Republicans plan to vote next week to start debate on Obamacare repeal, but it is not yet clear whether the Senate will vote on the repeal-and-replace bill. | Detroit News via AP Parliamentarian rules against key provisions in Obamacare repeal bill Republicans plan to vote next week on whether to begin debate on Obamacare repeal.

Several key provisions in the Senate's Obamacare repeal and replace bill, including language targeting Planned Parenthood, may have to be stripped or could be eliminated on the Senate floor by Democrats because they don't comply with budget rules, according to Democrats on the Senate Budget Committee.

The Senate parliamentarian advised Friday in an informal and preliminary ruling that key conservative agenda items, including defunding Planned Parenthood for one year and banning coverage of abortion in Obamacare insurance plans, do not comply with Senate rules on reconciliation, the fast-track procedure the GOP is using to repeal Obamacare.


Republicans plan to vote next week on whether to begin debate on Obamacare repeal, but it is unclear whether the Senate will vote on the repeal and replace bill. The other option for the GOP is to bring up a repeal-only measure that passed the Senate two years ago and was vetoed by President Barack Obama.

The 52 Senate Republicans would need to muster 60 votes to preserve each provision flagged by the parliamentarian for potentially violating the so-called Byrd rule. But Democrats have united in opposition to the GOP repeal effort. In addition to the Planned Parenthood and abortion language, other provisions identified by the parliamentarian would fund insurance cost-sharing subsidies and impose a six-month waiting period for individuals attempting to enroll in coverage for the first time.

The parliamentarian's guidance — provided as part of a process known on Capitol Hill as a "Byrd bath" — amounts to a significant win for Democrats, who are aiming to eliminate as much from the health care bill as possible. But Republicans cautioned that the rulings apply to a prior version of the Senate bill, and GOP aides are already reworking some of the provisions flagged by the parliamentarian, according to one source familiar with the effort. GOP lawmakers faced similar obstacles over language eliminating Obamacare's individual and employer mandates when they drafted the 2015 repeal bill but overcame them through rewrites.

An e-mail from Senate Majority Leader Mitch McConnell's office to Republican legislative directors said that the parliamentarian's guidance "largely follows what we expected; most of our bill is appropriate for reconciliation" and that "a few items may need modification" in order to comply with the Byrd rule. The message also urged GOP aides to "look out for bad reporting and Democrat spin."

"The parliamentarian has provided guidance on an earlier draft of the bill, which will help inform action on the legislation going forward," said Joe Brenckle, a spokesman for Republicans on the Senate Budget Committee.

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The guidance from parliamentarian Elizabeth MacDonough could still amount to yet another obstacle for the repeal effort. Two key groups that oppose abortion — National Right to Life and the Susan B. Anthony List — have been prominent advocates of the overall bill because of its abortion and Planned Parenthood provisions.

Planned Parenthood praised the decision Friday.

“No amount of legislative sleight of hand will change the fact that the primary motivation here is to pursue a social agenda by targeting Planned Parenthood because we provide the full range of reproductive health care, including abortion,” said Dana Singiser, a vice president of Planned Parenthood Federation of America.

The provision defunding Planned Parenthood did not pass muster with the parliamentarian because it was viewed as targeting a specific group, according to two Senate sources. That was the same reason MacDonough gave for ruling against a provision in the House -passed Obamacare repeal bill that changes the way New York funds Medicaid and was widely viewed as a way to win over GOP holdouts from the Empire State.

Democrats now believe the state-specific provisions in the Senate version of the measure — including language that may benefit Alaska, Louisiana and Florida — would not pass muster, either, although sources said MacDonough has not yet ruled on those particular measures.

"Republicans have given up on good policy, so they turned to legislative giveaways instead," said Sen. Chris Murphy (D-Conn.). "Today's ruling by the parliamentarian means they can't count on the Polar Payoff, Bayou Bailout, or Sunshine Sellout to do their whipping for them."

Other provisions on the chopping block include ending the Essential Health Benefits in Medicaid beginning in 2020, allowing states to set their own medical loss ratios — which influence how much insurers spend on patient care — and allowing states to roll over funding obtained by a block grant. Each would need 60 votes to overcome expected Democratic challenges.

The parliamentarian did informally approve of several parts of the bill, including allowing work requirements in Medicaid, providing funding to states that didn’t expand Medicaid and repealing the cost-sharing subsidy program in the future. MacDonough also approved a state stability fund along with an abortion restriction on the fund.

The parliamentarian has not yet ruled on state waivers, small business health plans, Medicaid block grants and allowing states to alter how much more older people can be changed than younger people.