ACA repeal will be a fucking mess, except for the huge tax cut for the rich..

McConnell's fallback: A 'skinny' ACA repeal

Four sources told POLITICO that the "skinny repeal" would involve rolling back the ACA's individual and employer mandates.

By DAN DIAMOND

Senate Republicans are floating a "skinny repeal" plan that would leave major parts of the Affordable Care Act intact while knocking out its mandates, but also allow the Senate to move a repeal bill to conference with the House if they can't agree on a more comprehensive measure.

Four sources told POLITICO that the "skinny repeal" would involve rolling back the ACA's individual and employer mandates. It also would repeal the ACA's medical device tax, a revenue raiser that has been a major target of the device industry.

Republican leadership is broaching the skinny repeal as an option for senators who are wary of voting on Tuesday's planned motion to proceed on an Obamacare repeal bill. If the motion to proceed is successful but the Senate's replacement bill and a "straight repeal" of Obamacare — basically the Senate's 2015 reconciliation bill — both fail as expected, the skinny repeal would be brought up as another option, two lobbyists with knowledge of the process told POLITICO.

A skinny bill would have to be negotiated with the House, which passed a much more sweeping bill this spring.

“Whatever gets to 50,” said John Thune of South Dakota, the Senate’s No. 3 Republican, when asked about the prospect.

The skinny repeal could still have significant consequences for Obamacare. Knocking out the individual mandate could push the ACA’s fragile insurance market into a death spiral, actuaries warn. CBO has projected that repealing the individual mandate could lead to 15 million fewer Americans having health coverage in a decade.

The plan wouldn't touch Obamacare's Medicaid expansion, making it more palatable to Senate moderates. But it could trigger significant resistance by preserving the ACA's insurance regulations, which senators like Mike Lee of Utah and Rand Paul of Kentucky have insisted need to be struck down. "How do the ultra-conservatives vote for it?" asked one former Senate Republican aide.

Leadership is nonetheless wagering a slimmed down bill would move the repeal process another step forward and serve as a starting point for a conference with the House.

With Democrats expected to vote in lockstep against any effort to weaken Obamacare, the chamber’s 52 Republicans can't afford to lose more than two votes for any repeal measure.

While there are questions over whether a skinny repeal would survive the budget reconciliation process, which requires the measure to reduce the deficit, CBO previously projected that repealing the individual mandate would save $416 billion over a decade.

A skinny repeal also raises questions about how the Senate and House would ultimately compromise in conference committee and what final measure would emerge, considering the House bill's sweeping changes to Medicaid and the ACA markets.

"Who would dominate the conference?" said one liberal activist. "House Freedom Caucus Chairman [Mark] Meadows in my view."