At 10 p.m. on Thursday night, Majority Leader Mitch McConnell (R-KY) finally unveiled his “skinny repeal” bill, a scaled back attempt to repeal portions of Obamacare.
This bill has been widely derided by many Senate Republicans. Lindsay Graham, for example, said the “skinny repeal” bill would “destroy the insurance markets.” He also called the proposal “half-assed” and the “dumbest thing in history.”
The bill would strip health insurance from 16 million people and raise premiums by 20 percent, according to a preliminary analysis by the Congressional Budget Office.
Tonight, Graham announced he’d be voting for it.
Graham and others have received assurances from McConnell and Speaker Paul Ryan that the bill would initially be sent to a House-Senate conference committee, rather than voted on directly by the House.
Senate leadership is presenting tonight's vote as essentially another Motion to Proceed–ie a procedural vote to keep repeal alive
— Eliot Fishman (@FishmanEliot) July 28, 2017
But that’s hardly a sure thing. Notably, in a public statement and a subsequent private conference call, Ryan did not rule out the House passing “skinny repeal” at another time.
Graham: Ryan didn't promise it won't pass ever but "why would we want to own a bill that increases premiums and doesn't fix the problems?"
— Paul McLeod (@pdmcleod) July 28, 2017
The text of the bill provides clues that passing the bill through the House is McConnell and Ryan’s ultimate goal.
If the purpose was simply to get to committee and preclude passage by House Republicans, the bill would be as bare bones as possible to make it an unattractive final solution.
Instead, the bill is packed with goodies that appear designed to appeal to House conservatives.
- McConnell’s bill defunds Planned Parenthood. This is an essential component of any bill that has a chance of passing the House.
- McConnell’s bill expands Health Savings Accounts. HSAs are wildly popular with House Republicans. They also function as a tax cut for the wealthy.
- McConnell’s bill allows states to attempt to waive some consumer protections. Many House Republicans would be loathe to vote for a bill that leaves all Obamacare regulations in place. This provision — although it’s been watered down from previous versions of Senate health care bills — gives them something, making passage easier to swallow.
So if Ryan is saying this bill will be sent to conference, how does it eventually pass the House unchanged? Very easily.
House and Senate negotiators may be unable to agree on a compromise. if this happens, Ryan could bring up the Senate bill and argue (correctly) it would be the last real chance to even partially repeal Obamacare.
Another possibility is that House and Senate negotiators could come up with a compromise that fails to pass the full Senate. Ryan made it clear that the Senate would have to vote first on any bill that came out of a conference process. If it failed the Senate, Ryan could move onto the bill that came out of the House.
Trump is desperate to sign a bill and, in either case, would apply extreme pressure on the House to pass something that he could claim as a major legislative victory.
Republican staffers told Axios that there is “at least a decent chance” that if “skinny repeal” passes the Senate, it will become law. Sen. Mike Lee (R-UT) said that if “skinny repeal” clears the Senate, there is a very good chance it pass the House unchanged.
They are correct. And Mitch McConnell is selling numerous members of his caucus a bill of goods.