Evil GOP bastard Mitch McConnell’s final desperate act to repeal ‘Obamacare’ (updated)

The straight repeal of “Obamacare,” the Obamacare Repeal Reconciliation Act, a policy that Tea-Publicans had voted for over 60 times in the past seven years when they used it as a bludgeon against Democrats and campaign fundraising talking point to the GOP crazy base — secure in the knowledge that their ideological antics would never actually become law — failed spectacularly in the Senate on Wednesday on a vote of 45 to 55, with seven Republicans (including Sen. John McCain) and all Democrats voting to block it. The latest vote to repeal Obamacare fails in the Senate.

Evil GOP bastard Mitch McConnell is down to his final desperate act to repeal “Obamacare,” the so-called “skinny repeal” bill that has yet to be drafted in secret in the dark recesses of McConnell’s star chamber,  a bill strategically designed to attract 50 GOP senate votes so that Vice President Mike Pence can, once again, break the tie vote to pass anything in the Senate to get it to a House-Senate conference committee.

Andrew Prokop at Vox.com provides analysis, Republicans’ last-ditch plan to save their health bill, explained in 500 words:

Republican leaders now have one last-ditch plan to keep their effort to repeal Obamacare alive.

Senate leaders’ new plan is to try to pass a simple, stripped-down “skinny repeal” bill that gets rid of just a few Obamacare provisions — like the individual and employer mandates and the medical device tax — while leaving the bulk of the law in place.

We don’t yet know whether skinny repeal will pass the Senate, or whether enough Senate Republicans will unify around some alternative proposal that can squeak through. We don’t even yet know what, exactly, would be in a skinny repeal bill.

But if the leadership’s reported plan succeeds and Republicans do end up passing skinny repeal out of the Senate, there are two main possibilities for what would happen next: Either House and Senate Republicans will hammer out final text that goes back before both chambers or the House will just pass the Senate’s bill.

1) Republicans narrow down one final version of the bill, which goes back for another vote in both the House and Senate: GOP leaders in the Senate are currently selling their plan to pass skinny repeal not as an intended final product, but as a vehicle to kick-start some sort of conference committee process.

This is the process where, after the House and Senate pass different versions of the same bill, negotiators from both chambers come together to try to agree on its final text. (This could involve the formal creation of a conference committee, or more informal negotiations between leaders in each chamber.)

We don’t know how this process would play out. Party leadership could well push hard for a sweeping repeal-and-replace and Medicaid restructuring bill that looks like Paul Ryan’s House-passed bill, or the bill Mitch McConnell tried and failed to get through the Senate. It’s also possible that something more limited could be crafted, if party leaders think that’s their best chance to get something passed.

But in the end, just one bill would emerge, and it would need both House and Senate approval again. Republicans in both chambers would then be put under tremendous pressure to vote for it.

2) Skinny repeal gets jammed through the House — and Trump signs it: Alternatively, GOP leaders could calculate that the conference committee process is unlikely to succeed, and that no fuller repeal can get through the Senate.

If so, they could then try to jam the scaled-back skinny repeal plan the Senate had already passed through the House, as their last best chance to claim some sort of a “win” on the issue.

House conservatives may grouse, but if they’re convinced the Senate’s plan is the best they’ll ever get, they could come around and vote to send skinny repeal without any changes to Trump’s desk for his signature.

Those appear to be the two paths forward for the GOP health bill at this point.

Mike Debonis at the Washington Post reports this second path appears highly unlikely. The Senate’s possible ‘skinny repeal’ of Obamacare faces skepticism in the House:

An emerging Republican strategy to get a health-care bill through a closely divided Senate faces serious head winds in the House, and lawmakers are already skeptical that the differences between the two chambers can ever be bridged.

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Some in the Senate have suggested that the downsized bill would represent a bridge to a conference committee, where the two chambers would meet to resolve their differences.

But House Republicans who fought tooth and nail over the course of months earlier this year to expand the scope of the repeal legislation are saying “fat chance” to the skinny repeal — including key members on the conservative and moderate ends of the GOP — and say it is difficult to see what legislative product could span the divide between the chambers.

“I don’t think it’s going to be very well received,” said Rep. Mark Walker (R-N.C.), chairman of the conservative Republican Study Committee. The group with dozens of members met Wednesday and had a “fairly negative” reaction to the skinny-repeal plan, Walker said.

Rep. Mark Meadows (R-N.C.), chairman of the House Freedom Caucus and a key player in the negotiations that produced the House health-care bill, told reporters in recent days that a skinny-repeal bill would be “dead on arrival” in the House and that a conference committee would have to be convened to work out a compromise.

In a continuing farce of legislative malpractice and an assault on democratic process and the rules of the Senate, Tea-Pepublican senators have not produced a skinny repeal bill for the CBO to evaluate (a prerequisite to a vote in the Senate). Dems asked CBO to score rumored “skinny repeal”: it would leave 16 million more uninsured:

A preliminary attempt to estimate the impact of Senate Republicans’ “skinny repeal” bill — their last-ditch attempt to repeal at least parts of Obamacare — suggests that it would result in 16 million fewer Americans having health insurance, according to a copy of a Congressional Budget Office report Senate Democrats shared with Vox on Wednesday night.

