Senate rejects
measure to partly repeal Affordable Care Act, dealing GOP leaders a major
setback
By Juliet Eilperin, Sean Sullivan and Kelsey Snell
July 28 at 2:00 AM - The Washington Post
Senate Republicans suffered a dramatic failure early Friday in their bid to
advance a scaled-back plan to overhaul the Affordable Care Act, throwing into
question whether they can actually repeal the 2010 health law.
Their latest effort to redraw the ACA failed after Sen. John McCainfs
decision to side with a couple other Republicans against President Trump and GOP
leaders. The Arizona Republican, diagnosed with brain cancer last week, returned
to Washington Tuesday and delivered a stirring address calling for a bipartisan
approach to overhauling the ACA, while criticizing the process that produced the
current legislation.
It was a speech that laid the groundwork for Fridayfs dramatic vote.
The vote was 49 to 51.
Senate Majority Leader Mitch McConnell (R-Ky.) had hoped to approve the new,
narrower rewrite of the health law at some point Friday, after facing dozens
amendments from Democrats. But the GOP defections left McConnell without a clear
path forward.
gOur only regret is that we didnft achieve what we hoped to accomplish,h
McConnell said after the failed vote. McConnell, in a dejected tone, pulled
entire legislation from consideration and set up votes on nominations.
gIt is time to move on,h McConnell said, culminating a nearly 75-minute set
of roll calls. At one point Vice President Pence -- there to be the tie-breaking
vote if needed -- stood talking at length with McCain.
On Thursday, McCain had been seeking an iron-clad guarantee from House
Speaker Paul D. Ryan (R-Wis.) that, if the Senate approved this latest proposal,
the House would not move to quickly approve the bill in its current form and
instead engage in a broad House-Senate negotiation for a broader rollback of the
law. Ryan issued a statement intended to assuage the concerns of McCain and two
others, Sens. Lindsey O. Graham (R-S.C.) and Ron Johnson (Wis.), but the 2008
presidential nominee deemed the speakerfs statement as insufficient.
The standoff between the two chambers highlighted the extent to which
Republicans have still not reached a consensus on how to rewrite President
Barack Obamafs 2010 health-care law, and the degree to which Republicans are
repeating many of the same back-room maneuvers that Democrats used seven years
ago to approve the ACA.
McConnellfs draft rattled both moderates – Sens. Susan Collins (Maine) and
Lisa Murkowski (Alaska) were the other Republican votes in opposition – and
Republicans who wanted a more robust uprooting of the existing law.
gIfm not going to tell people back in South Carolina that this product
actually replaces Obamacare, because it does not, it is a fraud,h Graham said at
a Thursday evening news conference with McCain and Johnson at his side.
And while GOP senators insisted the bill they were considering would not make
it into law, if enacted it would make sweeping changes to health coverage as
well as medical treatment in the United States.
It would eliminate enforcement of the ACAfs requirement that Americans obtain
insurance or pay a tax penalty, and suspend for eight years enforcing the
mandate that companies employing 50 or more workers provide coverage.
The measure also would eliminate funding for preventive health care provided
under the 2010 law and prohibit Medicaid beneficiaries from being reimbursed for
Planned Parenthood services for one year. Instead, the federal funding that
would have gone to Planned Parenthood would go to community health centers. It
would end a 2.3 percent tax on medical device manufacturers for three years.
And it would empower federal officials under an existing waiver program to
give states wide latitude in how they allocate their Medicaid funding,
potentially pooling that money with other programs such as one that helps
lower-income Americans buy private insurance. It also would increase the limit
on contributions to tax-exempt health savings accounts for three years.
After weeks of secretive negotiations, McConnell unveiled this draft only a
couple of hours before Friday morningfs vote.
Shortly after it was introduced, the Congressional Budget Office issued an
estimate finding that 16 million people would lose coverage and that premiums
would rise roughly 20 percent a year between 2018 to 2026 compared to
current law if Republicans enacted the pared-down bill.
Sara Rosenbaum, a health law and policy professor at George Washington
University, said the bill would make genormoush changes to private and public
insurance.
