Senate Majority Leader Mitch McConnell (Photo: McConnell)

Senate Republicans who have promised to demolish Obamacare are swerving toward a bare-bones approach that might eliminate just a few pieces of the Affordable Care Act.

Struggling under their slim 52-48 majority, Republicans say this week’s debate — including an all-night blizzard of amendment votes late Thursday known as vote-a-rama — may ultimately lead to a bill that merely ends the mandate that all Americans have insurance or pay a penalty, along with a few other provisions.

“This is likely to be a very long night,” Majority Leader Mitch McConnell said Thursday on the Senate floor as the chamber started the day’s session. He added, “It will not signal the end of our work, not yet.” 

(Related: Some GOP Senators Cast Mixed ACA Change Bill Votes)

The idea, Republicans say, is to get a bill through the Senate and then negotiate a final agreement with the House, which passed a broader Affordable Care Act overhaul, H.R. 1628, in May.

“All we’re looking at is a way to get to that conference quick so we can begin to have those discussions and get a result,” said Sen. John Cornyn of Texas, the No. 2 Republican leader. Republicans are discussing how many elements of the Affordable Care Act they must repeal to get enough support to pass, he said. The House could also choose to pass the stripped-down repeal and send it to President Donald Trump.

“This is a high-wire act,” Cornyn said. “The whole thing.”

Sen. John Thune of South Dakota, the No. 3 Republican leader, said a plan also might eliminate the Affordable Care Act requirement that most employers offer insurance to their workers, as well as a medical-device tax estimated to generate almost $20 billion over a decade.

The behind-the-scenes talks Wednesday contrasted with what was taking place on the Senate floor, where lawmakers were debating whether to replace keye elements of the Affordable Care Act with a broad revision or even try to repeal the whole act outright.

Early votes have underscored the majority party’s difficulty in pushing through a GOP-only bill amid unified Democratic opposition.

The Senate rejected a fuller repeal of Affordable Care Act provisions 45-55 Wednesday. Seven Republicans voted against it, including Senate Health Chairman Lamar Alexander and Sen. John McCain, who returned to Washington from Arizona after a brain-cancer diagnosis to help advance the debate.

Late Tuesday, a 43-57 Senate vote swept aside a revised version of Majority Leader Mitch McConnell’s proposal for replacing key Affordable Care Act provisions, a measure negotiated in secret during weeks of tense GOP talks. Hours earlier, senators barely agreed to start the debate on a 51-50 vote with Vice President Mike Pence casting a tie-breaker after two Republicans defected.

Bigger challenges await on the Senate floor, including the vote-a-rama, a fusillade of votes on dozens if not hundreds of amendments. Democrats may offer poison pills, and other proposals might divide Republican moderates and conservatives.

‘No Such Thing’

Senate Minority Leader Chuck Schumer of New York said that the passage of a “skinny repeal” alternative is a gambit to get Senate and House Republicans together in talks on a broader replacement plan.

“There is no such thing as ‘skinny’ repeal,” Schumer said Wednesday on the Senate floor. “It’s a ruse to get to full repeal, with all the concomitant cuts to Medicaid and tax breaks, which are so unpopular and which so many of my Republican colleagues here on the other side have opposed.”

Senate Republican leaders haven’t released a text of a “skinny bill,” even to members of their own party.

Schumer’s office, however, put out a Congressional Budget Office estimate of a bill that mirrors Republicans’ description of such a measure — one that would eliminate the individual and employer mandates, as well as repeal the medical device tax and defund Planned Parenthood. The CBO said such a measure would result in 16 million Americans losing their insurance, compared to the 22 million more envisioned under the most recent version of McConnell’s replacement bill.

Schumer said Wednesday night that Democrats won’t offer amendments until they see Republicans’ final proposal.

The Senate plans to vote Thursday afternoon on a “Medicare for all” amendment proposed by Republicans — with the goal of putting embarrassing Democrats by demonstrating whether they will vote for a single-payer plan the party has long supported in the debate over health care. “We’ll find out what support it enjoys,” McConnell said.

It’s not certain the splintered Republican caucus would agree to back a pared-back Obamacare repeal. Sen. Shelley Moore Capito of West Virginia said she’s “unsure” if she can support such a bill.

Sen. Lindsey Graham, a South Carolina Republican, said he won’t support it unless he’s assured his proposal for a broad Obamacare alternative can be considered in House-Senate conference negotiations.

“I’ve told our leadership that I wouldn’t vote for the skinny bill believing that would be the only thing we do, because that would be a complete abdication of what we’re trying to do,” Graham said.

— Read Trump Calls on GOP to ‘Repeal Obamacare’ Amid Uncertainty on Votes on ThinkAdvisor

Copyright 2018 Bloomberg. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.