That analysis found that the rumored provisions of skinny repeal would result in roughly 20 percent premium hikes, in addition to millions fewer Americans having health insurance compared with under Obamacare.

“We just heard from the nonpartisan Congressional Budget Office that under such a plan, as reported in the press, 16 million Americans would lose their health insurance and millions more would pay a 20 percent increase in their premiums,” Sen. Chuck Schumer (D-NY) said on the Senate floor.

The skinny repeal idea, which emerged just before Republicans voted to begin debate on Obamacare repeal, would roll back the individual mandate and curb some of the Affordable Care Act’s taxes, but leave much of the rest of the law in place. Skinny repeal is believed to be the only option that enough Republicans will vote to pass and that could still be called Obamacare repeal.

The provisions Senate Democrats asked the CBO to evaluate in this analysis include the following, according to a senior Democratic aide:

• Repealing the individual mandate
• Repeal the employer mandate
• Repealing the medical device tax
• Defunding Planned Parenthood
• Repealing the Prevention and Public Health Fund
• Repealing the Community Health Center Fund

Vox’s Dylan Scott has explained why Republicans’ skinny repeal plan, if passed, would have serious repercussions for the number of uninsured Americans.

“That policy could prove extremely disruptive to the individual insurance markets, where people buy coverage if they don’t get it through their employers or the government, if it became law,” Scott explains.

Further analysis from J.B. Silvers, professor of health care finance at the Weatherhead School of Management at Case Western Reserve University, at the New York Times, Why ‘Skinny’ Obamacare Repeal Is a Terrible Idea, and the Times‘ David Leonhardt, ‘Skinny’ Cynicism on Health Care.

The Washington Post editorializes, The hefty downsides of the ‘skinny’ health-care proposal.

Keep up the pressure on your senators to vote against this travesty of legislation to take health care away from millions of Americans just to give an undeserved tax break to the wealthiest Americans.

UPDATE: The Senate Tea-Publicans’ effort to pass the so-called “skinny repeal” to rescind parts of the Affordable Care Act was thrown into doubt Thursday afternoon. Senate Health Care Vote: Disarray Over Narrow Repeal Measure:

Senators Lindsey Graham of South Carolina, John McCain of Arizona, Bill Cassidy of Louisiana and Ron Johnson of Wisconsin declared Thursday evening that they would not vote for a slimmed-down partial repeal of the Affordable Care Act without ironclad guarantees that the House will negotiate a comprehensive measure.

You’re coming up short, Mitch!

The senators were unsparing in their criticism of the so-called skinny repeal, saying it would crater the health insurance market and send premiums skyward.

“The skinny bill as policy is a disaster,” Mr. Graham said. “The skinny bill as a replacement for Obamacare is a fraud.”

Senator Johnson said: “The skinny bill in the Senate doesn’t come close to meeting our promises.”

But they feared that House Republican leaders could just take the stripped-down bill, pass it and send it to President Trump.

“Right now, I am voting no,” Mr. McCain said.

Mr. Graham was emphatic.

“I need assurances from the speaker of the House and his team that if I vote for the skinny bill, than it will not be the final product,” Mr. Graham said. “I’m not going to vote for a pig in a poke.”

This might not have helped.

As Republican senators seek assurances that the bill they are being asked to vote on won’t become law, the House majority leader, Kevin McCarthy of California, may have sent shivers down a spine or two in the upper chamber with this announcement.

“While last votes are currently scheduled to take place tomorrow, Members are advised that — pending Senate action on health care — the House schedule is subject to change. All Members should remain flexible in their travel plans over the next few days. Further information regarding potential additional items will be relayed as soon as possible.”

That doesn’t sound like a man preparing for lengthy House-Senate negotiations on a comprehensive health care bill. So maybe the “skinny repeal” could become law after all?

Parliamentarian takes another scalp.

Senate Republicans also would have liked the “skinny repeal” to include a measure that 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.

Then the Senate parliamentarian stepped in. The parliamentarian, Elizabeth MacDonough, objected on Thursday to the waiver provision, saying it 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.”

Also, “to avoid a 60-vote threshold for passage, the bill must meet specific deficit reduction targets. It’s still not clear how those targets will be reached.”

And then there is this development:

Insurers come off sidelines with warning.

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.

And this development:

The American Medical Association piles on.

The American Medical Association, by far the largest physicians’ advocacy group, has stood firmly against each of the bills to repeal the Affordable Care Act. Now the A.M.A. has come out against the “skinny repeal.”

“There has been considerable speculation regarding a so-called ‘skinny package’ that would primarily eliminate penalties related to the individual and employer mandates and provide tax cuts to device manufactures and the health insurance industry. Eliminating the mandate to obtain coverage only exacerbates the affordability problem that critics say they want to address. Instead, it leads to adverse selection that would increase premiums and destabilize the individual market.

“We again urge the Senate to engage in a bipartisan process – through regular order – to address the shortcomings of the Affordable Care Act and achieve the goal of providing access to quality, affordable health care coverage to more Americans.”

Oh, and so does AARP.

The “skinny repeal” is simply legislative malpractice that no one in their right mind should in good conscience vote for. Those who do should be voted out of office.