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Senate Health Care Vote: Parliamentarian Chips Away at Health Bill

• Senate Republicans are moving closer to wrapping up debate on repealing the Affordable Care Act.

• The health insurance lobby came off the sidelines Thursday to warn Republicans against repealing the individual mandate.

• Interior Secretary Ryan Zinke called both Republican senators from Alaska to threaten them over their health votes.

• One giant question remains: What final bill will Senator Mitch McConnell, Republican of Kentucky and the majority leader, ask his colleagues to vote on?

The Senate parliamentarian objected on Thursday to another provision of the Senate Republicans’ health care bill, which would make it much easier for states to waive federal requirements that health insurance plans provide consumers with a minimum set of benefits like maternity care and prescription drugs.

The parliamentarian, Elizabeth MacDonough, said the provision appeared to violate Senate rules being used to speed passage of the bill to repeal much of the Affordable Care Act.

Republicans want to make it easier for states to get waivers for two reasons: State officials can regulate insurance better than federal officials, they say, and the federal standards established by the Affordable Care Act have driven up insurance costs.

But Republicans are learning the limits of the fast-track rules they are using. The Senate is considering the repeal bill under special procedures that preclude a Democratic filibuster, but the procedures also limit what can be included in the bill.

“The function of reconciliation is to adjust federal spending and revenue, not to enact major changes in social policy,” said Senator Bernie Sanders, independent of Vermont. “The parliamentarian’s latest decision reveals once again that Republicans have abused the reconciliation process in an attempt to radically change one-sixth of the American economy by repealing the Affordable Care Act.”

The Senate bill would give states sweeping new authority to opt out of federal insurance standards established by the Affordable Care Act. It builds on a section of the law that allows states to obtain waivers for innovative health programs. But it would relax many of the requirements for such waivers that Democrats put into the law, signed by President Barack Obama in 2010.

The health insurance lobby, America’s Health Insurance Plans, came off the sidelines on Thursday to warn Senate leaders against repealing the Affordable Care Act’s mandate that most Americans have insurance without approving some mechanism to pressure people to maintain their coverage.

“We would oppose an approach that eliminates the individual coverage requirement, does not offer continuous coverage solutions, and does not include measures to immediately stabilize the individual market,” the group wrote.

AHIP played a major role in getting the Affordable Care Act passed in 2010 but has been reluctant to intervene in the fight over its repeal. On Wednesday, the Blue Cross Blue Shield Association, a narrower insurance lobby, weighed in with a similar warning.

Both groups…

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