Senate Debates Possible ‘Skinny Bill’ Repeal of Obamacare

The Republican Party's seven-year long effort to repeal Obamacare fell into turmoil Thursday evening, when four key GOP senators demanded guarantees House will enter negotiations or they'll scuttle the bill.

Sen. John McCain speaks during debate on health care on July 27, 2017. (Credit: CNN)

House Speaker Paul Ryan has now offered assurances the House bill would proceed to a conference committee, but it was not immediately clear that will be enough to placate senators. Ryan also indicated it will be up to Senate leaders to put together the eventual bill that can reach the President's desk.

The strange drama -- Republican senators imploring their own colleagues across the Capitol to vow that they would not pass the bill they are about to pass -- unfolded as lawmakers prepared to kick off a long and exhausting open-amendment process in the Senate known as vote-a-rama.

It crystalized the remarkable dissatisfaction and deep reservations that Republican members feel just hours away from potentially voting to weaken the Affordable Care Act, something they had campaigned to do since the law's enactment more than seven years ago. And it threatens the prospect of providing a long-awaited legislative victory to the party and President Donald Trump.

"I'm not going to vote for a bill that is terrible policy and politics just to get something done," GOP Sen. Lindsey Graham said at a press conference. Joined by Sens. John McCain, Ron Johnson and Bill Cassidy, Graham said he has grown increasingly concerned that contrary to GOP leaders' assurances, the bill that the Senate passes would be immediately taken up by the House -- rather than going to a House-Senate conference for further negotiations -- and end up on President Donald Trump's desk.

"The skinny bill as policy is a disaster, the skinny bill as a replacement for Obamacare is a fraud," Graham added. "The skinny bill is a vehicle for getting conference to find a replacement."

Asked what assurance from House leaders would be satisfactory, the ever-quotable South Carolina senator said: "It's like pornography: you know it when you see it."

McCain, who returned to Washington this week just days after having surgery for brain cancer, said, "We have to have an assurance that it will go to a normal conference -- right now that is not the case."

Shortly after that press conference, Ryan responded that the House would be willing to go to a conference committee. But his carefully crafted statement did not include a specific guarantee that the House would not vote on the Senate's proposal, and appeared aimed at moving the process forward while protecting House Republicans from being blamed if should the entire process collapses.

"The burden remains on the Senate to demonstrate that it is capable of passing something that keeps our promise, as the House has already done," Ryan said. "Until the Senate can do that, we will never be able to develop a conference report that becomes law."

As of Thursday afternoon, the text of the Republican bill that would scrap Obamacare's individual and employer mandates -- known as the "skinny repeal" bill -- remained unseen by senators but it was discussed during a closed-door lunch and an outline of it has been circulating among lawmakers and lobbyists.

Multiple sources said the outline amounts to "repealing the pillars of Obamacare -- the mandates."

The outline, according to two sources who have viewed it, proposes: Repealing the individual mandate, repealing the employer mandate for a minimum of six years, providing greater flexibility to the states through the 1332 waiver, and defunding Planned Parenthood, directing those funds to Community Health Centers.

Ryan can't give guarantee

Many Republican senators simply do not view the "skinny bill" as good policy.

Majority Whip John Cornyn insisted he had "every expectation" that the bill would get to a conference, and that Senate Majority Leader Mitch McConnell and House Speaker Paul Ryan have been in communication about it.

But Ryan's office was not immediately able to give the guarantee GOP senators want. And there's no assurance Trump won't later call for the House to try a vote on the "skinny bill."

"Conference Committee is one option under consideration and something we're taking steps to prepare for should we choose that route after first discussing with the members of our conference," Ryan spokeswoman AshLee Strong told CNN.

As he received a barrage of questions from reporters about the Senate's strategy of passing something that it doesn't ultimately want the House to pass, Cornyn pushed back with this quip: "I guess we ought to go back to Schoolhouse Rock."

Rep. Mark Meadows, leader of the House Freedom Caucus, the group of conservatives who can help pass or sink a health care bill in the House, says he doesn't like a skinny-only plan.

"Am I gonna send a skinny health care plan to the President for him to sign? The answer is absolutely not," Meadows told reporters.

Sen. Ron Johnson, R-Wisconsin, noted that at the end of the day there's no controlling what the House will do. "We can't impose our will on the House," he said.

Vote-a-rama

The Republican Party's ongoing efforts to pass legislation to weaken the Affordable Care Act is expected to culminate in the famous Senate process known as vote-a-rama, in which senators can introduce an unlimited number of amendments -- often for the purpose of driving home a political point and forcing colleagues in the other party to cast uncomfortable votes.

Trump urged Republicans Thursday morning to get something passed.

"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!" he tweeted.

"Let's finish our work," McConnell urged his colleagues from the Senate floor shortly after the Senate gaveled into session for a session that likely won't conclude until early Friday morning. "Let's not allow this opportunity to slip by. We've made important progress already, we can build on it now. The moment before us is one many of us have waited for and talked about for a very long time."

Throughout the week, Democratic aides said they were fully prepared to flood the zone. The ultimate goal will be "to make this process so painful that voting 'no' on the final proposal will be the only thing that provides relief for them," was one aide's blunt outlook.

Sen. Patty Murray, D-Washington, blasted the possibility of an early-morning vote.

"It appears that the Republican leader has a last-ditch plan waiting in the wings," Murray said on the floor. "As soon as they have an official score from the CBO, which could be hours from now, in the dead of night, Sen. McConnell will bring forward legislation that Democrats, patients and families, and even many Senate Republicans, have not seen and try to pass it before anyone can so much as blink."

No matter what, senators are ready for an all-nighter.

"I brought my pillow," said Sen. John Kennedy, R-Louisiana. I don't think they let you sleep on the Senate floor -- but you can sleep in the hall if you need to."

Threat to Murkowski?

Leadership's careful maneuvering -- a "high-wire act," Cornyn, the second-ranked Republican chamber called it Wednesday -- came as the Trump administration was pursuing a different tact, according to a report in the Alaska Dispatch News.

According to that report, Interior Secretary Ryan Zinke called Alaska Sens. Lisa Murkowski and Dan Sullivan and informed them that Murkowski's opposition to the vote Tuesday to start debate "put Alaska's future with the administration in jeopardy."

Murkowski chairs the panel that's jurisdiction includes oversight of the Interior Department -- and Zinke.

The other Republican who voted against Tuesday's motion, Maine's Susan Collins, said she has not heard from the White House since that vote.

Asked directly if she's received any threats from the White House, Collins said, "No."