Senate Republicans have a last-ditch effort to get ‘skinny’ on their healthcare bill — here’s what it looks like

The Senate is moving ahead with its efforts to overhaul the US healthcare system, in what is shaping up to be a more moderate, “skinnier” attempt at repealing certain provisions of the Affordable Care Act.

There are a number of healthcare bills that the Senate will consider, including versions the Better Care Reconciliation Act (the repeal-and-replace plan — one of which already failed a vote) and the Obamacare Repeal Reconciliation Act (the repeal-only plan).

Should these fail to get support, GOP senators have said Senate Majority Leader Mitch McConnell would move on to a “skinny repeal” plan, a last-ditch effort in which a series of amendments would aim to repeal certain unpopular parts of the Affordable Care Act.

Here’s what ‘skinny repeal’ would look like:

  • The “skinny repeal” bill would repeal both the individual and employer mandates, which requires individuals to have health insurance, and employers to provide health insurance to employees. If they don’t, they face a penalty fee under Obamacare.
  • It would also repeal some of the taxes that the ACA put in place — most significantly, a tax on medical-device makers.
  • The skinny bill would likely leave everything else untouched.

While the text of the “skinny repeal” bill hasn’t been released yet, the bill would be nowhere near as extensive as the full-repeal plan or the BCRA. But it would seek to alter the much-criticised mandates that Republicans have targeted for years.

Getting rid of the individual mandate with no other changes to the bill, according to the Congressional Budget Office, would leave 15 million more Americans without healthcare by 2026. The change would also lead to a 20% increase in premiums, the CBO said. It could also send the ACA marketplace into a “death spiral,” health experts warn.

Why the Senate might resort to a ‘skinny repeal’

Chris Krueger, an analyst at the Washington-based Cowen and Company, compared getting every GOP senator on board with a bill to squeezing a balloon, because it’s so hard to align both moderates and conservatives on a plan.

That was clear Tuesday night with the vote on a revised version of the BCRA, in which nine Republican senators voted against the bill, including both conservatives and moderates. On Wednesday, a vote is scheduled for the Senate’s repeal-only bill, which should shed some light on who wouldn’t be swayed by that option.

If the Senate is successful in passing a skinny repeal, Senate Republicans would then need to find common ground with House Republicans to get to a bill that both chambers can agree on. That could be a rather lengthy process.