Procedural vote on health care reform expected today

Senate Republicans plan to hold a crucial vote today to begin debate on health care reform. The vote comes as the Senate Parliamentarian ruled on Friday that several provisions of the Better Care Reconciliation Act (BCRA) violate the Byrd rule. The provisions will need to be removed from the legislation or voting to begin debate on the bill will require 60 votes versus a simple majority of 51 votes required due to the use of reconciliation.

A number of the provisions involve key sections of the Better Care Reconciliation Act, (BCRA). One of the most significant concerns relates to the individual mandate, which requires people to buy insurance or pay a penalty. The BCRA proposes that people who go for more than a month without health care coverage and then get insurance, would need to wait 6 months for their coverage to take effect.

Also, some additional areas of concern relate to the provisions to sunset of essential health benefits requirement for Medicaid, the grandfathering of certain Medicaid waivers, and market stability funds, which includes the cost-sharing reductions to insurers that help them meet a requirement that low-income people receive assistance with deductibles and copays. A list of the provisions, as provided by the Senate Budget Committee, are listed here.

While the Senate Parliamentarian rulings are challenging to repeal and replace efforts, Republicans could elect to utilize the so-called, nuclear option. This would allow the Vice President to override the Parliamentarian and become the final decision maker.