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Get Ready for the Senate’s Obamacare Repeal Slog

Unlike the House, the Senate needs to wait for CBO

Senate Minority Leader Charles E. Schumer says the House-passed bill will likely run afoul of Senate rules. (Tom Williams/CQ Roll Call)
Senate Minority Leader Charles E. Schumer says the House-passed bill will likely run afoul of Senate rules. (Tom Williams/CQ Roll Call)


Don’t expect quick Senate action on the Republican bill to repeal large portions of the 2010 health law.

Aides caution that, regardless of House passage on Thursday, it could be weeks before the Senate can begin any significant work on the legislation.

The lack of analysis from the nonpartisan Congressional Budget Office will be a major contributor to the slowdown.

The estimate is necessary for the Senate parliamentarian to determine if the bill qualifies under the rules governing the fast-track budget procedure known as reconciliation.

Senate Majority Whip John Cornyn, R-Texas, declined to outline a schedule for Senate consideration of the health care reconciliation measure.

“There’s no timeline. When we get 51 senators, we’ll vote,” Cornyn said.

Sen. Susan Collins, R-Maine, also did not want to put any timetable on Senate consideration, in large part because lawmakers do not really know anything about its effects.

“We should take as long as necessary to do the job right,” Collins said. “We certainly need the CBO analysis on the impact on cost and coverage before we can produce our own [bill].”

“Part of the problem is that we don’t have the CBO analysis of the impact of the bill, so I don’t know what the impact is on coverage, I don’t know what the impact is on premiums, on cost-sharing, on the individual insurance market,” the Maine Republican said. “So, there’s so many unanswered questions.”

Sen. Bob Corker anticipated it could take about a month before the Senate is ready to move on health care, although he conceded Thursday morning that he largely focused on other issues after the previous failure of the House legislation. He also predicted changes in the Senate.

“There’s a working group over here of Republicans with, you know, with a range of ideology that are working to see where we go with the bill when it comes across. And I think you’re going to see very responsible, deliberate action on it,” the Tennessee Republican said on MSNBC. “People are going to want to improve it. I don’t see any way that it goes back in the form that it comes. And it’s not because I have any specific criticism. I just know that, over here, people want to make sure that it’s something that’s going to work for the American people.”

But the legislation could run into additional procedural hurdles. Democrats believe that several provisions in the bill would be ruled out of order because they do not have the kind of deficit effects required under the Senate’s Byrd Rule that’s crucial to using the budget reconciliation process to pass the bill with a simple majority.

Senate Minority Leader Charles E. Schumer singled out in particular a late-addition to the bill that would allow states to apply for a waiver out of several of the law’s coverage requirements, as well as another amendment that would provide states more money to help cover those individuals with pre-existing conditions. 

“Its chances for survival in the Senate are small. We don’t even know if the new version would survive under the rules of reconciliation,” the New York Democrat said on the Senate floor on Wednesday.

The GOP must also find consensus among a caucus divided on key issues in the bill. Under reconciliation, 50 votes will be required in the Senate to advance the legislation instead of the standard 60. But Republicans only holds 52 seats, which means they can afford only two defections (with Vice President Mike Pence breaking the tie).

Several GOP lawmakers have already expressed concerns about the phase-out of the health law’s Medicaid expansion included in the current version of the repeal legislation. Republican Sens. Cory Gardner of Colorado, Rob Portman of Ohio, Shelley Moore Capito of West Virginia and Lisa Murkowski of Alaska wrote to Senate Majority Leader Mitch McConnell, R-Ky., earlier this year outlining their criticisms of the bill.

“We are concerned that the February 10th draft proposal from the House of Representatives does not provide stability and certainty for individuals and families in Medicaid expansion programs or the necessary flexibility for states,” the lawmakers wrote.

The measures altering the Medicaid program remain largely unchanged from prior drafts in the version the House passed on Thursday.

Collins has also voiced alarm at a provision that would defund Planned Parenthood. She voted against a 2015 bill to repeal portions of the health law largely because of the inclusion of similar measure.

Any attempt to remove a loophole in the bill that would exempt members of Congress from the changes House Republicans are proposing, would likely require 60 votes to pass, an unlikely occurrence given the opposition among Democrats to the legislation.

“I can’t say [AHCA] is dead on arrival, but they don’t have 60 votes,” Sen. Joe Manchin III., D-W.Va., said at an event Thursday morning hosted by Politico.

Lawmakers and many congressional aides receive their federal health benefits through the small business exchange operated by the local government in Washington, D.C., rather than through the federal employee benefits system.

The House was voting Thursday on a separate bill to fix the issue of application to members and staff, but that fix would bring in the jurisdiction of either the Senate Homeland Security and Governmental Affairs Committee or the Rules and Administration Committee (or perhaps both).

Because no reconciliation instructions were directed at those committees, the provision would create an unambiguous Byrd Rule problem that might cause an entire chunk of the House bill related to state waivers favored by the conservative House Freedom Caucus to be stricken.

CORRECTION: An earlier version of this story mistakenly stated Lisa Murkowski voted against a 2015 bill to repeal portions of the health care law.

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