‘Skinny repeal’ could be the Senate’s health-care bill of last resort

Senate Majority Leader Mitch McConnell walks to a meeting in the Capitol on July 25, hours before lawmakers in the chamber might hold a key procedural vote on starting to undo the Affordable Care Act. (Win McNamee/Getty Images)

As the Senate prepared Tuesday to take a first-step vote on ill-defined Republican plans to go after the Affordable Care Act, a new phrase entered the lexicon of the debate: “skinny repeal.”

In substance, this plan would repeal just three parts of the ACA, according to several sources familiar with the approach. It would eliminate the requirement that most Americans carry health insurance as well as the requirement that employers with at least 50 full-time employees offer coverage to their workers. Both are central elements of the 2010 health-care law and its least popular aspects with the public.

The “skinny” plan also would rescind the tax on medical devices, one of several taxes the ACA created to help pay for other elements of the law.

A close variant of this surfaced two years ago in the House, as part of the GOP’s strategy back then to lower federal deficits. Congressional budget analysts estimated at the time that 15 million fewer Americans would have insurance coverage “most years” as a result.

For Republicans now in the Senate, the purpose is as much tactics as policy: A slimmed-down repeal plan would essentially be a placeholder bill. The idea would likely surface on the Senate floor as an amendment later this week if the chamber has been unable to pass a fuller demolition of the law. It would buy the Senate’s GOP leaders more time because any bill they successfully push through their chamber would lead to a conference committee with the House, which this spring passed its own anti-ACA legislation.

Negotiations between lawmakers of the two chambers could then continue past Congress’s August recess, preserving the ability of Senate Majority Leader Mitch McConnell (R-Ky.) and other GOP leaders to continue searching for a health-policy formulation that could garner the support of enough members of their caucus.