The US senate has arcane rules of operation that can mystify those who are not steeped in them. One of them involves the issue of how many votes are needed for procedural votes and to pass legislation. While most bills require a simple majority, some require more and certain votes that precede the final vote, such as whether to consider the bill at all, require 60 out of the 100 votes.
Since the Republicans have just a 52-48 majority, they are trying to craft a health care bill that can meet the requirements to need only a simple majority. But the person who rules on whether the new health care bill can meet those requirements is someone known as the Senate Parliamentarian. and she has said that the latest June 26 attempt by Republicans at repealing and replacing Obamacare does not conform to the requirements.
The parliamentarian has also specified which provisions automatically trigger the 60-vote rule and which don’t and the ones that do include some pet Republican anti-women provisions such as those that defund Planned Parenthood and those that “prevent premium tax credits and small business tax credits from being used to purchase health insurance that covers abortion.”
Another feature that will trigger an automatic 60-vote requirement is the Medical Loss Ratio that “allows states to determine how much insurers are allowed to spend on administration, marketing, and profits versus health care.” Health insurance companies hate this because they like to be free to siphon off as much money as possible away from providing health care so that they can pay bloated salaries to their top executives and big dividends to their shareholders.
Another provision that triggers the 60-vote rule is something called the ‘Buffalo Bailout’, a provision that was used by the Republican leaders of the House of Representatives to bribe hesitant Republican congresspersons in New York state to vote in favor of the bill passed by the House, which means that any attempt to reconcile bills passed by the House and the Senate will have to remove that provision.
This ruling by the parliamentarian definitely complicates matters for the Republican leadership and makes their efforts to thread the legislative needle that much harder. But given the way things are going, it would not surprise me in the least if they decide to attack the parliamentarian for being a secret Democratic operative and ignore her ruling, just as they are attacking the Congressional Budget Office that has warned of the over 30 million people who will lose health insurance if the current bills are passed.