Senate Healthcare Bill Hits Parliamentarian Road Blocks

Republicans will need 60 votes in the Senate to move forward with some of the worst provisions for women’s health included in their Trumpcare plan, including the defunding of Planned Parenthood, restrictions on abortion coverage, the continuous coverage penalty, and elimination of the guarantee of essential health benefits for Medicaid, among others.


On Friday evening, the Senate Parliamentarian determined that these provisions violate Senate rules that allow Republican leadership to push through the Trumpcare plan with only 51 votes. Advocates have hailed the decision as a step in the right direction, but the Trumpcare plan is still alive, and Senate Majority Leader McConnell is still expected to call a vote as early as Tuesday afternoon that will set the stage to repeal the Affordable Care Act (ACA), decimate Medicaid, and force at least 22 million people off their insurance.


Both the House and Senate are trying to repeal the Affordable Care Act (ACA) using a process called budget reconciliation that would require that the Senate bill receive just 51 votes to pass. The Senate, however, has a special rule called the Byrd Rule, which prohibits the use of the budget reconciliation process to create policy changes. If a specific provision violates the Byrd Rule—meaning that it has only a “merely incidental” impact on the budget—any Senator can challenge that specific provision. It will then be stricken from the legislation unless it receives 60 votes.


The Senate Parliamentarian determines whether a provision violates the Byrd Rule. On Friday, the Parliamentarian found that several provisions of the Better Care Reconciliation Act (BCRA), the Senate Trumpcare bill, violate the Rule, including:


  • Defunding Planned Parenthood by prohibiting the healthcare provider from receiving Medicaid funds for one year
  • Further restricting access to abortion coverage by preventing anyone receiving a premium tax credit from purchasing any private health plan that offered abortion coverage beyond the Hyde exceptions
  • Penalizing certain employers who offer coverage of abortion by prohibiting them from receiving certain tax credits
  • Eliminating the essential health benefits requirement for Medicaid coverage, impacting coverage of prescription drugs, mental health services, and substance abuse treatment
  • Imposing a six-month waiting period on individuals enrolling in coverage if they have experienced coverage gaps
  • Elimination of the 80/20 rule, which limited how much money from premium payments insurers could take as profit or spend on administrative costs by requiring insurers to spend 80% of premium payments on health care for consumers


The Senate Budget Committee Minority Staff has published the full list of provisions that violate the Byrd Rule. Other provisions are still under consideration, including the provision that allows states to waive the essential health benefits requirement, which would jeopardize coverage of maternity care, among other benefits, and allow insurers to once again impose annual and lifetime caps on coverage. The Parliamentarian is also reviewing the section that allows insurers to charge older adults five times more for coverage than younger people.


Majority Leader McConnell has indicated that the Parliamentarian’s determinations are merely “guidance.” McConnell is still expected to move forward with a Motion to Proceed to ACA repeal on Tuesday. He needs only 51 votes to win the motion. It remains unclear whether McConnell has the votes needed. If the motion passes, however, the Senate will engage in only 20 hours of debate before voting on at least two versions of Trumpcare: one that will repeal the ACA without a replacement, ripping coverage away from 32 million people, and another, the BCRA, which will force 22 million people off of their insurance. Both plans would eliminate the Medicaid expansion and make deep cuts to the Medicaid program—between $772 billion and $842 billion in cuts—that would decimate Medicaid, and put the health and lives of the 74 million people currently covered by the program at risk.


Media Resources: Kaiser Health News 7/21/17; New York Times 7/21/17; Senate Budget Committee Minority Staff 7/21/17; Center on Budget and Policy Priorities 11/9/16

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