In a major, and perhaps fatal, blow to any version of Trumpcare, senate parliamentarian Elizabeth MacDonough has excluded several key features of the latest bill to repeal-and-replace Obamacare as items that cannot be enacted under the filibuster-immune special budget rules.
In an explanatory document released late Friday by the Senate Budget Committee, a number of provisions have run afoul of the parliamentarian’s so-called “Byrd Bath,” a review (named after the late Sen. Robert Byrd) designed to ensure that budget bills stick to dictates that have an impact on the budget.
The GOP leadership can disregard the ruling, according to the rules.
But that appears unlikely, as it would amount in practise to gutting "the legislative filibuster" that Mitch McConnell has said, contrary to Trump's urging, he wants to preserve.
Out of Order
Here's the high-level overview of some of what they can't pass with 51 votes:
- Defund Planned Parenthood
- Remove tax credits for policies that cover abortion care
- Dropping Essential Health Benefits (EHB) coverage for Medicaid
- Requiring a "six-month lockout" for anyone whose coverage lapses
- Allowing states to determine the Medical Loss Ratio (what insurers can spend on overhead and marketing instead of health care)
- Allowing states to roll over unused Medicaid block grant funds to the following year and spend them on anything, including things which are unrelated to health care.
- State-specific buyoffs like the House-based "Buffalo buyout"
- The only provisions which can pass with 51 votes are the Medicaid work requirements, the extra money allocated to non-Medicaid expansion states, repealing cost-sharing subsidies, and some reporting requirements.
The Parliamentarian is still reviewing the state waivers for Essential Health Benefits, Association health plans, the Age Tax allowing insurers to charge older people 5 times what younger people pay, and the Medicaid block grant provisions.
The Cruz amendment allowing states to allow individual private policies that do not cover all essential services in order to keep prices down was added too late to go to the parliamentarian for evaluation, and it's very likely to get shot down, too.