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Key senators resist Republicans’ ‘skinny’ Obamacare repeal

A long day of Senate debate set up a longer night of voting, when Republicans plan to propose the one health care idea they think could pass: a stripped-down repeal that would abolish the individual and employer mandates, as well as one tax on medical devices, while leaving Medicaid and much of the Affordable Care Act unchanged. Lisa Desjardins and Sarah Kliff of Vox join Judy Woodruff for more.

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    Republican efforts to pass health care reform ran into even more roadblocks this evening. A group of key senators balked at voting for what some have called the last resort, a version labeled skinny repeal. This came as plans were laid for debate and maybe a final vote later tonight.

    Our Lisa Desjardins begins our coverage.

  • WATCH:

    These Republican senators say they won't vote for 'skinny' health bill unless there's broader debate


    A long day of debate setting up a longer night of votes, with Republicans stressing the failures of Obamacare.


    Conditions have changed in Tennessee. Our insurance market is — quote — "very near collapse." That means that up to 350,000 individuals in our state, songwriters, workers, farmers, who buy their insurance on individual market are sitting there worrying in July and in August whether they will have any option to buy insurance in 2018.


    And Democrats insisting that Republicans' plans could mean no choices, especially for the poor.


    Where there is a serious disagreement is, we say that the children of this country who have serious illnesses have the freedom to stay alive, even if their parents do not have a lot of money.


    The debate all leading lead up to a whirlwind called vote-a-rama. Senators will take up amendment after amendment with little debate and five-minute votes. All or nearly all are expected to fail. Then, at the end of the legislative marathon, comes the key moment.

    Republicans plan to propose the one idea they think could pass now: a stripped-down, minimal repeal. It would abolish Obamacare's individual and employer mandates, as well as one tax on medical devices. It would leave Medicaid and much of the rest of the Affordable Care Act essentially unchanged.

    Some on Capitol Hill call it the skinny repeal, but the nonpartisan Congressional Budget Office found it would mean 15 million fewer Americans with health insurance. And there is another issue: The CBO also found the idea would save $78 billion. But to comply with special rules that Republicans are using, this plan would need to save at least $133 billion, the score for the original House bill.

    As the votes stack up, so has more White House pushback at Alaska Senator Lisa Murkowski, who voted against starting debate. First reported by Alaska Dispatch News, Murkowski, along with fellow Alaskan Senator Dan Sullivan, received grave phone calls from President Trump's Interior Secretary Ryan Zinke.

    He warned that the no vote put Alaska's future with the administration in jeopardy. The paper speculated jeopardy meant problems for Alaska's energy concerns.

    Murkowski is standing her ground.


    I'm a pretty strong and independent individual.


    Meantime, as to the endgame, Republicans admit, if they pass a bill, it would be a placeholder to negotiate with the House.


    It is not a solution to Affordable Care Act problems. But is its a solution to how we get to a place where we can write a solution to the Affordable Care Act problems.


    Meantime, Democrats predict a last-minute bill would backfire.


    If they jam it through, they will be held accountable for the millions of people who lose care and the millions and millions more who will see their premiums go up.


    Everyone on both sides is looking at a long night.


    You can sleep out in the hall in between votes.


    So, Lisa, late today, what we were suggesting as we introduced your piece is you had a group of Republicans coming out and saying they're not even prepared to vote for this so-called skinny repeal, which many had thought was going to be the last resort.


    This is a late and rather potentially pivotal twist led by Senator Lindsey Graham of South Carolina. Also, John McCain was standing there, as well as Ron Johnson of Wisconsin.

    All three of those senators said they will not vote for that so-called skinny repeal or that smaller repeal bill unless they are guaranteed that that is not the end, that they are guaranteed that the chance to debate a larger bill what's called conference committee with the House.

    And that's critical. That means that we won't see the health care end — the health care debate end this weekend, as some people were starting to talk about.


    Lisa, how did they get to the point where right here at the — beyond the 11th hour, you still have Republican senators saying they're not comfortable with the options they're being offered?


    I think there is a graduate-level class and probably several in the works that will look at that exact question, Judy.

    But, from my viewpoint, one of the issues here was that they didn't go through the usual process. They didn't go through committees. They didn't have public discussion. They did not have drafts of this bill.

    And, in fact, Judy, as I talk to you right now, there is still no draft of what could be the final proposal before senators. I talked to Ron Johnson, who said he wants to improve this bill, along with those other senators, to give more money to states in block grants.

    I said, when will your amendment be drafted? He said, "We can't draft it now because we don't know what we're amending."

    So, I think the process itself has led to these large questions here near the very end.


