The clock is running out for Senate Republicans to repeal and replace the Affordable Care Act under a process that would only require GOP votes to pass.
And a handful of Republican senators are now scrambling to meet that deadline, with plans to introduce a new repeal bill on Wednesday that the GOP members hope could garner enough votes to succeed.
The plan will be introduced by Republican Sens. Lindsey Graham of South Carolina, Bill Cassidy of Louisiana, Dean Heller of Nevada and Ron Johnson of Wisconsin. It seeks to change the funding structure of the Medicaid expansion portion of the ACA, sending states the federal dollars in block grants while also nixing some of the ACA’s mandates.
However the plan faces some serious hurdles, the biggest of which is time.
Republicans initially attempted to repeal the ACA, better known as Obamacare, using a process called budget reconciliation. That process lowers the threshold for passage in the Senate, requiring a simple majority of votes to advance, rather than the 60 votes normally required of Senate legislation.
Under budget reconciliation, Republicans could pass an ACA repeal bill without a single Democratic vote, given that the GOP has 52 votes in the Senate.
Budget reconciliation must be tied to a budget passed by Congress. The budget this current reconciliation attempt uses expires at the end of the fiscal year on Sept. 30, giving Republicans just 11 legislative days to push a repeal bill through.
And Senate Republicans have a lot of work in those 11 legislative days to move the bill closer to passage.
The plan the GOP members introduce on Wednesday — 10 legislative days before the budget reconciliation deadline — would have to be analyzed by the non-partisan Congressional Budget Office. That process could take a few days.
The eventual CBO score would have to find that the plan doesn’t add to the deficit.
If the CBO determines that the bill is deficit neutral, it would then be kicked to the Senate parliamentarian, who has to review the bill to make sure it does not contain any non-budgetary provisions in order for it to comply with budget reconciliation. That process is called the Byrd bath, named after the late Sen. Robert Byrd of West Virginia who created the rule.
The Byrd bath would force Republicans to strip the bill text of provisions such as an abortion ban or defunding Planned Parenthood, or else it will require the bill meet the 60-vote threshold, effectively killing the bill.
If all of that occurs, Republicans would then need to find 50 votes for the legislation — which they were unable to do back in July, when their repeal effort died a spectacular and humiliating death on the Senate floor.
It’s unclear whether Republicans could find the votes for the proposal.
Sen. Rand Paul (R-Ky.) is against the proposal.
Without Paul’s vote, Republicans can only afford to lose one of the three Republicans who voted against the last proposal — Sens. Lisa Murkowski of Alaska, Susan Collins of Maine and John McCain of Arizona.
In order for McCain to vote for the bill, he’d have to backtrack on his demand that any ACA repeal effort go through “regular order.” That means holding hearings and seeking public input before a vote, something the current time crunch wouldn’t allow.
Even if the Senate does pass this ACA repeal plan, the House would then also have to vote for the proposal within the Sept. 30 time frame. That gives them little time, if any at all, to make changes to the legislation.
The incredibly challenging time frame and other obstacles has prominent Republicans throwing cold water on this last-ditch attempt to repeal the ACA.
Sen. Orrin Hatch (R-Utah) told the Daily Beast he doesn’t expect the proposal will receive a vote on the Senate floor.
And if that’s the case, the ACA repeal effort is dead for the rest of 2017 and possibly longer, until Republicans find a way to pass a new budget.