Senate parliamentarian rules against another key piece of the GOP repeal bill

The Senate parliamentarian on Thursday introduced another roadblock to the Senate Republicans' quest to repeal and replace the Affordable Care Act.

Parliamentarian Elizabeth MacDonough ruled that Republicans' plan to allow states to waive certain Affordable Care Act requirements would violate Senate budget rules, according to Senate Budget Committee Democrats. That decision prevents GOP leadership from passing a bill with a straight 51-vote majority.

The key provision of the Better Care Reconciliation Act that would have amended Section 1332 of the ACA to allow states to waive certain rules—such as the essential health benefits and pre-existing condition requirements, as long as the proposal didn't increase the federal deficit—violates the so-called Byrd rule, MacDonough determined.

The Byrd rule allows for any bill moving along the budget reconciliation process, like the Senate healthcare bill, to be blocked for containing provisions that aren't directly related to the federal budget.

Now the provision would need 60 votes to pass, which would require the support of Democrats who oppose the overall GOP legislation.

This isn't the first time MacDonough has ruled against the GOP bill. Earlier this week, MacDonough ruled that a measure in the bill to allow individual-market insurers to charge older people premiums five times higher than younger people cannot be passed under Senate budget reconciliation rules. The ACA only allows insurers to charge older customers three times as much.

She also held that the bill's provision allowing small businesses to band together across state lines to establish association health plans that are exempt from state regulation did not meet reconciliation rules. Last week, MacDonough held that a number of other key provisions did not comply with reconciliation rules. Those include prohibitions on Medicaid funding for Planned Parenthood for one year and on abortion coverage under health plans purchased with premium tax credits.