Obamacare is one step closer to repeal after Senate advances budget resolution

By Kelsey Snell and Mike DeBonis
January 12 at 1:20 AM - The Washington Post

The Senate voted 51 to 48 early Thursday to approve a budget resolution instructing House and Senate committees to begin work on legislation to repeal major portions of the Affordable Care Act. The House is expected to take up the legislation Friday.

Senate Democrats made a late-night show of resistance against gutting the Affordable Care Act by forcing Republicans to take politically charged votes against protecting Medicare, Medicaid and other health-care programs. The measure narrowly passed without the support of any Democrats.

The hours-long act of protest culminated in the early hours of Thursday when Democrats made a dramatic display of rising to speak out against the repeal measure as they cast their votes. The Democrats continued to record their opposition over their objections of Senate Republicans.

“Because there is no replace, I vote no,” said Sen. Claire McCaskill (D-Mo.) as she delivered her vote.

Sen. Rand Paul (R-Ky.) also voted no, in part over concerns that GOP leaders have not committed to a plan to replace the Affordable Care Act after it is repealed.

Democrats forced nearly seven hours of mostly symbolic votes amid growing concerns in the congressional GOP that the party is rushing to dismantle the ACA without an alternative. Democrats forced the frenzied vote series called a “vote-a-rama” well into Thursday morning, although they could not prevent the GOP from following through on its repeal plans.

Senate Minority Leader Charles E. Schumer (D-N.Y.) said Wednesday that Democrats intended to ensure that Republicans are held responsible for any chaos caused by ending President Obama’s landmark law providing roughly 20 million people with coverage in various ways.

“Put this irresponsible and rushed repeal plan aside,” ­Schumer said on the Senate floor. “Work with us Democrats on a way to improve health care in America, not put chaos in place of affordable care.”

In his news conference on Wednesday, President-elect Donald Trump insisted that repeal would not occur without a replacement plan. “Obamacare is the Democrats’ problem. We’re going to take the problem off the shelves for them. We’re doing them a tremendous favor,” Trump said.

The House is expected to take up the measure on Friday, although there were signs that disparate groups of House Republicans were concerned about it.

Moderates said they may oppose the measure because they are nervous about starting the repeal without a replacement plan.

Rep. Charlie Dent (R-Pa.), co-chair of the informal caucus of moderate Republicans called the Tuesday Group, said that moderate lawmakers have “serious reservations” about starting the process without replacement plans being spelled out.

And members of the House Freedom Caucus called for a fuller plan before any votes are taken — including on the preliminary budget measure.

“We just want more specifics,” said Rep. Mark Meadows (R-N.C.), the caucus chairman. “I’m willing to take a vote today if we have the specifics. So it’s not as much slow it down for slowing-it-down purposes as it is, we need to know what we’re going to replace it with.”

Senate Democrats tried to embarrass Republicans in the all-night vote series by forcing them to take tough votes on protecting mental-health services and womens’ access to health care. One such measure would block the Senate from passing any legislation “that would reduce or eliminate access to mental health services.” Another contains similar prohibitions against cutting funding for maternity care.

Republicans blocked six amendments from Democrats within the first several hours of voting. Among the failed measures was an attempt to prevent any changes to Medicare or Medicaid, or to reduce the number of people enrolled in private health insurance.

Democrats tracked how Republicans voted throughout the night — information that could be used during coming election campaigns, according to Democratic leadership aides who would not speak on the record to divulge internal party strategy.

The voting marathon was expected to end with a final vote instructing the House and Senate committees to begin work on legislation to render useless major portions of Obamacare.

The GOP divisions highlight the difficulty Republicans face in making good on one of their central campaign promises a little more than a week before they take full control in Washington.

Once the Senate passes the budget measure, it will be sent to the House, where it will not be subject to lengthy debate.

Pressure from House Republicans and from Trump’s public comments are prodding Republicans to more quickly produce additional details.

House Majority Whip Steve ­Scalise (R-La.) said Wednesday that lawmakers are “in sync” with Trump’s wishes but added: “I think it’s good that we all continue to press each other to work as quickly as we can.”

Trump’s comments Wednesday, as well as those made Tuesday in a New York Times interview, seem to conflate various aspects of the repeal process and set out what many on Capitol Hill see as an overly ambitious timeline for action.

Scalise and Rep. Patrick J. Tiberi (R-Ohio), chairman of the Ways and Means subcommittee on health, said that lawmakers are taking a close look at what elements of a replacement plan can be included in the initial Obamacare repeal bill.

That legislation is crucial because Republicans plan to pass it using special budget rules allowing the Senate to approve it with only a simple majority vote rather than a 60-vote supermajority. But Senate rules dictate that only measures with a discrete budgetary impact can be handled under those procedures.

So while Republicans could claim that the bill repealing Obamacare also contains a replacement blueprint, other parts would need 60 Senate votes — and significant Democratic support.

According to multiple GOP individuals, Republicans are looking at whether to use coming reauthorizations of existing programs, such as the Children’s Health Insurance Program, as vehicles for Obamacare replacement measures. That could give them leverage to secure cooperation from Democrats.

Another wild card is Trump’s pick for secretary of the Department of Health and Human Services, Rep. Tom Price (R-Ga.). Trump suggested Wednesday that Price would play a key role in shaping the Obamacare replacement strategy.