House Republicans on Thursday passed a bill to repeal the Affordable Care Act, but that doesn’t mean the law will be scrapped any time soon.
To win support of conservatives, the GOP leaders added provisions that allow states to gut benefits that insurers must provide and slash spending on Medicaid, which provides care for the needy. (If you’re wondering, the savings will fund a tax cut for people who earn more than $200,000 a year.)
Now the legislation moves to the Senate, where Republicans, who hold 52 seats, can only afford to lose one vote and where Democrats are united in their opposition to repeal.
The math doesn’t favor repeal along lines passed by the House. Among the GOP, Senators Rand Paul, Ted Cruz, Rob Portman, Lindsey Graham, Lisa Murkowski, Cory Gardener, Shelly Moore Capito, Bill Cassidy and Susan Collins all have expressed concerns with the legislation that emerged from the other chamber.
“Although I will carefully review the legislation the House passed today, at this point, there seem to be more questions than answers about its consequences,” Collins said following the House vote.
Unlike House Republicans, senators likely will wait for the Congressional Budget Office to assess what the bill – or any legislation for that matter – will do. When CBO last scored the legislation, it found that repeal of Obamacare would cause 24 million Americans to lose their health insurance over the next decade. Any estimate of the revised legislation that’s remotely close will leave Republicans concerned about the effect of repealing Obamacare on their prospects for re-election.
Elements of the House bill that likely will raise Republican objections in the Senate include the loss of coverage caused by the rollback of Medicaid and concerns that the House did not go far enough to preserve coverage for people with preexisting conditions.
But efforts to restore those protections in the Senate could jeopardize support from conservatives. Sen. John Cornyn, the Senate’s number two Republican, conceded as much following the House vote. “There is no timeline,” he told reporters. “When we get 51 senators, we’ll vote.”
Congress can send only one version of a bill to the president for his signature. So even if the Senate also passes a bill, congressional Republicans almost certainly will be left to negotiate among themselves. That means the Republican leadership in both chambers would appoint lawmakers to a conference committee, which would meet to reconcile the two versions. As the Congressional Research Service explains:
For a conference to reach agreement, a majority of the House conferees and a majority of the Senate conferees must sign the conference report. Once reported, the conference report must be approved by both chambers. Conference reports are privileged and debatable in both the House and Senate, but they may not be amended.
If both chambers approve the conference report, the legislation would be sent to the president for his signature. But for now hurdles remain. “This bill is going nowhere fast in the United States Senate,” Chuck Schumer, the chamber’s top Democrat, said on Wednesday.