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Senate Rules Entangle Bid to Repeal Health Care Law

The Senate’s minority leader, Harry Reid of Nevada, whose office weighed in on the Affordable Care Act battle on Thursday.Credit...Zach Gibson/The New York Times

WASHINGTON — Efforts to repeal the Affordable Care Act have become snarled in the complex rules of the Senate, raising questions about whether the Republican-controlled Congress can fulfill its pledge to send a repeal measure to President Obama.

Repealing the law, passed five and a half years ago, is a goal cherished by Republican politicians, including those running for president, and by elements of the party’s base. Mr. Obama has repeatedly vowed to use his veto power if necessary to preserve the health care law, the biggest change in domestic social policy in a generation.

The House on Oct. 23 adopted a budget-reconciliation package that would repeal core elements of the Affordable Care Act. The bill would eliminate the requirement that Americans have health insurance, and that larger employers offer coverage to full-time employees. It would also repeal taxes on medical devices and high-cost employer-sponsored insurance.

In the Senate, Republicans are determined to dismantle or defund the law using a fast-track procedure that requires a simple majority vote, rather than the 60 votes needed for most hotly contested measures.

But the Senate parliamentarian, Elizabeth MacDonough, ruled this week that some provisions of the House-passed bill were not eligible for expedited procedures, aides to Senate leaders of both parties said Thursday. Democrats said the ruling meant that Republicans would need a supermajority of 60 votes, which they do not have, to repeal the individual and employer mandates.

The office of the Democratic leader, Senator Harry Reid of Nevada, issued a statement on Thursday saying, “The parliamentarian has ruled that Obamacare cannot be repealed through reconciliation.”

“Any fix that repeals the individual or employer mandates will require 60 votes and therefore will not pass,” the statement added.

However, Republicans said that Mr. Reid had misrepresented the parliamentarian’s ruling, the text of which has not been made public. They said that if some provisions of the bill were changed, the Senate could still take up the bill by a simple majority vote and consider it using fast-track procedures.

“When the Senate begins debate on the Obamacare repeal bill, there will be an amendment that preserves the provisions of the House-passed bill, while ensuring that the underlying bill complies with rules that apply only in the Senate,” said Don Stewart, a spokesman for the Senate majority leader, Mitch McConnell, Republican of Kentucky.

The parliamentarian’s ruling complicates the political calculus for Mr. McConnell. He is under enormous pressure from the Senate’s right flank and from House Republicans, who have been counting on reconciliation as their final effort to gnaw away at the health care law before the 2016 elections.

The reconciliation process was created by the Congressional Budget Act of 1974. Under the law, a provision of a budget reconciliation bill can be eliminated in the Senate if it “produces changes in outlays or revenues which are merely incidental to the nonbudgetary components of the provision.”

Repealing the health law mandates would have substantial budgetary effects. The government would lose money: The penalties that would otherwise be paid by individuals and employers who violate the law’s requirements. But a repeal would also save money because fewer people would be enrolled in Medicaid, the Congressional Budget Office says.

The parliamentarian evidently concluded that the budgetary effects were “merely incidental” to the Republicans’ policy objectives.

The exchange on Thursday between the offices of Mr. Reid and Mr. McConnell was part of a larger struggle going on behind the scenes.

Mr. Reid’s office asserted that the Senate version of the reconciliation bill “will have to be more supportive of Obamacare’s mandates than the House-passed bill.”

Republicans described that as an effort to scare off conservative Republicans like Senators Ted Cruz of Texas, Mike Lee of Utah and Marco Rubio of Florida, who object to the House bill because it “repeals only parts of Obamacare,” as they said recently in a joint statement. They want to go further, demanding a bill that “fully repeals Obamacare.” Mr. Cruz and Mr. Rubio are running for president.

Since Republicans hold 54 Senate seats, Mr. McConnell cannot write off such objections. At the same time, he wants the support of moderate Republicans like Susan Collins of Maine and Lisa Murkowski of Alaska, who worry about a section of the bill that would eliminate most federal funds for Planned Parenthood for a year.

Anti-abortion groups like the Family Research Council and the National Right to Life Committee are lobbying for passage of the reconciliation bill because they favor the restrictions on federal funds.

Previous Republican efforts to eviscerate the Affordable Care Act have failed in the Supreme Court and died in the Senate when Democrats controlled that chamber.

A version of this article appears in print on  , Section A, Page 21 of the New York edition with the headline: Senate Rules Complicate Bid to Repeal Health Care Law. Order Reprints | Today’s Paper | Subscribe

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