On Friday, Senate Democrats released a list of provisions in the Republican health-care bill that the Senate parliamentarian holds can pass via a simple, filibuster-proof majority vote. Among those provisions that didnt meet her scrutiny are the bills plans to defund Planned Parenthood, restrict tax-credit funding for insurance plans that provide abortions, and a six-month lockout period from purchasing insurance for people who dont maintain continuous coverage.

If this preliminary guidance holds, the Better Care Reconciliation Actwhich is already in dire straitsseems likely to fail.

The GOP Escalates Its Battle With the CBO

The final assessment of the parliamentarian, Elizabeth MacDonough, is a critical step in the GOPs strategy for passing their bill to repeal and replace Obamacare. Republicans have opted to pass their health-care legislation via the special reconciliation process, under which they can cut debate short in the Senate and thus eliminate indefinite filibusters, which Democrats would certainly use in order to block any attempt to repeal Obamacare. But bills have to follow a certain procedurecalled the Byrd Rulein order to pass by reconciliation.

Broadly, the Byrd rule states that reconciliation legislation can only include changes to laws that directly affect the federal budget, and can be scored by the Congressional Budget Office. So for example, Republicans could repeal Obamacare premium tax credits via reconciliation by making the credit $0 for everyone, but couldnt in theory use the same bill to eliminate the requirement for insurers that take premium tax credits to also take people with pre-existing conditions.

In practice, the parliamentarian reviews every provision of a reconciliation bill and outlines which ones pass muster under the Byrd rule by her own judgment. In this instance, according to the Democratic outline, MacDonoughs office ruled that abortion restrictions on the premium tax credit and the small business tax credit, and the language defunding Planned Parenthood, violate the Byrd Rule. Additionally, other provisions on the chopping block include the BCRAs six-month continuous-coverage lockout, and its sunset of minimum requirements for alternative private-administered Medicaid plans.

Still under review are the BCRAs provisions that allow states to waive certain essential health benefits for exchange plans, increase the age-rating scheme for older adults, and allow Medicaid funding to go to states in lump sum block grants.

Notably, all of these provisions that have either been challenged by the parliamentarians office or still await a final determination are those that were included in the BCRA to gain the support of hard-core conservatives, who, like their counterpart moderate faction have often criticized the bill and could harpoon any legislative action. Its hard to see how a bill that retains Planned Parenthood funding and the use of premium tax-credits for plans that cover abortion would proceed to debate through conservative objections.

There is hope among the backers of the bill that the parliamentarians guidance would allow them to rewrite the key provisions in a way that would allow them to pass the Byrd rule. But the clock is ticking, and substantive rewrites might have to pass CBO review again, and the CBO has been a thorn in Republicans side over the past few weeks.

Some Republicans are hinting at more radical steps to get past MacDonoughs review. Senator Ted Cruz of Texas has been floating the idea of simply ignoring the parliamentarians review for months now. The presiding officer of the SenateVice President Mike Pencetechnically makes the final call on parliamentary procedures, and could overrule the parliamentarians objections, although this would be a highly controversial break of Senate norms that hasnt been attempted for over 40 years.

But this seems to be the era of flouting norms, as evidenced by the increasing willingness of Senate Republicans to challenge the CBO scoring process, and perhaps even consider the filibuster nuclear option. Its hard to rule anything out at this stage.

Link:

The GOP Health-Care Bill's Byrd Rule Dilemma - The Atlantic