Translating their pledge to repeal what they derisively call Obamacare into a
law has proved embarrassingly difficult for Republicans. First, the House took
an extra six weeks to pass its version of the bill in early May. Most
Republicans agreed that the measure was flawed — Trump later called it gmeanh
for how it would deny insurance to 23 million people — and hoped that the
Senate would craft a better bill.
But McConnellfs closed-door negotiations ended in gridlock, leaving him to
pull together this gskinnyh repeal of the ACA, just to keep alive the
possibility of negotiations with the House to come up with a different plan
later this summer.
gIfm not going to tell people back in South Carolina that this product
actually replaces Obamacare, because it does not; it is a fraud,h Graham said at
a Thursday evening news conference with McCain and Johnson at his side.
McCain, who was diagnosed with brain cancer last week and returned this week
calling for a bipartisan approach, was poised to be the critical vote on
McConnellfs new proposal, which has no Democratic support.
Many conservatives in both chambers object to the measure because they say it
wouldnft go far enough in repealing the ACA.
For instance, the expansion of federal funding to use Medicaid to provide
insurance to about 14 million Americans is left intact, a major victory for
half a dozen Senate Republicans from states that accepted the additional money.
Governors, under the new Senate proposal, would have more leeway in how they can
spend Medicaid funding overall.
Major insurers are warning that the proposal could destabilize the individual
insurance market. Blue Cross Blue Shield Association criticized it on Wednesday,
and on Thursday the industryfs largest trade group suggested it was
unacceptable.
gWe would oppose an approach that eliminates the individual coverage
requirement, does not offer continuous coverage solutions, and does not include
measures to immediately stabilize the individual market,h Americafs Health
Insurance Plans wrote in a letter to Senate leaders.
Senate Republicans, however, framed the bill as just a vehicle to keep alive
their ACA repeal efforts.
gMy sense is people arenft so much focused on the substance as they are this
being the lifeline to get to a conference and expanding the bill,h said Sen. Bob
Corker (Tenn.).
Before Ryan issued his statement, the prospect of an immediate up-or-down
vote in the House raised alarms in the Senate. House Republican leaders
instructed their members not to leave town for their month-long summer recess
just yet.
Key House conservatives said they would not back a skinny repeal in its
current form. Rep. Mark Meadows (R-N.C.), chairman of the House Freedom Caucus,
said that he wouldnft vote for such a measure and that he didnft think other
conservatives would, either.
Speaking on the Senate floor Thursday, McConnell emphasized that the votes
this week would not reverse the ACA even if they culminate in the passage of a
bill.
gOne phase of that process will end when the Senate concludes voting this
week, but it will not signal the end of our work. Not yet,h he said.
In an effort to muster enough votes for a narrow bill, GOP leaders suggested
that even some proposals that have died in the Senate could resurface once
senators enter negotiations with the House. And some members tried to add a few
more provisions to the skinny bill, using their leverage to try to strengthen
their negotiating positions in conference.
While McConnell has led the negotiations over health-care legislation for
weeks, Trump has sought to drum up support by pressing wavering Republicans.
Interior Secretary Ryan Zinke called Sens. Dan Sullivan and Lisa Murkowski,
both Alaska Republicans, separately Wednesday to warn them that the
administration may change its position on several issues, according to people
briefed on the conversations, given Murkowskifs vote against proceeding with
health-care legislation this week.
Since Trump took office, Interior has indicated that it is open to
constructing a road through the Izembek National Wildlife Refuge and drilling in the Arctic
National Wildlife Refuge while expanding energy exploration elsewhere in Alaska.
But now these policy shifts may be in jeopardy.
Speaking to reporters Thursday, Sullivan said the Trump administration has
been cooperative on Alaska issues with Murkowski, who chairs the Senate Energy
and Natural Resources Committee.
gFrom my perspective, the sooner we can get back to that kind of cooperation
between the administration and the chairman of the ENR Committee, the better for
Alaska and the better for the country,h he said. Sullivan said he is not telling
Murkowski how to respond.
The Alaska Dispatch News first reported the calls; Interior officials did not
respond to a request for comment.