Senate rejects broad Obamacare repeal bill
By Thomas Kaplan and Robert Pear
The New York Times
July 25, 2017 8:27 PM
WASHINGTON – The Senate voted narrowly Tuesday to begin debate on a bill to
repeal major provisions of the Affordable Care Act, but hours later, Republican
leaders suffered a setback when their most comprehensive plan to replace former
President Barack Obamafs health law fell far short of the votes it needed.
The Tuesday night tally needed to reach 60 votes to overcome a parliamentary
objection. Instead, it fell short, 43-57. The fact that the comprehensive
replacement plan came up well short of even 50 votes was an ominous sign for
Republican leaders still seeking a formula to pass final health care legislation
this week.
For Republicans, the failure ended the day on a sour note, hours after a more
triumphant scene on the Senate floor. Lawmakers from both parties had risen to
their feet in the afternoon and applauded when Sen. John McCain, R-Ariz., showed
up in the chamber despite his diagnosis of brain cancer. He cast a crucial vote
in favor of opening what promises to be a freewheeling, hard-fought debate over
the future of the Affordable Care Act.
The 51-50 vote to start debate, with Vice President Mike Pence breaking a
tie, came only a week after the Republican effort to dismantle a pillar of
Obamafs legacy appeared all but doomed. It provided an initial win for President
Donald Trump, who pushed, cajoled and threatened senators in recent days to at
least begin debating the repeal of the health care law.
But the victory could be fleeting: Senate Republicans still have no agreement
on a repeal bill that they can ultimately pass to uproot the law that has
provided health insurance to millions of Americans.
The Senate is now moving ahead with debate, amendments and ultimately a final
vote in the coming days on legislation that would have a profound effect on the
American health care system – roughly one-sixth of the U.S. economy. But it is
entirely possible that by weekfs end, they will have passed nothing.
gNow we move forward towards truly great health care for the American
people,h Trump said from the White House Rose Garden, where he was holding a
news conference with the visiting prime minister of Lebanon. gThis was a big
step.h
Only two Republicans, Sens. Susan Collins of Maine and Lisa Murkowski of
Alaska, voted against the procedural motion, although at least several other
Republicans had been seen as possible holdouts. No Democrats voted in favor of
the motion.
The Tuesday night vote was on a comprehensive amendment that included
disparate proposals calculated to appeal to conservatives and moderates in the
Republican caucus.
One proposal, offered by Sen. Ted Cruz, R-Texas, would have allowed insurers
to sell stripped-down health plans, without maternity care or other benefits
required by the Affordable Care Act, if they also sold plans that included such
benefits.
gYou shouldnft have to buy what the federal government mandates you must
buy,h Cruz said. gYou should choose what meets the needs for you and your
family.h
The amendment also included money to help pay out-of-pocket medical costs for
low-income people, including those who buy private insurance after losing
Medicaid coverage as a result of the Senate bill. This proposal was devised by
Sen. Rob Portman, R-Ohio, and other senators from states that have expanded
Medicaid under the Affordable Care Act.
But nine Republicans, spanning the partyfs ideological spectrum, voted
against the package.
The debate to come will have broad implications for health care and
households in every state, and emotions are high.
Before senators voted to start the debate in midafternoon, protesters in the
Senate gallery chanted, gKill the bill, donft kill us!h and gShame, shame,
shame!h
Despite his vote to move ahead, McCain offered harsh words for the secretive
process by which Senate Republican leaders came up with their bill to repeal and
replace the health law, and he delivered a pessimistic take on its chances.
gAsking us to swallow our doubts and force it past a unified opposition – I
donft think thatfs going to work in the end, and probably shouldnft,h McCain
said, adding that it gseems likelyh that the current repeal effort would end in
failure. Still, McCain voted with Republican leaders in favor of the
comprehensive replacement plan on Tuesday night.
