Parliamentarian Deals Yet Another Killing Blow to Trumpcare

Jeff Malet/Newscom via ZUMA

I’ve been wondering when the Senate parliamentarian will rule on various provisions of the Senate health care bill, and apparently she already has. Today, Bernie Sanders released a summary of what’s in and what’s out. As you read this, keep in mind that the Byrd Rule allows a reconciliation bill to contain only provisions that directly affect the budget. If a provision only “incidentally” affects the budget, it needs to pass via regular order, which means it needs 60 votes—which means it’s dead. Here are the main provisions that are dead:

Abortion. The GOP bill contains two separate provisions that ban the purchase of health care policies that cover abortion. Freedom Caucus chair Mark Meadows says that killing these provisions makes passage “almost impossible.”

Planned Parenthood. This is a provision that prevents Medicaid from covering services provided by Planned Parenthood. Presumably this doesn’t pass muster because it doesn’t affect total spending, only where money can be spent.

Essential benefits. A provision in the Senate bill allows states to propose Medicaid alternatives that don’t cover essential benefits. However, this is merely a regulatory change, not something that changes overall spending.

CSR funding. This one is kind of ironic. The House has sued to stop the payment of CSR subsidies under Obamacare, and President Trump has deliberately refused to say if he’ll continue them. However, Republicans recognize how important they are, so they included them in their own health care bill. The parliamentarian struck down this provision because it duplicates something that already exists, which means it doesn’t affect the budget.

6-Month Lockout. This is the Republican replacement for the hated individual mandate. Instead of legally requiring everyone to buy insurance, they encourage everyone to buy insurance by mandating a waiting period if you fail to maintain continuous coverage. With this gone, there’s no longer any incentive to buy insurance. You might as well just wait until you’re sick and then buy it.

Medical Loss Ratio. This is a provision that does away with Obamacare’s mandate that insurance companies spend at least 80 percent of their revenue on medical care.

This stuff is deadly. Conservatives will hate the abortion and Planned Parenthood decisions. Insurers will hate the CSR and lockout decisions. Medicaid reformers will hate the essential benefits decision. And the end of the 6-month lockout provision will almost certainly have a big negative impact on the next version of the CBO score.