Senate Democrats are unanimously opposed to the provisions, and Republicans, who control only 52 seats, are guaranteed not to have the votes to keep them in the bill if they remain unchanged.
“The parliamentarian has provided guidance on an earlier draft of the bill, which will help inform action on the legislation going forward,” Joe Brenckle, spokesman for the Senate Budget Committee Republicans, told CNN.
Republicans will now have to revise the provisions to place them in accordance with budget rules before they get to the floor, have them defeated on the floor, or drop them from the bill all together.
The rules of reconciliation dictate that provisions within the health care overhaul can’t have just an “incidental” budgetary effect. There was running skepticism that the Planned Parenthood provision would comply with that rule.
Some critics of the GOP’s efforts to gut Obamacare have accused Republicans of specifically targeting Planned Parenthood in their legislation, casting it as an ideological move wholly unrelated to the budget.
This year, the Congressional Budget Office appeared to give those critics some back-up. The CBO’s analysis of the House and Senate health care bills determined that language prohibiting federal funds from being directed to certain family planning and reproductive health would affect “only one organization” — Planned Parenthood.
Democrats on the Senate Budget Committee flagged the parliamentarian’s guidance Friday evening.
“The parliamentarian’s decision today proves once again that the process Republicans have undertaken to repeal the Affordable Care Act and throw 22 million Americans off of health insurance is a disaster,” Vermont Sen. Bernie Sanders, the ranking member on the Senate Budget Committee, said in a statement.
Defunding Planned Parenthood was only one of the provisions that violate the Senate rules; the parliamentarian also ruled that abortion restrictions on tax credits under the Republican bill could be subject to a point of order on the Senate floor, as could other provisions.
Another key provision cited by the parliamentarian would have imposed a six-month waiting period for those who let their coverage lapse. This measure was meant to replace the individual mandate. Both are designed to prod younger and healthier people to sign up for and maintain coverage since they offset the higher costs of the sick. This type of provision is critical to keeping insurers in the market.
The parliamentarian also said that a provision in the Senate bill that would limit New York’s ability to require upstate counties and Long Island to contribute to the state’s Medicaid program — which critics refer to as the “Buffalo Bailout” — also did not pass muster. This addition was key to garnering the support of several New York Republicans for the House bill.
That potentially does not bode well for any provision in the legislation that is viewed as targeting a certain state or region. In search of votes, Senate leadership has been closely engaged in recent weeks with specific senators who have serious reservations about a repeal-and-replace approach, and is considering various offers aimed at addressing state-specific concerns. Those negotiations could now become much more complicated.
The parliamentarian is still reviewing whether to allow several key changes Republicans want to make to Obamacare’s insurance regulations. Obamacare mandated that insurers cover 10 essential health benefits, including maternity, substance abuse and prescription drugs. The Senate bill would allow states to apply for a waiver from this requirement so insurers could offer skimpier polices with lower premiums.
Conservatives will not be pleased if this waiver section is removed.
Also, the parliamentarian is still considering whether to allow a provision that would allow insurers to charge higher premiums to older enrollees, as compared to younger ones. Obamacare limited insurers to charging those in their 50s and 60s up to three times the rates of younger consumers. The Senate bill would widen that to five times, hiking the premiums that older enrollees must pay.
This provision has drawn sharp criticism from the influential AARP, which has slammed it as an “age tax.”