Portions of the Republican bill to repeal and replace ObamaCare will require 60 votes for passage, the Senate parliamentarian said Tuesday evening. The parliamentarian has advised senators that two provisions could be stripped out, according to a document released Tuesday by Sen. Bernie Sanders (I-Vt.), the ranking member of the Senate Budget Committee.

The provisions in question would allow insurers to charge older people premiums up to five times as high as what they charge younger people — which AARP has called an “age tax” — and would allow small businesses to establish “association health plans” that could be sold across state lines. That aspect has been championed by Sen. Rand Paul (R-Ky.)

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Senate Republicans voted to advance to floor debate on their efforts to repeal and replace Obamacare.

Vice President Mike Pence cast the tiebreaking vote. In a dramatic moment, Sen. John McCain returned from Arizona to applause from fellow senators. He cast a necessary Republican vote for the motion after two GOP senators — Susan Collins and Lisa Murkowski — sided with all Democrats in opposition.
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Following a week of high-level negotiations among GOP senators, Republican leadership is planning a Tuesday vote on the motion to proceed to the House-passed American Health Care Act (AHCA) — the vehicle for their health care reform efforts. The process has been shrouded in confusion and uncertainty, as it still remains unclear what legislation Senate leaders ultimately hope to move forward. And while knowing what’s in the Senate bill may be, as Senate Whip John Cornyn said, a “luxury we don’t have,” it’s worth acknowledging that there’s still a narrow path towards passage.

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The larger stakes in the ObamaCare fight are whether Republicans can be a governing party. They can win elections but not since the early 2000s have they showed they can pass a major reform through Congress. They blew it the last time they controlled both ends of Pennsylvania Avenue in 2005-2006. They’ve already wasted six months on health care in this Congress with nothing to show but division and discord.

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On July 21, all eight former directors of the Congressional Budget Office sent a letter to Congress defending the integrity and professionalism of CBO. But even institutions with integrity can occasionally be wrong. CBO’s score of the House and Senate healthcare bills is a case in point.

The former directors did not comment on, much less defend, those specific CBO scores. They merely objected “to recent attacks on the integrity and professionalism of the agency and on the agency’s role in the legislative process.” They could not defend the scores of the Republican plans, because they, like all other Americans, cannot see the underlying models and assumptions.

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President Trump on Monday made a late-hour appeal to senators – targeting members of his own party – to move forward with debate over faltering Republican legislation to overhaul the Affordable Care Act. “Any senator who votes against starting debate is telling America that you are fine with the Obamacare nightmare, which is what it is,” Trump said in an afternoon address from the White House on the eve of an anticipated Senate vote that could spell defeat of the long-sought legislation.

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The latest version of the Senate GOP’s bill to partially repeal and replace Obamacare was pronounced dead the evening of Monday, July 17, when Utah senator Mike Lee and Kansas senator Jerry Moran announced their opposition, bringing the number of “no” votes to at least four. Where do things go from here on health care? No one knows. Here are five possibilities:

2. “Repeal-and-delay.”
3. A small bill.
4. Bipartisan bailout.
5. Nothing.

Thirty years before Republican lawmakers imperilled President Donald Trump’s hopes of uprooting Obamacare, the property mogul penned some negotiating tips in The Art of The Deal. “The worst thing you can possibly do in a deal is seem desperate to make it,” he wrote.

In a week when his party’s inability to repeal and replace his predecessor’s health programme bordered on farce, Mr Trump has appeared to be following that tip. “Let Obamacare fail, it will be a lot easier,” he said, suggesting that if there was to be no deal on an orderly overhaul of the system, it should be left to collapse on its own.

With disarray over healthcare ranking among the ignominies of the president’s first six months in office, the let-it-fail mantra injected a fresh dose of chaos and confusion and drew accusations of callousness. Next week the Senate may attempt another vote on Obamacare, also known as the Affordable Care Act, but whether it will be repeal-only, repeal-and-replace or something else remains undecided.

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If President Trump is serious about repealing ObamaCare—about delivering a better policy with more choice and lower costs—there’s a simple move he could make that wouldn’t require congressional approval. It would align the interests of lawmakers and their staffers with the interests of voters.

Congress is essentially unaffected by the high costs of the ObamaCare exchanges because of a special exemption crafted under the Obama administration. The Affordable Care Act required members of Congress and their employees to participate in the health-insurance exchanges it established. They should have lost the generous coverage they had in the Federal Employees Health Benefit Program and instead bought one of the government-mandated options offered on the ACA exchanges.

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Recriminations are already underway – at the White House, on Capitol Hill, in the news media. They are debating whose fault it is that Senate Republicans can’t pass a health care bill. Was it the fault of Mitch McConnell? Or Mike Lee?  Or the half dozen other senators who balked?

In order to successfully pass a health reform bill, Republicans must do something they so far haven’t done. They must go on TV and explain how reform of Obamacare is going to solve real problems real people face. If they can’t do that, they will never have the support of the general public. Without that, Congress will never have the courage to enact major reforms.

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