    When are the arguments, Lisa, that are mainly being used by the Republican leadership, and for that matter by the White House? Do they have any presence as this moves closer to an attempt to pass something?


    Vice President Pence has certainly been an important factor. He was here today speaking to small business owners. I have not seen him on the Senate side today, but I understand he has been making phone calls.

    But I think the basic gist of this, Judy, is rather simple. Republican leaders in the Senate seem to be saying, vote for this or nothing. This is your one shot. Initially, they were saying, we will add to it, we will improve it later.

    But late today, they seemed to be saying, we actually could pass this with the House this weekend. And that's another important development to watch, Judy. The House has now signaled to its members that they should be ready to stay this weekend, and they are preparing a rule that would allow them to pass anything, including a health care bill, same day.

    So if the Senate passes something, the House could pass it very quickly. But just like on the Senate, it's not clear that the House Republican Conference supports any one vehicle. Very complicated, and right now, it seems the last hour has not worked to the leadership's advantage.


    So, as we sit here or stand here, or you stand there, Lisa, as the evening gets under way, you're saying this is truly up in the air?


    That's right. It is.

    And I think it will be a long night. And that vote-a-rama that we explained, right now, the timing of that is on hold. I know this, Judy. A lot of people have ordered pizza. I have brought my toothbrush. My husband doesn't know that yet, but I think we just don't know what's going to happen, but it will be an important next 24 hours.



    Toothbrush better than pizza.

    Lisa, thank you. And good luck staying up all night.


    Thank you.


    Well, as you have heard, we keep talking about so-called skinny repeal.

    Let's look at exactly what that means.

    And, for that, we bring in Sarah Kliff. She is a senior policy correspondent for the Web site Vox. She has written extensively on health care.

    Welcome back to the program.


    Thank you.


    Sarah, so we are throwing around this term.

    As we heard from Lisa, there are senators who are saying even this may not be acceptable to them. But for purposes of conversation, it is going to be one of the measures, we think, on the table. What does it mean?


    So, it basically means repealing the individual mandate, this requirement to purchase health coverage.

    We have seen other parts come in, come out, the medical device tax, defunding Planned Parenthood, but, at the core, it's the repeal of the requirement to purchase health coverage.


    So, it's rolling back some of Obamacare, some of the Affordable Care Act, but not as much as full-blown repeal would be?


    It's certainly not as much, so compared to the other bills, the one that passed through the House, for example, the American Health Care Act, which would get rid of much more in the health care law, the essential health benefits, for example, this is smaller, but it would affect a lot of people.


    Well, and that's what I want to ask you about, because you wrote a piece for Vox today which was titled "Skinny Repeal Isn't Skinny at All."


    Yes, this is a bill would cause about 15 million people to lose coverage.

    So, I kind of say skinny repeal is a misnomer, that this would really change the individual market. The Medicaid expansion, that would mostly function the same, but for people who purchase coverage in the individual market, they could expect premium increases of 20 percent. A lot of people would drop out of the market.

    I don't think most Americans would see that as a skinny, small change.


    One of the things you were writing about is the integral role that the individual mandate plays in all this.

    Remind us why that matters so much.


    That's a requirement that nearly all of us in the United States have to purchase health insurance.

    And the draft version of the Affordable Care Act, they knew that was unpopular. They included it because they needed a way to get healthy people into the insurance market. If you don't have mandate, the fear is that only the sick people who really need coverage sign up, premiums get really high, you could enter a death spiral, where premiums just go higher and higher.

    So, even Republican senators agree on this point, that the mandate, it is what makes the market work. It gets the healthy people to sign up.


    And that explains the number you gave at the beginning of our conversation, the 15 million.

    The larger repeal would have meant 24, 25 million people losing coverage. But you're saying even this is 15, 16 million.


    Yes, the big difference is Medicaid.

    So, those other bills, they would have ended Medicaid expansion, would have had much, much more significant Medicaid losses. And there are actually some Medicaid losses associated with individual mandate repeals.

    The CBO thinks that, if there isn't a mandate, if people don't hear this message health insurance is mandatory in the United States, they might not sign up for Medicaid. But the real challenge here is in the individual markets.


    And it does sound like, with this, as we said, late-day news conference, Senator Lindsey Graham, other Republicans coming out and saying, we're not prepared to support this unless we know the House is going to work with us on this, indicates that they're getting some of this message.


    Yes, they understand.

    Lindsey Graham was saying, you know, in his press conference, we don't think this is good policy. We don't think it's good to take the individual mandate out of the marketplace. So they recognize these consequences.


    Sarah Kliff with Vox watching it all very closely, thank you so much.


    Thank you.

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