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Republicans Strain For Modest 'Skinny' Redo Of 'Obamacare'

Sen. John McCain, R-Ariz., who returned to Capitol Hill after being diagnosed with an aggressive type of brain cancer, leaves the chamber after vote the Republican-run Senate rejected a GOP proposal to scuttle President Barack Obama's health care law, Wednesday, July 26, 2017.
Associated Press
Sen. John McCain, R-Ariz., who returned to Capitol Hill after being diagnosed with an aggressive type of brain cancer, leaves the chamber after vote the Republican-run Senate rejected a GOP proposal to scuttle President Barack Obama's health care law, Wednesday, July 26, 2017.
GOP Seeks Support For Narrow Version Of 'Obamacare' Repeal
What's Next In The Health Care Debate? GUEST:Dr. Robert Hertzka, health care policy instructor, UC San Diego School of Medicine

The top story on midday addition, the Senate will take a series of mini votes on healthcare revote -- reform, testing the waters to see what Republicans may agree on. So far, the GOP senators have rejected bills that would repeal and replace the affordable care act. It is reported that the next attempt will be a so-called skinny repeal which would cancel part of the ACA. I have a healthcare policy instructor. Dr. Hertzka, welcome.Thank you.They have been talking about repealing Obama care. They control all three branches of the government and he is putting a great deal pressure on the Senate to get this done. Why in your opinion, is this so difficult to accomplish?There are several things. One, there is a general sense of Republicans that Obamacare is a relatively poor policy and should be adjusted/replaced, there are few Republicans in the Senate, Ted Crees and Rand Paul, and the so-called freedom Caucus, they do not believe that government has a role in healthcare. When you start talking about replacing Obamacare, you are talking about a different way of financing and helping low income people. You have enough Republicans that do not want to do that that that is the first problem. Second, they made a decision in January, which is not well-publicized, they would do healthcare before tax reform and they would strip out the taxes in the affordable care act to help their budget scoring for the tax reform which would follow three weeks later. They did not think about the consequences of stripping out the taxes of Obamacare then see the CBO, if you defunded, 20 million people lose insurance. They did not anticipate the media firestorm. Third, by going to budget reconciliation and saying we will not try to be bipartisan, you are in a Senate situation where you need 50 out of 52 people to agree.Republican leadership is working on a skinny repeal measure which would eliminate the requirement that everyone have health insurance. Businesses with more than 50 employees should provide health insurance. How would eliminating those requirements affect the markets ?The mandate is weak. I can make a case that it is ineffective, much less effective than the CBO things. It is an incentive to get insurance. If you remove it entirely and if you publicize that there is no penalty, you will have millions of people who are only getting insurance now because they would otherwise be penalized and not get insurance. Then, your in the classic death spiral where only sick people get insurance in healthy people do not. The premiums go up.It would be a bit of a step backwards from a policy point of view.Republican say this Bill, if they were able to come together on the skinny repeal would be a device to enter a reconciliation with the house and come up with a more comprehensive reform bill. Do you see a danger to that strategy ?The danger that is expressed is that the house rather than going to conference, okay. If that is the best you were going to do, even though the freedom Caucus does not like it, it does knock out several things we do not like as libertarian Republicans, they might just take it. We would actually at that point, we would not have replaced Obamacare. We would have made it worse.You say this might make Obamacare worse. In public opinion polls, the affordable care act has never been more popular than now. Do you see Obamacare as it is now as the failure that it is characterized as ?It has quite a bit of dubious policy. The largest thing that Obamacare has done which we have not discussed, dramatically expand Medicaid by telling everyone who makes less than $16,000 per year, they get free Medicaid. The doctors will see them and they end up in the ER. It is a rather poor delivery system. I do not think anyone who is not on Medicaid would volunteer. If you really want to have fun with Congress,'s day that they have to go on Medicaid. See how popular Obamacare is. That needs to be addressed. Most people are not on Medicaid or they may know so but he was on. If you were on Medicaid, you do not have to pay bills. You are happy. That seems nice. It does not bother me. Some people are getting healthcare. Over time, the focus is on some people have gotten something, even if it is not great. They used to have nothing. Most people are on ensure your based insurance. They are completely oblivious to what is going on through the affordable care act. It does not seem so bad and it has not affected my life. There are people who seem happier. The public opinion polls, it is still people do not have a sense of the real policy. There are real problems and issues that eventually need to be addressed.I have been's peeking with Dr. Hertzka, thank you.My pleasure.

