Republicans Give Up On Repealing Obamacare

As we head into another election year, Republicans appear to be officially giving up on any effort to ‘repeal and replace’ the Affordable Care Act:

WHITE SULPHUR SPRINGS, W.Va. — Republicans are giving up on their years-long dream of repealing Obamacare.

Though the GOP still controls both chambers of Congress and maintains the ability to jam through a repeal-and-replace bill via a simple majority, there are no discussions of doing so here at House and Senate Republicans’ joint retreat at The Greenbrier resort. Republicans doubt they can even pass a budget providing for the powerful party-line “reconciliation” procedure used to pass tax reform last year, much less take on the politically perilous task of rewriting health care laws in an election year.

“I don’t think leadership wants to,” said Sen. Bill Cassidy (R-La.), who worked with South Carolina Sen. Lindsey Graham (R-S.C.) on a last-ditch repeal effort last fall. “In the sense of Graham-Cassidy, a partisan exercise? Doesn’t look like it.”

Republicans’ decision to abstain from another attempt at gutting Barack Obama’s health law — at least this year — goes back on a pledge the party has made to voters since 2010. And it underscores how Republicans overpromised in their ability to reform the nation’s health care and never fully recognized how divided the party is over key Obamacare planks like protecting pre-existing conditions and preserving the law’s Medicaid expansion.

And now the GOP is facing reality. Senate Republicans would struggle to pass a bill slashing at Obamacare under the best circumstances this year. They lost a Senate seat in Alabama in December and are down another vote as Sen. John McCain (R-Ariz.) undergoes cancer treatment. GOP leaders would rather put the debacle of last year’s failed attempt behind them.

“It would be a heavy lift. I think everybody knows,” said Sen. John Thune (R-S.D.), the No. 3 GOP leader. “We sort of tested the limits of what we can do in the Senate last year. And we’re one vote down from where we were then.”

Republicans very well may lose the House or Senate this fall, which would officially stick a fork in their efforts to move a partisan agenda item like Obamacare repeal while President Donald Trump is in office. But there appears to be no urgency to capitalize on unified Republican control: None of the lawmakers interviewed for this story believe that Congress will pass a budget this year that would allow Republicans to use reconciliation to evade the Senate’s supermajority requirements.

And rather than make a major play to the frustrated conservative base on health care, Senate Majority Leader Mitch McConnell (R-Ky.) has charted a bipartisan approach in his comments when asked about the matter.

“I don’t think we’re going to get a budget. And without a budget I don’t think we can do reconciliation,” said Sen. Shelley Moore Capito (R-W.Va.). “When you hear the leader speak, he’s speaking about bipartisanship. So I think that’s the direction we’re going to go in this year.”

The news is not being taken well in some corners of the party. Rep. Mark Meadows (R-N.C.), who leads the conservative House Freedom Caucus, winced when reminded of the party’s failure to repeal Obamacare and the lack of formal discussion on undermining the law at the retreat.

Yet he was hopeful that Republicans can pick up Senate seats in November and try again with a bigger Senate majority.

“Do I see a full repeal of Obamacare happening on a reconciliation vehicle this year? No. And to suggest otherwise would be to ignore 51 votes in the Senate,” Meadows said. “If we keep the majority in the House and they get a larger majority in the Senate then you might look at a reconciliation vehicle after November.”

(…)

In the meantime, some members of both parties are pushing bills to help stabilize the insurance markets, hoping to bring down premiums after Trump eliminated key payments to health insurers. But even that effort has flagged in recent weeks as conservatives have fought any effort seen as propping up Obamacare, most notably the stabilization bill written by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.).

“It’s on the backburner too,” Capito said. Altering Obamacare is “still being looked at. But not with the intensity it was.”

