It might sound like another trendy low-calorie caffeine drink promising all of the boost with none of the regrets.

But the skinny repeal is the fad sweeping the Senate Republican caucus as senators desperately try to find a way to advance their efforts to repeal and replace the Affordable Care Act (ACA).

The pared-down plan has yet to be published but it would:

• eliminate the individual mandate, which requires all Americans to have health insurance or face a penalty

• remove the employer mandate, the requirement that companies with 50 or more full-time employees must provide health insurance or pay a fine

• and repeal the so-called cadillac tax, an excise tax on expensive insurance plans offered by employers that is due to go into effect in 2020.

It would not affect Obamacare’s expansion of Medicaid, the government health program for low-income Americans, which some moderate Republicans want to keep.

Without a prepared text, the legislation has also not yet been analyzed by the nonpartisan Congressional Budget Office. This is a requirement if the bill is to pass through the special budget process known as reconciliation, which would mean it would only need a simple majority of 51 votes to get through.

But Democrats asked the budget agency to estimate the effect of the rumored amendment. The preliminary analysis on the yet-to-be-filed provisions found that it would leave 16 million fewer people insured over the next decade compared with current law and would raise premiums by roughly 20%.

The skinny repeal is the latest effort by Senate Republicans try to find some legislation that can achieve a majority. Fifty of the 52 Republicans in the Senate would need to vote for the legislation for it to pass, with vice-president Mike Pence breaking the tie.

As Senator John Thune of South Dakota told reporters: “Clearly, it has proven to be quite challenging to get 50 Republicans on board with one solution, but it’s been trying to move pieces around to try to get everyone comfortable and find a good landing spot. We just haven’t gotten there yet.”

“Come on Republican Senators, you can do it on Healthcare,” Donald Trump tweeted on Thursday morning. “After 7 years, this is your chance to shine! Don’t let the American people down!”

While the skinny repeal could break the impasse among Republicans over how to repeal or replace the ACA, popularly known as Obamacare, it is not without significant consequences.

Doctors, medical organizations and insurer groups have warned that the proposal would discourage healthy people from staying in the health insurance markets and could drive up costs, and could therefore lead to the eventual collapse of the Obamacare system.

“If there is no longer a requirement for everyone to purchase coverage, it is critical that any legislation include strong incentives for people to obtain health insurance and keep it year-round,” the BlueCross BlueShield Association, an insurer group, said in a letter. “A system that allows people to purchase coverage only when they need it drives up costs for everyone.”

But Republican senators have downplayed the criticism, arguing that the “skinny repeal” is just a vehicle to trigger a conference committee with the House, which passed a replacement plan in May. A conference committee is a bicameral committee of representatives and senators that meets to hammer out a bill that has been passed in different forms by each chamber. It produces a conference report, which is almost impossible to amend, for the House and Senate to approve.



“The so-called skinny provision is not a resolution of this problem,” said Senator Lamar Alexander, a Republican from Tennessee. “It only takes us to the next step, where hopefully we can find one.”

Activists opposed to Obamacare repeal have called the measure a “Trojan Horse”, noting that it could be replaced in conference by pieces of the failed Senate replacement plan or the House bill, which would weaken protections on sicker Americans. And while Senate Republicans insist the “skinny repeal” will not become law, there is a possibility, albeit an unlikely one, that the House could decide to forgo a conference and approve the measure, sending it to Trump who is waiting “pen in hand”.

On Wednesday, a bipartisan group of governors weighed in on a skinny repeal to urge against it.



“The Senate should also reject efforts to amend the bill into a ‘skinny repeal’, which is expected to accelerate health plans leaving the individual market, increase premiums, and result in fewer Americans having access to coverage,” said a letter signed by 10 governors, including the Republicans John Kasich of Ohio and Brian Sandoval of Nevada.

But on Capitol Hill, several senators expressed a sense of the urgency to do something – anything – to keep momentum moving toward repealing the 2010 law.

“I think there’s a consensus that we need to produce some outcome. Is it going to be something that would be on my top three list of outcomes? I don’t know,” said Senator Thom Tillis of North Carolina. “It’s just moving the ball along because the problem doesn’t get solved if we fail to produce an outcome.”

Bill Cassidy of Louisiana shared his view, telling reporters he’d support anything that “moves the process forward” while Richard Burr of North Carolina more bluntly said: “Anything that gets conference, I’m happy.”

However, with the skinny repeal legislation still not yet written, senators from both parties expressed concern that they didn’t know what they would ultimately vote on.

The Maryland Democrat Ben Cardin took to the Senate floor to bemoan the fact that his staff couldn’t prepare amendments to protect Medicaid, because they didn’t know what the underlying language would be.

This was echoed by the Republican Mike Lee, of Utah, who proclaimed to reporters: “I don’t know what the skinny bill is. I haven’t seen it. I look forward to seeing and finding out what it is.”

Nearly 20 million people gained healthcare coverage under Obama’s Affordable Care Act. The law requires all Americans to have insurance or face a penalty, and offered states funding incentives to expand Medicaid coverage for people with low incomes.

A vote on the new legislation is expected early Friday morning.

