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US Senate in Showdown Over Health Law Overhaul


Senate Majority Leader Mitch McConnell leaves the Senate floor following a healthcare vote on Capitol Hill in Washington, July 26, 2017.

Three prominent Republican senators said late Thursday they would not vote for a partial repeal of the country’s health care law unless they received a guarantee from leaders in the House that they would not pass the plan “as is,” but instead would agree to negotiate a more comprehensive replacement to Obamacare.

Earlier this week, Senate Republicans failed twice to overturn the 7-year-old Affordable Care Act (ACA), either to repeal the law outright or to repeal it and at the same time replace it with a new version.

On Thursday, the party attempted to win enough votes to approve what Republicans are calling a “skinny” bill that would void part of the ACA. The proposal would end the requirement that most Americans must either buy health insurance or pay a penalty, and that employers must offer medical insurance to their workers.

Congressional Budget Office says the pared-down health care bill would result in 16 million more uninsured Americans.

‘Skinny’ repeal would limit changes to law

The scaled-down effort, which also would abolish a separate tax on medical devices, would leave intact much of what is commonly called Obamacare, the signature domestic legislative achievement of former President Barack Obama. There would be no change to an ACA requirement that insurers cannot deny coverage to people with pre-existing medical conditions that are costly to treat.

Some senators have been concerned the House of Representatives might simply ignore an earlier repeal bill it passed four months ago and instead duplicate the language of the Senate’s “skinny” bill and send it to President Donald Trump for his signature.

Republican Senators John McCain of Arizona, Lindsey Graham of South Carolina and Ron Johnson of Wisconsin threatened to withhold their votes for the “skinny” bill unless Speaker Paul Ryan guaranteed the House would form a conference committee with the Senate to negotiate more comprehensive legislation to replace the ACA.

“There’s an increasing concern on my part and others that what the House will do is take whatever we pass ... vote on it, and that goes to the president’s desk with the argument this is better than doing nothing,” Graham said. “I’m not going to vote for a bill that is terrible policy and horrible politics, just because we have to get something done.”

Ryan waits for Senate passage

Later Thursday, Ryan said the House would be willing to negotiate with the Senate over details of the health care legislation, once the Senate leadership manages to pass a bill.

“The House remains committed to finding a solution and working with our Senate colleagues,” Ryan said, “but the burden remains on the Senate to demonstrate that it is capable of passing something that keeps our promise” to voters to repeal Obamacare.

So far, Republican leaders have yet to secure enough votes to approve even the scaled-down bid, which they see as a way of honoring their campaign promises to repeal and replace the law. Conservative lawmakers want to gut as much as possible of Obamacare, while more moderate Republicans are worried that such changes could affect insurance coverage for millions of poorer Americans.

The House narrowly passed its original version of an Obamacare repeal in May. Trump initially applauded their achievement, but later he described the reduced benefits in the legislation disapprovingly, saying it was too “mean.”

Cheerleader Trump calls for action

Trump exhorted the Republican majority in the Senate in a tweet Thursday to move ahead on health care overhaul: “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!”

Hours later, the Senate was still debating the measure, a process expected to continue into the early morning Friday.

Republicans hold a 52-48 majority in the Senate. With all 48 Democrats opposed to overturning Obamacare, Republican leaders can only afford to lose two dissenters. Vice President Mike Pence would cast a tie-breaking vote in the event of a 50-50 deadlock, just as he did earlier this week in favor of formally opening the health care debate.

Of the two failed votes earlier in the week, nine Republicans first joined all the Democrats in rejecting a proposed bill crafted by Majority Leader Mitch McConnell. The second effort called for outright repeal of the law in two years’ time, during which period Congress would be expected to agree on replacement legislation; that was rejected by a similar margin, with seven Republicans joining the unified Democratic minority bloc.