For the first time, Congress is passing a bill to gut Obamacare and sending it to President Barack Obama’s desk. That vote occurs Wednesday in the House, after the Senate passed the package last month.
The bill awaits a veto, as both parties have always known. Even so, the final Affordable Care Act repeal package reflects the results of a long, careful drafting process that, for Republicans, undoes as much of Obamacare as possible.
Despite the clear lack of real-world policy implications that Democrats publicly touted as a waste of lawmakers’ time, both parties took the bill’s crafting seriously. Senate Democrats went on defense behind the scenes by raising parliamentary questions, forcing Republicans to write several complicated drafts.
People on both sides say the effort wasn’t wasted. “I think because we took the time to do the really hard work, frankly on a line by line basis …we learned a lot,” said a GOP Senate aide close to the process. “I would say what we got through the Senate was just a baseline for where we can go in the future.”
Republicans crafted the ACA bill through reconciliation, a budgetary tool that allows legislation to be passed in the Senate without the threat of a filibuster. Using this tool, a bill can be can sent to the president’s desk with a simple majority in both chambers. However, the bill is subject to complicated criteria in the Senate, dubbed the Byrd Rule, and must be squared away with the Senate parliamentarian to retain its privileged status.
That’s why the story of how the reconciliation bill was written rests largely in the Senate. The House passed an earlier, more limited version in October. It then went to the Senate, where it wasn’t voted on until December. It was there that the measure grew. The House version only repealed a handful of the health care law’s major provisions, while the Senate version canceled out many more, including ACA’s Medicaid expansion and several health care taxes.
Reconciliation is typically a tool of the majority party, but Democrats were far from idle during the months of debate. “I think decisions were made to try to counter any politics they were playing with reconciliation,” said a Democratic Senate aide familiar with the Democrats’ strategies.
The aide said one of the party’s main goals was to maintain the integrity of reconciliation. “We don’t want this to start being used as a work-around just because you don’t have 60 votes in the Senate, but you still want to say you passed legislation for a political purpose.”
The second goal of the Democrats was to demonstrate the negative consequences the bill would have on insurance markets and low-income people if it actually became law. Millions would lose their insurance with no known alternative.
It’s a political exercise now, but it could have real consequences in the future. An Obamacare repeal is precisely what will occur if a Republican occupies the White House next year, both Republicans and Democrats say. To that end, the current reconciliation process ended up putting Democrats on the defensive. “There’s no doubt about it that more of the bill is exposed than some people had thought in the past,” said Jim Manley, a former aide to Senate Minority Leader Harry Reid. “They went further than many people thought. Is this the crippling blow that some had expected? No. But does it do some real damage to the bill? Absolutely.”
The Senate Republican aide described the reconciliation process as “iterative … It’s one of those things where there’s not a hard and fast, ‘Yes! You passed the Byrd Rule!’ test.” The relevant committees (Finance, Budget, and Health, Education, Labor, and Pensions) got to work almost a year ago crafting a repeal package, as soon as a budget resolution passed that made reconciliation possible.
In the fall, Democrats challenged some of the provisions brought to the parliamentarian, and they were successful on at least one major issue. The House bill repealed Obamacare’s individual and employer mandates, but Democrats were successful in arguing that these provisions did not comply with Senate rules. But then the GOP brought back new language that cleverly didn’t erase the penalties, but simply dialed them to zero. That time, the parliamentarian found the provision in compliance with Senate rules.
“Overall, the process was very time-consuming, and I think we did the work that was necessary to make strong arguments. But unfortunately, some of the arguments just didn’t hold,” the Democratic aide said.
During floor debate, Democrats decided to carefully choose amendments that highlighted where their priorities contrasted with that of Republicans. A clear example was an amendment to strike language defunding Planned Parenthood and create a fund to support women’ health and clinic safety.
In the end, Republicans were pleased with the bill’s contents. Sens. Marco Rubio (R-Fla.), Ted Cruz (R-Texas) and Mike Lee (R-Utah), who had threatened to vote against the House bill because it didn’t repeal the whole law, voted for the final version in the Senate. Republicans point to the process as a rare example of party unity.
Democrats downplay the strong Republican vote count, saying it would not have been the same had the bill not awaited certain veto. “I think when things actually have real impact, people are going to take a second look at what they’re doing,” said the Senate Democratic aide.
Now, both parties must dig in their heels and say the future of the health care law hinges on who voters elect to the White House at the end of the year. On Monday, Democratic presidential front-runner Hillary Clinton said a Republican president would repeal the Affordable Care Act. Then, she added, “We will have to start all over again.”
“They have no plan,” she said. “The Republicans just want to undo what Democrats have fought for for decades and what President Obama got accomplished. So we need a president, just as President Obama will, to veto that.”
Republicans tout the bill as a concrete example of what would be accomplished under a Republican president, acknowledging that Obama will never sign a repeal of his signature domestic policy. This bill, they say, paves a path forward to a life without the ACA in 2017.