This would seem to be the end of a saga that made up a significant part of the agenda on Capitol Hill for much of last year, as well as an end to the Republican Party’s efforts to repeal and replace the Affordable Care Act until at least the next session of Congress assuming they don’t lose control of the House or Senate in November. It began when the House of Representatives, after some difficulties in March of last year,  passed the American Health Care Act with barely a vote to spare. At that point, the battle shifted to the Senate, which spent three months trying to pass a bill with even just 51 votes (or 50 votes plus the Vice-President’s tie-breaking vote.) From the start it was clear that the House bill had no chance of passing in the Senate, so Senate Republicans put forward their alternative, the Better Care Reconciliation Act. As with the AHCA, the BCRA was drafted behind closed doors without either committee hearings or public debate, and of course no input from Democrats. Almost immediately, the BCRA ran into roadblocks. First, Mitch McConnell’s plan to vote on the bill before the July 4th recess collapsed when the Congressional Budget Office released a devasting score for the bill. After that happened, the BCRA quickly lost support and was pulled from the floor before voting began. After the recess, Senate Republicans put forward a revised plan that also received a bad CBO score and quickly came under fire. When it became obvious that this bill would also fail to get even the fifty votes required to pass the bill, McConnell proposed yet another plan that would repeal the Affordable Care Act without actually replacing it with anything, but that plan ended up falling apart after only eighteen hours. Undaunted, the Senate still refused to give up and decided to go forward even though it was unclear which direction they were heading. Ultimately, the Senate ended up voting on something they called “Skinny repeal,” which repealed only parts of the PPACA such as the individual and employer mandates and some other regulations. Bizarrely, though, even Senators who voted for that bill said they never intended for it to become law. Instead, they said it would be the basis to force a conference committee with the House in an effort to put together a bill that could get through both bodies. That effort, though, came to an end when McCain, who had just been diagnosed with cancer, returned to the Senate to deliver a late-night thumbs down that sealed the bill’s fate. Finally, after first declaring that there would be no more efforts to pass a health care bill, Senate Republicans made one last effort with a bill proposed by Senators Lindsey Graham and Bill Cassidy, but that too failed to pass even under that bodies relaxed reconciliation rules which avoid the need for a sixty-vote majority in order to invoke cloture and pass a bill.

Part of the reason for the apparent surrender on health care is related to the ongoing budget process and the mess being created over that issue. As of now, Congress has yet to pass a budget for Fiscal Year 2018 and it’s being reported that Congress may not bother to even pass a Budget Resolution for Fiscal Year 2019. This last item means that any spending bill for that Fiscal Year would have to come in the form of an omnibus bill of some kind that would likely not be voted on until the Lame Duck session after the November elections. Before that, we’ll likely be operating on a Continuing Resolution.for the first part of the Fiscal Year, especially since Congress will be eager to get out of town as quickly as possible after September 30th to go back to their districts and campaign for the final stretch of the midterm elections. Failing to pass a Budget Resolution also means that the Senate would be unable to make use of the reconciliation process to make another attempt at a health care bill and that they’d need to get sixty votes to invoke cloture on any ‘repeal and replace’ bill. Since that would require the support of at least nine Democrats, assuming there are no Republican defections, to vote with them to invoke cloture. Since that is clearly not going to happen, any effort to pursue a change to the health care laws would be doomed.

The interesting question going forward, of course, is what impact all of this will have politically in the midterm elections. Republicans will no doubt fall back on the same anti-Obamacare rhetoric that seemingly worked for them in 2010 and 2014, but it’s not clear how effective that will be this time around since the big stories of the midterms are likely to be Trump and the state of the economy. Of more immediate importance to Republicans, though, is how their base is going to react to the fact that they failed to fully repeal the PPACA despite having control of the House, Senate, and White House for the first time in a decade. The fact that they failed hasn’t exactly gone over well with the GOP base, and this could play a role in upcoming primaries against Republicans in the House and Senate, and the fact that they’re basically giving up on the effort is likely to go over just as badly. This isn’t something they can blame on Democrats no matter how hard they try, this is all a Republican failure and the base isn’t likely to forget that.

