July 22 (UPI) -- The Republican-led effort to overhaul healthcare incurred a potentially significant roadblock when the Senate parliamentarian said several provisions key to winning conservative votes would require 60 votes to pass, rather than 51.
Senate Majority Leader Mitch McConnell, R-Ky., chose to undertake healthcare reform using a process known as reconciliation. The procedural tactic was first introduced as a means for legislators to quickly alter budget-related legislation. In order to help quicken the process, legislation being considered under reconciliation is not subject to filibuster. The caveat is that the legislation must relate strictly to matters affecting the federal budget -- legislation dealing with policy rather than the nation's pocketbook is not eligible to be considered under reconciliation rules.
The Senate parliamentarian, Elizabeth MacDonough, acts as the referee, determining whether legislation meets the reconciliation requirements.
After Democrats voiced objections to elements of the GOP healthcare plan, MacDonough investigated. She offered initial guidance this week that several key parts of the GOP plan were outside the bounds of reconciliation, and would be subject to the 60-vote threshold necessary for ending a filibuster.
Specifically, MacDonough said GOP plans to cut all federal funding for Planned Parenthood and outlaw government-subsidized insurance plans that pay for abortion were policy-focused, rather than budget-focused, and would not be subject to reconciliation.
Additionally, she cited a provision in the House-passed healthcare overhaul known as the "Buffalo Bailout" because it permitted the federal government to redirect how it would disperse Medicaid funds specifically in New York. The provision was instrumental in winning the votes of the large bloc of House Republicans who represent parts of the state outside New York City. Though the measure does directly affect the federal budget for Medicaid, MacDonough said because it only affects one state and not the entire country, reconciliation would not apply.
That fact called into question whether other state-specific fixes included in various versions of the GOP legislation would also become problematic. GOP leaders have drafted legislative fixes to address specific concerns by lawmakers from Alaska, Florida and Louisiana.
"Republicans have given up on good policy, so they turned to legislative giveaways instead," said Sen. Chris Murphy, D-Conn. "[Saturday's] ruling by the parliamentarian means they can't count on the Polar Payoff, Bayou Bailout, or Sunshine Sellout to do their whipping for them."
The other key provision on the chopping bloc is the GOP provision permitting health insurance companies to impose a six-month waiting period for plans to kick in if someone had previously been uninsured. The provision addresses one of the most reviled portions of the Affordable Care Act for conservatives, the federal mandate all Americans have to buy insurance. Eliminating that penalty would enable healthy people, who insurance companies need to enroll to help bring down the cost of insurance, could simply wait until they get sick to buy insurance. The six-month waiting period was meant to address that problem, but again MacDonough said such a provision is a policy question and not relevant to the federal budget, and thus not subject to reconciliation.
A spokesman for McConnell's office downplayed the potential effect of MacDonough's initial ruling, saying it "largely follows what we expected; most of our bill is appropriate for reconciliation" and that "a few items may need modification," according to Politico.
"The parliamentarian has provided guidance on an earlier draft of the bill, which will help inform action on the legislation going forward," said Joe Brenckle, a spokesman for Republicans on the Senate Budget Committee.
Republicans overcame similar rules objections in 2015, when they passed a bill to repeal the Affordable Care Act, though that legislation did not attempt to replace Obamacare, a considerably larger undertaking.
When Democrats passed former President Barack Obama's signature domestic policy achievement in 2007, they enjoyed a filibuster-proof 60-seat majority in the Senate, and did not face the same parliamentary hurdles the GOP must now navigate.
The parliamentarian's rulings could be moot anyway if Republicans can't muster the 51 votes necessary to begin formal debate of the legislation. With a slim 52-48 majority and all Democrats expected to vote "no," Republicans can afford to lose only two votes and still proceed, with Vice President Mike Pence breaking a 50-50 tie. As of last week, at least four GOP senators had publicly stated their opposition, split between moderates who want the bill to cover more people and conservatives who are seeking to cut Medicaid spending and repeal regulations on the healthcare industry put in place under the ACA.