Arizona is one of the 31 states that expanded Medicaid under the Affordable
Care Act, and McCainfs remarks could reflect concerns of other senators from
states that expanded Medicaid, including the junior Republican senator from his
state, Sen. Jeff Flake.
gWe are ground zero for the failure of the exchanges, but we are also an
expansion state,h Flake said. gI think all of us are concerned that we donft
pull the rug out from people.h
Just before the Senate vote, the Democratic leader, Chuck Schumer of New
York, made an impassioned plea to Republicans.
gWe know that ACA is not perfect,h Schumer said. gBut we also know what
youfve proposed is much worse. We can work together to improve health care in
this country. Turn back now before itfs too late and millions and millions and
millions of Americans are hurt so badly in ways from which they will never, ever
recover.h
Given the divisions within their caucus, Senate Republican leaders were
considering a new approach to keeping their repeal quest alive: They could try
to reach agreement on a slimmed-down bill that would repeal a few major
provisions of the Affordable Care Act, like the penalties imposed on people who
go without insurance and businesses that do not offer insurance to their
employees. Republican leaders would not intend for such a bill to become law,
but they believe that it could win approval in the Senate.
That gskinnyh bill could then be a basis for negotiations with the House.
Republican leaders in Congress have struggled all year to fulfill their
promise of repealing the 2010 health care law. By a vote of 217-213, the House
approved a repeal bill in early May, but only after Republicans overcame their
own difficulties in that chamber.
Trump kept up pressure on the Senate on Tuesday with Twitter posts. After the
procedural vote, he applauded the Senate, but was cutting toward Collins and
Murkowski: gWe had two Republicans that went against us, which is very sad, I
think. Itfs very, very sad for them.h
The successful procedural vote was also a moment of redemption, at least
temporarily, for the majority leader, Sen. Mitch McConnell of Kentucky, who just
last week appeared to have failed in his effort to put together a health bill
that could squeak through the narrowly divided Senate.
That said, it remained far from certain whether Republicans would be able to
agree on a bill in the days to come – and what exactly the contents of that bill
would be. McConnell promised an gopen amendment processh in which members of
both parties could propose changes.
gThis is just the beginning,h McConnell said. gWefre not out here to spike
the football.h
For weeks, McConnell has been promoting and revising a comprehensive bill
that would repeal the health law while also replacing it, but he has struggled
to nail down the support needed to pass that measure. The nonpartisan
Congressional Budget Office has yet to assess the most complete version of that
legislation, which includes the proposals by Cruz and Portman.
Without that assessment, the measure needed 60 Senate votes, and it failed
that test Tuesday night.
The Senate is also expected to vote on a measure that would repeal the health
law without putting in place any replacement, but that approach does not appear
to have enough support to pass, either.
That proposal resembles a bill passed by the Senate in 2015 and vetoed by
Obama in early 2016. But it would increase the number of people who are
uninsured by 32 million in 2026, the budget office said.
Portman had anguished for weeks over provisions of McConnellfs repeal bill
that would make deep cuts in projected Medicaid spending and roll back the
expansion of the program under the Affordable Care Act.
Portman voted to move ahead with the debate Tuesday after being assured that
the Senate would vote on his plan to provide financial assistance to people
moving from an expanded state Medicaid program to private health insurance.
States could have used the money, totaling $100 billion, to help low-income
people pay deductibles and other out-of-pocket costs when they receive medical
care.
Portman worked on the plan with the Trump administration and with several
other Republican senators from states that have expanded Medicaid, including
Sens. Shelley Moore Capito of West Virginia and Dean Heller of Nevada.
Heller voted Tuesday to open the debate, but he made no commitment to vote
for the repeal bill itself.
gIf the final product isnft improved for the state of Nevada, then I will not
vote for it,h Heller said. gIf it is improved, I will support it.h
Reporting was contributed by Avantika Chilkoti, Emily Cochrane, Julie
Hirschfeld Davis and Jennifer Steinhauer.