Senate Parliamentarian Delivers Blow to Any GOP HCR Hopes

The Senate Parliamentarian  has ruled the following are required to comply with the filibster rule, and are not subject to modification through the reconciliation.  Put another way, the GOP now needs 60 votes for the following:

Defunding Planned Parenthood: This section prohibits Planned Parenthood from receiving
Medicaid funds for one year. (Sec. 124)
* Abortion Restrictions for Tax Credits: Two separate provisions contain Hyde Amendment
language to prevent premium tax credits and small business tax credits from being used to
purchase health insurance that covers abortion. (Sec. 102(d)(1) and Sec. 103(b))
* Sunset of Essential Health Benefits Requirement for Medicaid: This provision states that,
beginning in 2020, states no longer have to cover essential health benefits in their Medicaid
alternative benefit plans. (Sec. 126(b))
* Funding for Cost-Sharing Subsidies: This section replicates current law by providing
funding for the subsidies through 2019. (Sec. 208)
* Stabilizing the Individual Insurance Markets (“Six Month Lock Out”): This section
imposes a six-month waiting period for individuals attempting to enroll in coverage in the
individual market who cannot demonstrate that they have maintained continuous coverage.
(Sec. 206)
* Medical Loss Ratio: This section allows states to determine how much insurers are allowed
to spend on administration, marketing, and profits versus health care. (Sec. 205)
* Availability of Rollover Funds: This provision allows states that spend less than their
targeted block grant amount to rollover funds to the following year and to use funds for nonhealth
purposes, specifically repealing the provision of the Social Security Act that prohibits
states from using Medicaid funds to build roads, bridges, and stadiums. (Sec. 134 –
1903B(c)(2)(D)) (Note: this provision has been removed from the most recent draft).
* Decrease in Target Expenditures for Required Expenditures by Certain Political
Subdivisions (“Buffalo Bailout”): This provision limits the ability of New York State to
require counties other than New York City to contribute funding to the state’s Medicaid
program. (Sec. 133 – 1903(c)(4))
* Grandfathering Certain Medicaid Waivers; Prioritization of HCBS Waivers: This
section says that the Secretary will encourage states to adopt Medicaid Home and
Community Based Services (HCBS) waivers but does not set forth any actual details for this
plan. (Sec. 136)
* Reporting of CMS-64 Data (T-MSIS): This provision requires the Secretary of HHS to
submit a report on Congress recommending whether expenditure data from the Transformed
Medicaid Statistical Information System (T-MSIS) is preferable to data from state CMS-64
reports for making certain Medicaid decisions. (Sec. 133 – 1903(h)(5))
* Coordination with States: This section requires the Secretary to consult with states before
finalizing Medicaid rules. (Sec. 137)

It was Sanders staff that did the bulk of the arguing before the Parliamentarian. Topher is from the Center for American Progress: in no way is he a Bernie guy.