FILED UNDER: Campaign 2018, Congress, Doug Mataconis, Health Care, US Politics
Doug Mataconis
About Doug Mataconis
Doug holds a B.A. in Political Science from Rutgers University and J.D. from George Mason University School of Law. He joined the staff of OTB in May 2010. Before joining OTB, he wrote at Below The BeltwayThe Liberty Papers, and United Liberty Follow Doug on Twitter | Facebook

Comments

  1. OzarkHillbilly says:

    This isn’t something they can blame on Democrats no matter how hard they try, this is all a Republican failure and the base isn’t likely to forget that.

    Yeah but they’ll still find a way to blame Hillary.




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  2. MarkedMan says:

    I think this is being reported inaccurately. The Republicans didn’t just promise to repeal Obamacare, they said they were doing so because it was a bad bill and they would easily be able to offer one that covered more people for less money with more generous benefits and conditions. (Because, Ayn Rand.) Those on either side of the debate who were tuned in knew that the Republican Health Plan was just more Republican lies. But the average voter accepted didn’t. So the Regina arent just giving up on repealing Ocare. THey are admitting they don’t have anything to offer in it’s place.




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  3. michael reynolds says:

    @MarkedMan:
    Yep, exactly.

    When this debate started back at the dawn of time my position was that Obama had gotten the best anyone could under the circumstances. That remains my position, and I’m glad to see that Republicans now agree.

    From here on in Republicans will be undermining Obamacare while admitting they have no replacement. They’ll just be pushing people off health insurance because that insurance came by way of the black president. People can go sick, people can live in pain, people can live in fear of medical bills, people can die, all so that the party that now admits it cannot do better, can express its racist fury.




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  4. al-Ameda says:

    Republicans do not need to repeal it in order to kill it, and that’s what they’re doing.




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  5. Liberal Capitalist says:

    I agree with Doug’s assessment of the events and Michael’s bitterness…

    Why bother to have votes to repeal Obamacare when they:

    * can defund it through a thousand cuts,
    * allow the red stares to easily eliminate funding
    * avoid any replacement vote (which would alienate their contributor base)
    * blame Obama and the Democrats for the tattered remains of the program.

    For them, it’s a solid win.

    And while Sideshow Bob Trump continues his presidential acts, no one will focus on the devastation to the poor and lower middle class.




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  6. Kylopod says:

    Of course there were multiple times last year in which Republican leaders in Congress seemed to make noises about giving up on Obamacare repeal, only for this to be followed by a Trump freakout, and before long they’d be trying again.

    One of the differences now (besides the heightened political dangers of attempting it during an election year with fewer votes to spare, as well as the difficulties in going about it now that the law’s least popular provision is already gone) is that Trump no longer seems to be pushing back against these reports. The line he’s taking is that he’s already repealed the law, by repealing the individual mandate. From here on, that’ll be the right’s excuse for declaring victory and moving on.




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  7. Kathy says:

    From the outside looking in, I see two BIG problems with the US system of healthcare and insurance:

    1) Insurance seems to cover everything, from a band-aid and an aspirin to brain surgery and intensive care. This obviously means bigger premiums. Typically insurance is used as a hedge for catastrophic or major expenses, especially ones that are likely or certain at some point. If auto insurance included everything from gas fill-ups and oil changes to major repairs, it would also be more costly than it is now.

    2) Health insurance is largely paid for through employers, who can get better rates through volume in some cases. This si problematic in an era where employees are seen as mere labor costs, and when outsourcing and the gig economy get bigger every day.

    Those problems need to be solved before healthcare costs can be controlled in a rational manner not requiring rationing.




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  8. Daryl's other brother Darryl says:

    OT…is Comey calling Trump a weasel and a liar?

    All should appreciate the FBI speaking up. I wish more of our leaders would. But take heart: American history shows that, in the long run, weasels and liars never hold the field, so long as good people stand up. Not a lot of schools or streets named for Joe McCarthy.




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  9. MarkedMan says:

    @Kathy: Your points are all good. I would add that perhaps the biggest driver of the cost of our healthcare system is administering that system. We have one or two orders of magnitude more people employed in the payment of medical bills than any other system. My back of the envelope calculation is that it represents 30% of our costs. That is a gigantic number.




