I want to share a quick update on where we’re at as you’ve likely seen the developments on the prospects of the Senate passing a “skinny repeal” bill throughout the day. I also have some key materials, analysis and information to share with you below. The bottom-line is we are down to the wire on the “skinny repeal” bill making final passage presumably late tonight.

 

As you have likely seen, Republicans are still in the process of piecing together their final “skinny repeal” bill language with the goal of putting it up for final passage tonight. Senate GOP leadership has been marketing this bill to Senators as a vehicle to get to conference so other amendments can be considered as part of an agreement.

 

Earlier this afternoon rumors began to surface that House Republican leadership was planning to hold a concur vote on the Senate-passed “skinny repeal” bill, rather than have it go to conference. The House Majority Whip has instructed members to clear their calendars this weekend and they are looking to take up martial law in the House, which would allow them to pass the Senate repeal bill in one day.

Shortly after Senators McCain, Graham, Cassidy and Johnson held a press conference threating to vote no on final passage of the “skinny repeal” if they did not get strong assurances from the House that this bill would go to conference, and not be voted on or passed as is. Developments on this are happening as we speak and it remains to be seen if and how much an assurance the House will give the Senate on this bill going to conference. If they do not provide a strong assurance, based on these Senators comments today – they will vote no. If they DO give an assurance – we are close to this bill getting enough votes for final passage this evening. Right now, it is expected Speaker Ryan will give the assurance it will go to conference.

It has shaped up to be a long, late night. Vote-a-rama could start shortly, which will allow for technically unlimited amount of amendments to be voted on.  Hundreds have been lined up, but Leader McConnell does have the procedural ability to shut it down if he feels it’s gone on too long. After that, they would theoretically get to voting on final passage for the “skinny repeal” bill sometime later tonight.

 

We are certainly concerned at the prospects of this “skinny repeal” making final passage. It is definitely not too late – calls, calls, calls and showing up at vigils, rallies, events and other actions happening near you tonight (and tomorrow if the schedule slips) is another last minute, but powerful way to give your Senator a very compelling visual of the strong opposition to this bill in their state. Check www.townhallproject.com for events.

 

Thank you again for everything – we will continue to keep you updated & posted. Please feel free to share updates, intel, and pictures of the amazing actions I know are happening as we speak. More to come soon – thank you for everything you’re doing!  

 

1. Keep an eye on our Senate Floor Debate Tracker – we are updating it regularly with posts & analysis as it relates to issues being debated on the floor:
   1. https://www.cbpp.org/blog/tracking-the-senate-floor-debate-on-health-care-repeal#0725171915
2. Bi-partisan Governor’s letter opposing skinny repeal bill (attached)
3. New! CBPP Paper on the Cassidy-Graham Amendment
4. New! House-Senate Conference on Health Bill Likely Just as Secretive as Senate Process (Conference process explainer)
   1. Corresponding shareable graphic attached!
5. PoliticoPro – the latest on what’s likely to be included in the skinny repeal bill (pasted below)
6. AHIP Letter to Senate opposing skinny repeal bill
7. American Cancer Society CAN statement opposing skinny repeal (attached)
8. ICYMI, PoliticoPro: Senate Republicans hope their own Obamacare repeal won't become law

 

3. New! CBPP Paper on Cassidy-Graham amendment:

 

We’ve just posted a paper from Judy, Edwin, Aviva, and Matt on the Cassidy-Graham amendment:

https://www.cbpp.org/research/health/cassidy-graham-amendment-would-cut-hundreds-of-billions-from-coverage-programs-cause

 

The lede:

Senators Bill Cassidy and Lindsey Graham have introduced an amendment to the GOP health bill that they describe as focused on state flexibility and equalizing payments across states rather than cuts. But the amendment would make drastic cuts to both Medicaid and marketplace financial assistance.  

 

Tweet idea

Cassidy-Graham amendment would cut hundreds of billions from coverage programs, cause millions to lose insurance: http://bit.ly/2tHmWHO

 

4. New! CBPP Explainer on House-Senate Conference:

House-Senate Conference on Health Bill Likely Just as Secretive as Senate Process

July 27, 2017 at 1:00 PM

by David Reich

https://www.cbpp.org/blog/house-senate-conference-on-health-bill-likely-just-as-secretive-as-senate-process

Now that the Senate has rejected two measures to repeal the Affordable Care Act (ACA), Majority Leader Mitch McConnell is promoting a so-called “skinny repeal” with the sole and explicit goal of advancing health legislation to a conference with the House, which passed its own ACA repeal bill in May. On this issue, a conference committee — a traditional method of resolving differences between House- and Senate-passed legislation — won’t likely be any more open and inclusive than the Senate’s secretive approach to date. And nothing in the rules for House-Senate conferences prevents Republican leaders from continuing their closed-door, partisan approach to rewriting our nation’s health care laws.

