Republicans won’t succeed in their most strategic move yet to repeal Obamacare, but they’re laying out a roadmap for killing the healthcare law if they win the White House next year.
The House is poised to pass a bill Friday that uses special rules known as “budget reconciliation” to get rid of some of the healthcare law’s biggest provisions, including its individual and employer mandates to buy coverage, its taxes on high-cost health plans and medical device manufacturers, and an independent board charged with cutting Medicare costs.
The rules will allow Senate Republicans to pass the repeal measure this year or next with just 51 votes instead of 60, sending it to President Obama’s desk for a likely veto. But despite that roadblock, Republicans see the process as one that will not just score them political points in the elections, but also give them a sense of what they will be able to repeal in the healthcare law.
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“The GOP Congress has to show resolve more than anything,” said Republican pollster Wes Anderson. “Obama vetoes are a good thing for us at this point.”
If a Republican wins the White House in 2016, he or she almost certainly would agree to repeal the law. But Republicans aren’t likely to win 60 votes in the Senate, so they still would have to use the budget reconciliation approach to get rid of parts of it.
“This is a whiteboard exercise, it’s also a political exercise, it’s also a campaign exercise,” said Elizabeth Letchworth, a former Senate secretary for Republicans and founder of the firm Congressional Global Strategies. “It’s also an exercise to show the American people we believe this is what they want.”
Republican congressional aides have labored for weeks to figure out which parts of the healthcare law to repeal using reconciliation and which ones to ignore. To pass muster, each provision must be related to federal spending. And the bill as a whole can’t increase the deficit.
There’s a lot of gray area there, as the ultimate call will be up to the Senate parliamentarian, Elizabeth MacDonough, whose job it is to decide what meets the qualifications for reconciliation under what’s known as the “Byrd rule.” A lot of it will depend on whether she buys Republicans’ arguments for why a particular provision might affect federal spending even if it doesn’t immediately appear evident.
“It really is gray,” Letchworth said. “You could talk about all the crazy scenarios you want to … there are all these ways you could try to convince her.”
The nonpartisan Congressional Budget Office found on Tuesday that the bill would decrease the federal deficit by about $130 billion over the next decade or so, but raise it long term.
Aides say the three House committees that put together the reconciliation package tried to include only parts they think the parliamentarian will agree qualify under the special rules. The House bill doesn’t touch the law’s insurance regulations, like its requirements that insurers spend only a certain percentage of revenue on overhead and cover certain healthcare services.
Letchworth said Republicans could try to make the case that the insurance provisions affect federal spending, but if it’s too much of a stretch, the parliamentarian will likely throw them out of the bill. It would take 60 Senate votes to override her decision.
And then there are political considerations. House Republicans chose not to touch two big parts of the law expanding insurance to the low-income: its Medicaid expansion and its subsidies to buy coverage.
While those provisions are the biggest drivers of federal spending in the law, many Republicans fear political repercussions if they strip away assistance people have been receiving for at least two years. Nearly half of House Republicans represent states that have chosen to expand their Medicaid programs under the law.
Plus, if Obama is given an Obamacare repeal bill that ditches the most unpopular parts of the law but leaves in place the assistance programs, it becomes politically more difficult for him to veto it.
“We want to make the reconciliation bill as hard to veto as possible,” said one House Republican aide.