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  10. Kathy says:

    @MarkedMan: I guess that should be looked into, but also that solving my first point ought to greatly reduce this problem.




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  11. michael reynolds says:

    You know the problem with death? It never happens in the future ‘when you’re old,’ it happens right now, today. So one’s romantic notion that at some distant point in the future one will accept death gracefully is nonsense, because when you get there it won’t be the future, and you won’t be some fantasy version of yourself.

    Unless disease and depression have softened you up with a preliminary artillery barrage of pain and futility, you’re never going to think, “Okay, today will be a good time to die.” At that moment, as you squirm, as desperate as a bait worm on a hook, along comes medical science to say, “You know, for a couple hundred grand we could cut you up, fill you full of chemicals, and maybe add, oh, two days to your lifespan,” and people snatch at that straw don’t they?

    The paradox of death: Life is too short, but eternity is too long.

    So long as people are terrified of death, and so long as medical science has no real cure for death, we have this uncomfortable situation where fear feeds profit. The medical industry feeds fear of death, fear of death feeds the medical industry, and around we go.

    This is supposedly a Christian country where the majority of people ‘believe’ in heaven. A heaven they will bankrupt their children to avoid. A heaven they evidently fear every bit as much as a non-believer fears obliteration. Except that my anecdotal sense is that atheists actually have less fear of death – possibly because it makes their case – while Christians know in the hearts that their ‘faith’ is baloney. The atheist goes to the end he expects. The Christian goes to what he’s spent a lifetime pretending won’t happen.

    We have a problem of philosophy, a problem of avoidance and false expectations. Our weakness is exploited by the medical industry just as it is exploited by religion.

    We are all going to die. 100% of us, no exceptions. And when the day comes 90% of us will be begging for another 24 hours. Why? Because we fear death? That’s silly – death is nothing. Literally, nothing. Or is it that we love life? That’s a better answer, but usually (not always) false: no one loves another day on a breathing machine, or another day recovering from pointless surgery.

    It’s interesting to see is how much Genesis anticipated the core problem of homo sapiens, our awareness of our own impending deaths. It was not an apple tree Adam and Eve ate of:

    17 But of the tree of the knowledge of good and evil, thou shalt not eat of it: for in the day that thou eatest thereof thou shalt surely die.

    Let me just edit me some Moses: “For in the day that thou eatest thereof thou shalt learn that thou shalt surely die.” FTFY. Self-awareness is the original sin.

    As far as we know, we are the only species that has an awareness of its own mortality, and there’s the rub. Cats don’t spend their days fearing death, we do. If you believe Genesis we made a bargain as a species: let us know. Let us gain knowledge. Whatever the cost.

    22 And the Lord God said, Behold, the man is become as one of us, to know good and evil: and now, lest he put forth his hand, and take also of the tree of life, and eat, and live for ever:

    23 Therefore the Lord God sent him forth from the garden of Eden, to till the ground from whence he was taken.

    24 So he drove out the man; and he placed at the east of the garden of Eden Cherubims, and a flaming sword which turned every way, to keep the way of the tree of life.

    Once you become woke – to repurpose a modern word usage – you know you will die. And then you will not be content with just the tree of knowledge, you’re going to want the tree of life. There are sword-wielding Cherubim in the way, but medical science will do its best, and in the process separate you from your wealth and quite often reduce you to a desperate, semi-conscious husk of yourself.




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  12. KM says:

    @michael reynolds:

    One of my mother’s contemporaries just “died suddenly” recently. She expressed shock at how someone “so young” could pass away “so quickly” – the woman was 72 and had a history of heart disease. When I pointed out 72 is elderly no matter how Boomers feel about it, she got pissed off and told me they all have many years left. My parting shot was a decade isn’t that many years if you think about it and the chances of multiple decades ahead gets slimmer by the day.