Here’s why:

• Congressional leaders can exclude conferees from the real negotiations. Under the conference process, the House and Senate each appoint conferees, who come from both parties and are charged with negotiating a final compromise, called a conference report. If both chambers pass the report, it goes to the President for his signature.

Fundamentally, there are only two requirements for conference committee conduct: it must meet publicly at least once, and a majority of conferees from each chamber must sign the report. The conferees can hold extensive public meetings, or the chair can simply convene the conference once, for a brief session in which no actual business is transacted, while the real negotiations occur behind closed doors. Thus, nothing would stop Senator McConnell and House Speaker Paul Ryan from excluding all but a few Republican members from the decision-making process, which they’d likely do in an effort to craft a conference report that will secure a slim majority in both Republican-controlled chambers.

• Conference reports are final products and can’t be amended. A conference report receives special treatment on the House and Senate floors, enabling each chamber to vote up or down on it without amendment. Also, in the case of a “budget reconciliation” bill like the current health legislation, Senate debate on the conference report is strictly limited to just ten hours.
• A conference report retains reconciliation’s special protections. As long as Republican leaders continue to use the reconciliation process to modify or repeal the ACA, the conference report can pass the Senate with just a simple majority rather than the 60 votes needed to end a filibuster on other kinds of legislation.

Of note, the “Byrd Rule” still applies to the conference report. Named after its chief sponsor, the late Senator Robert Byrd of West Virginia, the rule allows senators to block provisions of reconciliation bills that are “extraneous” to reconciliation’s basic purpose of implementing budget changes. The conference report must comply with the Byrd Rule, so any provisions that don’t are subject to a “point of order” that could force the Senate to remove them from the bill. That applies to all Byrd Rule violations, whether the violations were present in earlier versions of the health legislation or were added during the conference.

 

5. PoliticoPro blurb on the latest skinny repeal bill outline

 

By Jennifer Haberkorn, Seung Min Kim and Rachana Pradhan 07/27/2017 12:23 PM EDT

Republican leaders are making the Senate's so-called skinny Obamacare repeal bill even slimmer.

Sources on and off Capitol Hill have described a new outline that would do the following:

— Repeal the Affordable Care Act's individual mandate.

— Partially repeal the ACA's employer mandate.

— Defund Planned Parenthood for one year and transfer the funding to community health centers.

— Give states new authority in Section 1332 waivers.

— Significantly cut the ACA's Prevention and Public Health Fund.

The slimmed-down package would no longer repeal the ACA's medical device tax, or other taxes created by the health law.

The bill is likely to go through further changes as Republicans try to pass a repeal plan at the end of an all-night Senate "vote-a-rama" anticipated to begin this evening.

To view online:
https://www.politicopro.com/health-care/whiteboard/2017/07/skinny-obamacare-repeal-getting-slimmer-sources-say-091176

ICYMI: Key quotes in this article…

 

Senate Republicans hope their own Obamacare repeal won't become law

By John Bresnahan, Burgess Everett, Jennifer Haberkorn and Seung Min Kim

07/27/2017 11:36 AM EDT
Updated 07/27/2017 03:55 PM EDT

Mitch McConnell is making one last frantic plea to his Senate Republican members to advance the party's scaled-back Obamacare repeal, assuring them at a private lunch that the vote is merely aimed at getting to conference with the House rather than immediately becoming law.

The Senate majority leader picked up some key votes at lunch, with Rob Portman (R-Ohio) endorsing the shriveling repeal effort as a bridge to bicameral negotiations. Not everyone was sold, but GOP leaders were emphasizing that the bill, which would slash Obamacare's coverage mandates and result in millions more uninsured, is not the ultimate goal.

"I believe the leader has been in communication with Speaker [Paul] Ryan on that topic," said Majority Whip John Cornyn (R-Texas). "The request to go to conference has to come from the House, so that would probably be the best people to talk to. But I have every expectation we will."

Rank-and-file members struggled to explain if there is a guarantee that the bill they are set to vote on within hours would not actually become law. There is some concern that the House would adopt a "martial law" procedure that would allow them to take up and pass the health care bill in the coming days.

Steve Daines (R-Mont.) likened it to a "motion to proceed" to conference rather than concrete policy, though Roger Wicker (R-Miss.) said "theoretically there's no way" to get a concrete assurance that the House won't just pass the bill and send it to the president.

"We want assurances of that. And I think they will get them. I know Mitch is planning to give that, and I think people will support whatever it is that can keep our efforts alive," said Bob Corker (R-Tenn.).

McConnell was short of the votes as of Thursday afternoon even as some senators cautiously predicted victory.

Republicans must get 50 of their 52 members on board; Vice President Mike Pence would break a 50-50 tie to pass the bill.

Dean Heller (R-Nev.), who indicated earlier support for the effort because it skirts the issue of Medicaid, was noncommittal on Thursday afternoon after Nevada Gov. Brian Sandoval savaged the bill. So were Shelley Moore Capito (R-W.Va.) and Lisa Murkowski (R-Alaska). Mike Lee (R-Utah) wants a "fatter repeal" than has been presented, a spokesman said.

