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Reconciliation Bill to Widen Health Law Repeal on Senate Floor

By Paul M. Krawzak, CQ Roll Call

Senate GOP leaders plan to take up a reconciliation bill to repeal much of the 2010 health care law next week, assuming it is clear after a conference meeting Nov. 30 that they have the 51 votes needed to pass the legislation.

People with knowledge of the process said final language in a Senate substitute amendment to the House-passed reconciliation bill (HR 3762) will be run by Senate Parliamentarian Elizabeth MacDonough on Dec. 1 to make sure modifications to the House bill do not violate the Senate’s Byrd rule.

The Senate on Dec. 2 then would begin consideration of the substitute, which has been crafted to protect against violations of the rule. The Byrd rule bars what is called "extraneous matter" from reconciliation bills, including provisions that do not have a budgetary impact.

People who have heard about the plan said Senate Republicans envision expanding the partial repeal of the law contained in the House bill by doing away with or scaling back the exchange subsidies, the Medicaid expansion and most of the taxes created by the law.

The first step is to make sure there is enough GOP support for the legislation, since several senators are opposed to the partial repeal approach in the House bill because they think it doesn't go far enough.

A few others are concerned about a provision that would suspend for a year federal Medicaid reimbursement to Planned Parenthood or other health care providers that perform abortions.

Republican senators received notice on Tuesday of the conference meeting, set for 6 p.m. Nov. 30, to discuss "Obamacare repeal."

By putting the reconciliation measure on the Senate agenda prior to consideration of any omnibus spending bill, it's possible Republicans could defuse at least some of the fights that could affect the appropriations measure, including Planned Parenthood defunding.

Attack on the Health Care Law

The House-passed bill sought a partial undoing of the health care law (PL 111-148, PL 111-152), including the repeal of the individual and employer mandates, taxes on high-cost health care plans and medical devices and a public health prevention fund, along with the Planned Parenthood defunding.

The partial repeal proved unacceptable to some GOP senators including presidential hopefuls Ted Cruz of Texas and Marco Rubio of Florida, as well as Mike Lee of Utah. They are pushing for total repeal or at least as much repeal as can be accomplished under Senate rules.

With a 54-seat majority, the GOP can only afford to lose three Republicans and still pass reconciliation with 51 votes, since all Democrats and the two independents in the Senate are expected to oppose the bill. President Barack Obama has said he would veto any repeal of the health care law.

Still, House and Senate Republicans view the reconciliation exercise as a dry run for what they might be able to accomplish if a Republican is elected president next year. The measure also serves as a powerful messaging tool communicating the party's intentions when it comes to the law, a signature of the Obama presidency.

By expanding the breadth of the repeal, Senate GOP leaders may be able to persuade most, if not all, of the Republican dissidents to vote for the legislation. However, that approach also runs the risk of alienating some other Republican senators, who may be hesitant to support a repeal of health insurance subsidies or the Medicaid expansion unless there is a credible replacement for the health coverage.

Planned Parenthood

The reconciliation bill also could lose support from some Republican senators who oppose defunding Planned Parenthood. That issue, however, could be resolved in the amendment process.

Susan Collins, R-Maine, who opposes defunding Planned Parenthood, expects an amendment to be offered to remove that provision. Even if the defunding provision is preserved in the bill, the opportunity to vote against it could provide cover for Planned Parenthood supporters.

The Senate substitute is needed to modify language in the House bill that MacDonough has said violates the Byrd rule, including repeals of the individual and employer mandates. MacDonough told leaders the budgetary impact of the repeals is "merely incidental" to the broader impact of ending the mandates and that it therefore violates the Byrd rule. GOP leaders said the language repealing the mandates could be modified in such a way as to achieve the same purpose without running afoul of the Byrd rule.

The repeals of the so-called Cadillac and medical device taxes in the House bill also create Byrd rule problems, since the revenue loss would add to the deficit in the "out years" after the budget window closes in 2025.

The GOP may be able to solve that problem by coupling additional deficit reduction–such as through repealing the exchange subsidies and Medicaid expansion–with the tax repeals.

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