What Went Down On Health Care This Week

One thing worth bearing in mind throughout the next crazy hours of Senate debate: Senate Majority Leader Mitch McConnell chose to approach the GOP effort to repeal and replace parts of the ACA using the reconciliation process. The benefit of this process for the GOP is that it needs only 50 votes to pass — with Vice President Mike Pence as tiebreaker — so the party doesn’t have to work with Democrats to craft or pass the bill. The down side is that there are limitations on what can be included in the bill, because each provisions must be primarily about making changes to the budget. It also puts a deadline on passing the bill for complicated reasons. The Senate parliamentarian, who determines whether the bill follows those rules, has issued guidance that many of the GOP ideas included in the various iterations of Senate legislation proposed so far don’t comply. That includes provisions that would:

• Restrict funding for Planned Parenthood.
• Allow insurers to charge older adults five times as much as younger adults.
• Institute a six-month waiting period to buy insurance if you haven’t had continuous coverage (which is supposed to function as a replacement for the individual mandate).
• Make available waivers to allow states to forgo insurance market regulations.

Getting rid of these provisions makes Swiss cheese out of the bills Republicans have put forward so far. It’s unclear what that will mean for their final bill proposal. At the moment, two of the options seem to be to leave those provisions out (as would be the case with a true “skinny repeal” bill that just ended the individual mandate, the employer mandate and perhaps a few other things) and hope they can get enough votes without them, or they could choose to overrule the parliamentarian, ending the Senate as we know it.