WASHINGTON -- The Senate parliamentarian's ruling on the Better Care Reconciliation Act (BCRA) is making repealing and replacing the Affordable Care Act (ACA) more complicated for Senate Republicans.
On Friday, Senate parliamentarian Elizabeth MacDonough issued a report stating that several provisions -- including one to eliminate funding for Planned Parenthood -- in the Republican Senate bill to overhaul the ACA cannot be included due to the so-called Byrd Rule.
That rule, named after the late Sen. Robert Byrd (D-W.Va.), states that any provision in a bill to be voted on under the filibuster-proof reconciliation process must affect the budget in a substantive way. Provisions that are not germane to the budget must be struck from the bill -- or, if the provision is kept in, the bill must be voted on using the regular process, which can be filibustered and therefore requires 60 votes to pass.
According to a posted by Democrats on the Senate Budget Committee, the following provisions were deemed not to comply with the Byrd Rule:
- Defunding Planned Parenthood: Bill prohibits the group from receiving Medicaid funds for 1 year
- Abortion Restrictions for Tax Credits: Prevents premium tax credits and small business tax credits from being used to purchase health insurance that covers abortion
- Sunset of Essential Health Benefits Requirement for Medicaid: Beginning in 2020, states no longer have to cover essential health benefits in their Medicaid alternative benefit plans
- Funding for Cost-Sharing Subsidies: Provides funding for the subsidies, which help with out-of-pocket costs for low-income enrollees in health insurance plans bought on the ACA's insurance exchanges, through 2019
- Stabilizing the Individual Insurance Markets: Requires a 6-month waiting period for people getting coverage on the individual market if they haven't maintained continuous coverage
- Medical Loss Ratio: Allows states to determine how much insurers are allowed to spend on administration, marketing, and profits versus health care
The American Congress of Obstetricians & Gynecologists (ACOG) praised the ruling. "The Senate parliamentarian has confirmed what we already know, that denying Planned Parenthood health clinics the ability to provide Medicaid primary and preventive care is purely politically motivated," ACOG president Haywood Brown, MD, said in a statement. "Rather than doing what's best for women's health, the Senate bill would leave millions of women without access to the care they need."
"ACOG's strong opposition to the BCRA is unchanged by the parliamentarian's rule," he added. "This bill will devastate and turn back the clock on women's health. No one provision or fix can make it better. We are urging every senator to vote NO on the motion to proceed, reject this bill, and work with ACOG and the physician community on real solutions to reducing healthcare costs and improving our nation's healthcare system."
Planned Parenthood also said it was pleased with MacDonough's ruling. "The 'defund' Planned Parenthood provision is the epitome of a mean-spirited policy that hurts millions of women and has no place in legislation, period," Dana Singiser, vice president for public policy and government affairs at the Planned Parenthood Federation of America, said in a . "The bottom line is that it is absurd for anyone to assert that the purpose of this provision is budgetary."
With a vote on a motion to proceed with debate on an ACA repeal-and-replace bill scheduled for Tuesday, the parliamentarian's ruling could complicate Senate Republicans' plans. Even now, that it is unclear what the Senate will be voting on if the motion to proceed passes -- it could be the current BCRA bill, or a 2015 bill that would repeal the ACA's mandate for individual and employer-sponsored coverage but would keep the law's other provisions. It is also unclear whether Sen. John McCain (R-Ariz.), who was diagnosed with brain cancer last week, will be able to make the vote.