Sure, Republicans would like to do it all at once — peeling off this section of the Band-Aid has been painful enough. But they can't. That's because of a special budget rule called reconciliation, which forces them to make a decision: undo some of Obamacare with a simple majority vote in both chambers, or undo all of it and face a 60-vote majority threshold — a majority Republicans don't have and won't get — in the Senate.
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The ability to buy insurance across state lines, an attempt to lower drug prices and malpractice liability protections for health-care providers, “can't be done through this current bill,” Trump press secretary Sean Spicer acknowledged this week.
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Ryan outlined three phases in which health-care reform would be achieved: first, via the special budget procedure known as reconciliation, of which the current measures are a part; then, through regulations at the Department of Health and Human Services; and finally, the passage of other bills that will need bigger backing and could include the ability to buy insurance across state lines.