The GOP’s months-long debate over when and how to send a repeal of Obamacare to the president’s desk now appears to have an answer.

They can’t do it all at once.


Repealing the law “root and branch” is probably out of the question, the chamber’s parliamentarian is hinting, because some parts of Obamacare don’t affect the federal budget. That’s a must in order to use the obscure procedure known in Senate parlance as reconciliation, which allows lawmakers to avoid the 60-vote filibuster hurdle and pass bills on a simple majority vote.

That’s not the GOP’s only problem. Under those rules any Obamacare repeal has to reduce — not increase — the deficit. So Republicans will have to pick and choose which parts of the Affordable Care Act they most want to ditch.

Obama will, of course, veto any bill that significantly damages his signature domestic policy achievement. But the entire process has the makings of a difficult political exercise that will reveal something about the GOP’s priorities when it comes to the reviled law, forcing the party to go beyond the pile-on repeal rhetoric and say specifically what it would do and how it would pay for it.

Republicans could try to get rid of the mandates and taxes, but then they’d have to plug a trillion-dollar hole. Cut the Medicaid expansion to the states? Sounds simple enough, but then they could put themselves at odds with governors.

They’ll also have to decide if they want to scrap federal Obamacare subsidies, currently on the hot seat across the street at the Supreme Court, which this month will rule whether they’re constitutional. Gutting them would yield almost a trillion dollars in savings, which could then be used to repeal other parts of the law. But moderates also may experience a political backlash for slashing health care tax credits for poor and middle-class families. Extending or replacing the subsidies, though, could further limit their repeal options and alienate conservatives at the same time.

The complex puzzle isn’t what Republicans who’ve been vowing for years to abolish the law so despised by the right — the GOP-controlled House has voted dozens of times to overturn Obamacare — had in mind. Their vow to get a repeal to Obama’s desk seemed closer than ever to being realized after Republicans gained control of both chambers of Congress in the midterm elections.

But it’s turning out to be a lot more complicated.

“We went through this exercise in 2012, and what we concluded is that [you cannot repeal] the whole thing, but there are a number of different things that you could knock out: the individual mandate, … employer mandate, the exchanges, maybe even Medicaid expansion,” said Lanhee Chen, a Hoover Institute fellow who advised Mitt Romney’s campaign — which looked into what could and couldn’t be repealed through reconciliation during the 2012 election cycle.

The conundrum has many on the far right urging GOP leaders to take on the Senate parliamentarian, who will ultimately rule what can and cannot be repealed through reconciliation, and try to repeal the entire law using a one- or two-line sentence that simply reads: “Repeal the Affordable Care Act.”

But policymakers and staff working on the matter are finding it’s not so straightforward. The so-called Byrd rule prevents reconciliation from being used to make policy changes that don’t affect the deficit, which is the main goal of the fast-track procedure.

“We’re really just trying to game out all of the different options our members have to basically repeal in whole or in part,” said one senior GOP Senate aide. “We definitely are preparing to do only budgetary things.”

In their budget deal, Republicans agreed to employ reconciliation narrowly — namely for a repeal of Obamacare or a “fix” to King v. Burwell, should the Supreme Court in late June knock down subsidies used by nearly 8 million people.

But the parliamentarian has quietly suggested to Senate Republican aides that full repeal is out of the question, two sources told POLITICO.

“The message came out loud and clear that total repeal won’t work,” said Tom Miller, a health care policy expert at the right-of-center American Enterprise Institute, referring to private conversations on the Hill about what can and can’t be done.

That means Republicans will probably have to go through the ACA provision by provision and strike only policies that have a direct cost to Uncle Sam, what’s known on the Hill as a “Byrd rule scrub” or “Byrd bath.”

Former staff, including former top GOP budget staffer Bill Hoagland, believe Republicans won’t be able to repeal some ACA provisions that affect private markets but don’t directly affect the federal budget. Those include rules that set the minimum standards of coverage that insurers have to offer; requirements that insurers spend a certain amount of premiums on health costs; and the prohibition on denying coverage because of pre-existing conditions.

That doesn’t mean Republicans won’t try. A senior GOP aide in the Senate told POLITICO they are considering arguing to the parliamentarian that such provisions actually do hurt the deficit and should be repealable. One potential case they’ll make: These requirements drive up the cost of premiums, which are covered by federal subsidies, so they may increase the cost to the Treasury.

Some conservatives and staff in both chambers, like House Freedom Caucus Chairman Jim Jordan (R-Ohio), are urging the chambers to do a straight one- or two-sentence repeal of everything. They argue that the parliamentarian has to look only at the words in front of her during reconciliation and should not be able to force lawmakers to break out the provisions on their own.

One aide working on the matter suggested they may try this and see if it works — but others are doubtful.

There’s also a limit to what can be included in the fast-track budget process because the GOP budget requires each of the five health-related committees to find $1 billion in savings; yet a full repeal bill in 2012 was scored as adding $100 billion to the deficit, according to Congress’ budget scorekeeper.

The King case is the big X factor in all of this. Should SCOTUS knock down subsidies, most Republicans agree they’ll need to either extend them legislatively or replace the federal help with a health care tax credit. Both options cost money, which would again scramble the reconciliation puzzle.

There’s even disagreement about whether such a “fix” should be part of reconciliation at all. Budget Chairman Tom Price (R-Ga.) said enacting a GOP alternative through reconciliation may be even tougher than trying to repeal Obamacare.

“I think it’s important to do the repeal of Obamacare as much as can be done given the Senate rules, but I don’t know how you address a [new policy] in the health care system,” he said.

The party may have a wild card or two up its sleeve, however. The GOP budget deal allows for the House to score a reconciliation bill “dynamically,” meaning Republicans can account for assumed economic growth that will help plug the costs of repeal. Republican staff are also considering whether they can find savings elsewhere to pay for repeal, just as Democrats made education cuts to help pay for the overhaul in the first place.

But even these tricks may not amount to a full repeal, Hoagland said: “You can shoot a big hole in [Obamacare]. You can put it on the operating table, but you can’t just repeal the whole thing.”