    This kind of denial is rampant among the population. We constantly downplay how close we are to the end of our tenure in this world with nonsense like “60’s the new 30”. I *HATED* dealing with end of life issues when practicing – so many people willing to leave behind millions of dollars in debt for their family only to eke out a few measly weeks chained to machines in a bed. It was a major factor in my decision to change fields – the denial and the violence that denial provokes. I’d lost count of the number of patients and families that physically attacked me for telling them the truth that their loved one was dying and they needed to accept it.

    You’re right in that death is terrifying since it’s the ultimate “we don’t know” . What we do know is it’s the end of you as you are: your mind, your body, your personality and the sum total of everything you value about yourself. Whatever happens, the you who exists now is gone for good. No amount of money or medical care will fix that so spare your loved ones the bill and enjoy your last moments as yourself. I’ve never seen anyone regret that decision.




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  13. michael reynolds says:

    @KM:
    Wow, that family would attack someone over stating the obvious is. . . well, it probably shouldn’t surprise me, but it does.

    My father-in-law is 86, is in late stages of COPD, carrying an oxygen bottle and in need of a stent for a blocked artery. He’s in such bad shape the docs won’t OK a stent because he’s too likely to die on the table. And he doesn’t think he’s dying.

    What do people think death looks like? Because to my eyes it looks a lot like pushing 90, unable to breathe. How do you live that long and not figure out that the life behind you is waaaay longer than the life ahead of you? Do people get to 86 and think, “Okay, then, halfway to 172?”

    I’m 63, in good health, and I’m already trying to plan for the aftermath of my (hopefully painless) launch into oblivion. I worry my wife will be alone. I worry my kids won’t cope. I worry the insurance won’t pay off. I also, incidentally, worry about just what the hell I do (professionally, financially) if I live another 20 years. I’m not sure I can afford to live that long. But I’m not so cocky I imagine I’ll be immune to the urge to prolong at all costs. I don’t think so, but you don’t know till you’re there.

    She should have died hereafter;
    There would have been a time for such a word.
    To-morrow, and to-morrow, and to-morrow,
    Creeps in this petty pace from day to day
    To the last syllable of recorded time,
    And all our yesterdays have lighted fools
    The way to dusty death. Out, out, brief candle!
    Life’s but a walking shadow, a poor player
    That struts and frets his hour upon the stage
    And then is heard no more: it is a tale
    Told by an idiot, full of sound and fury,
    Signifying nothing.




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  14. MarkedMan says:

    Fear of death definitely plays into it. Hearing what you want to hear also plays into it. I used to hang out with surgeons a lot and when you get a group of them together there is a lot of chest thumping behavior. Amongst general surgeons they often discussed a particularly difficult surgery in pancreatic cancer. Once I thought to ask a group who had been patting themselves on the back over their technique, “So, what’s the prognosis?” Complete change of demeanor. It turns out that the amount of time it adds to your life is small and the side effects make that life even worse. Not a single one of them would have it done to themselves if they had cancer. I knew a couple of these guys fairly well. They were not the kind to sugarcoat the news – quite the opposite in fact. So why did patients elect to go through with it? Well, there’s a whole lot of statistics that come up in an explanation of options and buried in that is one number that pops out to people: median survival rate is 15 months post surgical. I think all the other stuff goes in one ear and out the other, including the part about the median survival rate for people who don’t get the operation. My guess is they hear that number, and translate it to mean “15 more months of life”. That sounds like enough to take the gamble. After all, dying of pancreatic cancer without the operation is no walk in the park either.




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  15. MarkedMan says:

    @michael reynolds: One thing I’ve observed when watching family members age and die: the older and sicker you get, the more cognitive ability you lose. And the more ability you lose, the more… basic… you become. You focus on the abstract less and the immediate much more. These shoes are good for my feet. This blanket is scratchy. John will visit tomorrow. Essentially (and this sounds much worse than my intent) you lose the higher functioning and become more animalistic.And there is no more powerful animalistic urge than the will to live.

    I know two people who, at 60, stated plainly they didn’t want drift into decrepitude. But as they got older they gradually lost their ability to think of themselves in the abstract. It happened so slowly it was barely noticeable. Both ended their lives in a twilight fog of one bout of illness after another.




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