution (S Con Res 11), five authorizing committees across both chambers were charged with reporting their reconciliation proposals to the Budget committees by the end of last week, but action has been put off until at least after the August recess. Although the House is in for a limited time in September, the Budget Committee is hoping to receive and assemble reconciliation submissions from its three authorizing committees.

"I hope so," Budget Chairman Tom Price, R-Ga., said when asked if he expects to report out a reconciliation bill in September.

In the end, House lawmakers said the direction Republicans take with reconciliation will come down to the Senate.

While the House already sent a repeal bill (HR 596) to the Senate this year, Brady said the chamber could do it again through reconciliation if the Senate is eager to send something to President Barack Obama's desk. Charles Boustany Jr. of Louisiana, another Ways and Means Republican, said whatever moves through reconciliation has to pass muster with the Senate parliamentarian and that the House is working to understand what the Senate wants to accomplish.

"Is it a symbolic vote or a real vote that can get through to the president’s desk?" Boustany asked. "We're trying to get an understanding."

Earlier this month, Senate Majority Leader Mitch McConnell , R-Ky., said Senate Republicans are going to consider using reconciliation "for repealing as much of Obamacare as is reconcilable" but did not provide a timeline for action.

A selective repeal could make it easier to meet the deficit reduction requirement in the reconciliation instructions. The individual mandate is expected to provide substantial savings if it’s repealed.

The Congressional Budget Office (CBO) estimated in March 2014 that putting off the mandate's penalties until 2019 would have decreased the deficit more than $159 billion over 11 years. In comparison, CBO projected in June that full repeal of the law would increase the federal deficit by $137 billion from fiscal 2016 to 2025 using a dynamic score, and by $353 billion under traditional scoring practices.

Boustany said Republicans are "certainly aware" of the savings associated with a repeal of the individual mandate and that there is talk about packaging something, but he’s unsure what it will be. Brady also maintained that it’s easier to understand a repeal of specific provisions, though he said he doesn’t have a preference about which approach Republicans take.

Tennessee Republican Phil Roe, co-chairman of the GOP Doctors Caucus, opts for using reconciliation to move a replacement to the 2010 overhaul. But his fellow caucus chairman John Fleming, R-La., cautioned that targeting the law will leave Republicans with a big battle at the end of the year that GOP leadership may not have the stomach for, even though he would like to repeal as much the law as possible.

"I'm pretty much in the dark," Fleming said. "I just haven’t heard any discussion about it at all in several weeks."

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