John McCain (R-Ariz.) said he was "certainly not" a yes and needed to talk to his governor.

Lindsey Graham (R-S.C.) said he would vote against it unless he is assured that the parliamentarian will allow his proposal to block-grant federal health care money to the states and keep Obamacare's taxes.

Graham and other senators said they are wary of voting for a proposal that is not good policy and is being sold as a bridge to conference.

"I cannot tolerate our skinny bill being the final answer on health care. ... No way. If you passed it as a standalone proposition, it would destroy the insurance markets and we would own the failure of Obamacare," Graham said. "I'm a no" if it's not allowed in conference.

Jeff Flake (R-Ariz.) and Portman said they would vote "yes." Portman's governor, Republican John Kasich, also urged against voting for the bill on Wednesday, though Portman said he would only vote for the bill if it leads to negotiations with House Republicans.

The bill itself was evolving rapidly, as Senate Republicans' once-ambitious Obamacare repeal effort kept narrowing, with growing doubts over whether the GOP can fully eliminate the health law's coverage mandates or any of its taxes.

The GOP's "skinny" repeal bill, in other words, is getting even skinnier.

"I don't know whether at the end of this process it's going to be fat, skinny, bulimic, anorexic, I don't know. This is not being orchestrated, I can assure you," said John Kennedy (R-La.).

Sources on and off Capitol Hill on Thursday described a blueprint that would repeal the law's individual mandate and partially delay its employer mandate. It also would defund Planned Parenthood and give states more flexibility to opt out of Obamacare regulations; the law's Prevention and Public Fund is also expected to be sharply cut. But there are growing concerns among Republicans that budget requirements will prevent the Senate from repealing any of Obamacare's taxes.

McConnell emailed GOP senators on Thursday outlining the current provisions in the bill; the message noted that the employer mandate would be repealed for a minimum of six years, according to a source who viewed the email. Another GOP source said the employer mandate would be halted for eight years.

Not everyone said they were familiar with the bill.

"I don't know what it looks like," Murkowski said.

Even as the chamber careens toward a final decision on whether to repeal, replace or revise Obamacare, with no certain outcome, Republican leaders are desperate to get rid of their political headache after several failed votes earlier this week.

"We have to pass something," said Orrin Hatch of Utah, the most senior GOP senator and chairman of the Finance Committee.

The Senate will begin a series of votes on Thursday afternoon designed to test what senators will support for an Obamacare replacement bill, dubbed a "vote-a-rama." This will help determine whether Senate Republicans can reach any consensus among themselves. The session could last until Friday morning, depending on GOP and Democratic maneuvers, and culminates in a final passage vote.

A GOP effort to see whether Democrats support a single-payer health care system garnered 0 votes. Most Democrats voted "present," though some moderates voted against it.

McConnell is expected at some point to unveil the GOP's highly anticipated "skinny repeal" bill — the narrowest effort to dismantle Obamacare that can win at least 50 votes.

"We all know this is likely to be a long night. It's part of a long process that has taken a lot of hard work from a lot of dedicated colleagues already," McConnell said on the floor Thursday.

Senate Minority Leader Chuck Schumer said he's been assured by senators in both parties that if the bill fails, the Senate will start over in committee. But Republicans want to get the issue off their plate and are seeking a bridge to negotiations with the House, not necessarily a final policy solution.

They want to pass something — anything — and hope they can forge a broader deal in conference committee with the House and White House, even if it could reopen painful party divisions on proposed cuts to Medicaid spending and efforts to slash Obamacare regulations.

McConnell and his top lieutenants started from a bare-bones plan that would repeal Obamacare's individual and employer coverage mandate, as well as the medical device tax. There are now major questions about whether those three things can pass Senate rules.

Republicans are seeking to repeal as many of Obamacare's taxes as they can, but doing so would blow holes in the budget. Some sources doubted Republicans would even be able to repeal the medical device tax.

Some GOP senators were pushing for billions of dollars in new funding for fighting opioid addiction to be included in leadership's package, part of an effort to restore the $45 billion in such funding already promised by McConnell in previous bills. But that has been ruled out as spending too much money to hit budget targets; the Senate must hit at least $133 billion in savings, as required under Senate rules, GOP sources said.

The parliamentarian has found that language allowing states to undo some of Obamacare's consumer protections might not be allowed under reconciliation rules, according to Bernie Sanders (I-Vt.), the ranking member on the Budget Committee.

"We're trying to come up with a package that does the things that we want, and I think principally those are going to be the mandates," said South Dakota Sen. John Thune, the third-ranking Senate Republican. Asked if that would include tax cuts, he said: "At the moment, it doesn't look like it."

To view online:
https://www.politicopro.com/health-care/story/2017/07/senate-waits-for-gops-skinny-repeal-bill-160187