Health Care

What to Expect if the Senate Passes Skinny Repeal


Mitch McConnell is trying to force his Skinny Repeal through the Senate, telling his caucus that it’s an innocuous step that gets them to conference, where everything will get magically fixed and every Senator will get what they want.

This is a lie. And every single Republican senator knows it.

If McConnell succeeds in getting Skinny Repeal through, there are two possible outcomes—each terrible for the American people.

Scenario 1: The House quickly passes Skinny Repeal (most likely)

This is the most likely outcome if Skinny Repeal passes the Senate. This is true for three basic reasons:

  1. House Republicans are eager to put health care behind them, and they’re eager to avoid having to continue taking bad votes on something they know will have political consequences in 2018. Passing Skinny Repeal allows House Republicans to say they repealed ACA, with the cover of a Senate-approved bill.
  2. Going to conference committee guarantees that the bill will be made worse than what’s currently in Skinny Repeal, and they want to avoid having to vote on that. There is also no guarantee that the bill produced by a Conference Committee will get through the Senate, so if Republicans want to pass something, their best bet is Skinny Repeal.
  3. It’s a tactic to force Democrats to negotiate on ACA repeal. Skinny Repeal itself would absolutely destroy health insurance markets, cause increases in premiums, and would cause fewer health insurance options for Americans. Some Republicans are banking that destroying the health insurance market will be too big a mess for Democrats to ignore, forcing them to work to fix it.

The result? 16 million more Americans uninsured in the first year and an average premium increase of about 20%. It would also defund planned Parenthood. (But hey, they’ll give Donald Trump a chance to have another big press conference about it.)

Scenario 2: Conference Committee

Mitch McConnell is asking Republicans to vote for Skinny Repeal so that they can get to a Conference Committee, where all of their concerns will be magically fixed. This is less likely than the House simply passing Skinny Repeal, but even if the House and Senate do go to conference, we know the outcome would be certainly worse than Skinny Repeal. We know this because:

  1. The purpose of a conference committee is to reconcile the differences between bills passed by the House and Senate, meaning it will get worse. The Senate Skinny Repeal bill would result in at least 16 million Americans losing health coverage, while the House bill would result in at least 22 million. So a conference committee bill would land somewhere in the middle.
  2. The return of Medicaid cuts. There is a reason why Medicaid cuts aren’t included in Skinny Repeal—McConnell doesn’t have the votes for them. But those cuts are in the House version that was passed, meaning that they’d be back on the table in a conference committee. Conservatives in both the Senate and the House consider Medicaid cuts one of their priorities, so they will be pushing for them to be added into a conference committee bill.
  3. The composition of the conference committee will likely be extremely conservative and negotiations will happen behind closed doors. The more moderate voices in the Senate and the House, especially those that voted against these ACA repeal bills, will not be allowed to participate in the conference committee. This means the final product will be more extreme. And, because conference committee negotiations don’t need to public, the bill will probably be hammered out behind closed doors.

Will a conference committee bill pass the Senate and House? Unclear. But the pressure only mounts on Republicans to pass a conference committee bill. Plus, if they can’t pass the conference committee bill, the House can always just take up Skinny Repeal and pass that.

If McConnell passes Skinny Repeal, it will become law. It’s the camel’s nose getting under the tent.