Battered by repeated failures to repeal or replace "Obamacare," Senate GOP leaders retreated to a narrow approach Thursday that would undo just a few of the most unpopular elements of Barack Obama's law.

Democrats vowed opposition as the Senate prepared for a bizarre Capitol Hill ritual, a "vote-a-rama" on amendments that promised to last into the wee hours of Friday morning.

The "skinny repeal" they were considering was being touted as a way for Republicans to get something, anything, out of the Senate after frittering away the first six months of Donald Trump's presidency trying unsuccessfully to abolish the current law.


Talks with the House would follow, with the aim of crafting a compromise repeal-and-replace bill that could pass both chambers sometime in the fall. Whether Republicans can make it that far looks iffy at best.

RELATED: What’s Next In The Health Care Debate?

But Trump tweeted his encouragement, albeit with an ominous touch: "Come on Republican Senators, you can do it on Healthcare. After 7 years, this is your chance to shine! Don't let the American people down!"

The "skinny bill" strategy emerged after Republicans barely succeeded earlier this week in opening debate on health legislation in the narrowly divided Senate, winning the procedural vote to do so thanks only to Vice President Mike Pence breaking a 50-50 tie.

Hours of debate followed, as well as a few amendment votes that starkly revealed Republican divides. On Tuesday, on a 57-43 vote with nine GOP defections, the Senate rejected a wide-ranging proposal by Majority Leader Mitch McConnell to erase and replace much of the Affordable Care Act.


Then on Wednesday, a straightforward repeal measure failed 55-45 with seven Republicans joining Democrats in voting "no," even though nearly identical legislation had passed Congress two years earlier.

That left Republican senators hunting for other options, and the skinny repeal rose to the top. The measure has not been finalized, but senators have said it could eliminate Obamacare's two mandates — for individuals to carry insurance and for employers to offer it.

Lobbyists said Republicans were also planning to include a one-year ban on federal payments to Planned Parenthood, extra money for community health centers and waivers for states to permit insurers to sell policies with far narrower coverage than current law allows.

But leaders were encountering problems. The Senate parliamentarian advised that the waiver language violates chamber rules, meaning Democrats could block it. And plans to eliminate Obama's medical device tax could be abandoned because Republicans need that money for their package.

"It is being called a skinny bill because it won't have much in it," said Sen. Lamar Alexander, R-Tenn. "It is not a solution to the Affordable Care Act problems. But it is a solution on how we can get to a place where we can write a solution to the Affordable Care Act."

Whether Republicans have the votes even to pass that much is unclear. And in a peculiar twist, some GOP senators were seeking assurances that the House would not pass the "skinny repeal" as-is, but would commit to going into a conference committee with the Senate to hammer out a more comprehensive replacement.

On their own, the changes in the skinny bill could roil insurance markets and send premiums skyrocketing. Yet the scenario at hand, with senators trying to pass something while hoping it does not clear the House or become law, was highly unusual.

"We're in the twilight zone of legislating," said Democratic Sen. Claire McCaskill of Missouri.

A countervailing argument was also circulating, that House passage of a Senate skinny bill could allow Republicans to claim at least partial victory and move on to other issues. With tax legislation and other priorities waiting in the wings, Republicans are eager to rid themselves of the burden of making good on their many campaign promises to repeal and replace Obamacare, which has proven far more difficult than they seem to have expected.

During the "vote-a-rama," unlimited amendments can be offered from both sides.

Most will be dismissed along partisan lines; some may resurface in years to come in the form of attack ads. But at some point along the way McConnell is expected to offer the skinny bill as an amendment of his own, with hopes it will get a majority.

"I think it is quite likely we will be here much of the night, if not all night," said Sen. Ted Cruz, R-Texas. "And at the end of it hopefully we'll have a bill that can bring us together."

Yet as has happened every step of the way, no sooner did the latest bill emerge than opposition arose against it.

The insurance company lobby group, America's Health Insurance Plans, wrote to Senate leaders Thursday saying that ending Obama's requirement that people buy insurance without strengthening insurance markets would produce "higher premiums, fewer choices for consumers and fewer people covered next year."

And a bipartisan group of governors including John Kasich of Ohio and Brian Sandoval of Nevada also announced against it.