Senate Once Again Fails On Health Care Reform
Seven years of rhetoric on health care reform ended early this morning with a narrow vote on a bill that even Republicans didn't really support.
Just over a month ago, in the wake of a razor thin vote in the House of Representatives in favor of the American Health Care Act, the Senate proposed the so-called Better Care Reconciliation Act, its own version of a bill to repeal and replace the Affordable Care Act. As with the House bill, this bill was created behind closed doors with no committee hearings or public debate of any kind, and no input whatsoever from the opposition party, and, just like its House cousin, it quickly ran into road blocks. Plans to hold a vote on the original bill before the July 4th recess, and thus avoid the possibility of Senators being influenced by angry constituents at town halls back home, fell apart when the Congressional Budget Office released a devasting score for the bill. After that, the bill quickly lost support and was pulled from the floor before the voting process could begin. When the Senate GOP put forward a revised plan that also received a bad CBO score and quickly came under fire. When it became apparent that this revised bill would also fail to get even the fifty votes that the GOP would need to pass under the Senate’s reconciliation rules, Senate Majority leader Mitch 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.
All of this led to the absurdity that occurred on Tuesday when the Senate voted to proceed to debate on a bill even though they had no idea what they were voting on. Since then, the Senate voted on proposals that included the original House bill with only a few cosmetic changes, the revised version of the BCRA, and the full repeal-only bill proposed by Texas Senator Ted Cruz. Each of these bills failed to garner even the fifty votes that would allow the Vice-President to break a tie and send something to the House. By that point, the only idea left on the floor was so-called “Skinny Repeal,” under which only certain provisions of the Affordable Care Act would be repealed. In what can only be described as a stunning admission, several Republican Senators admitted that this proposal was not a serious idea and that it would be a “disaster” if it became law. The intention, apparently, was to get the matter to a House-Senate Conference Committee where the two bodies and both parties would try to come up with something that could pass both chambers.
With all of that history, the Senate headed into an all night voting session last night that ended rather dramatically with the defeat of “skinny repeal” and the past three months or so of legislative effort lying in ruins thanks in no small part to Senator John McCain:
WASHINGTON — The Senate in the early hours of Friday morning rejected a new, scaled-down Republican plan to repeal parts of the Affordable Care Act, derailing the Republicans’ seven-year campaign to dismantle President Barack Obama’s signature health care law and dealing a huge political setback to President Trump.
Senator John McCain of Arizona, who just this week returned to the Senate after receiving a diagnosis of brain cancer, cast the decisive vote to defeat the proposal, joining two other Republicans, Susan Collins of Maine and Lisa Murkowski of Alaska, in opposing it.
The 49-to-51 vote was also a humiliating setback for the Senate majority leader, Mitch McConnell of Kentucky, who has nurtured his reputation as a master tactician and spent the last three months trying to devise a repeal bill that could win support from members of his caucus.
As the clock ticked toward the final vote, which took place around 1:30 a.m., suspense built on the Senate floor. Mr. McCain was engaged in a lengthy, animated conversation with Vice President Mike Pence, who had come to the Capitol expecting to cast the tiebreaking vote for the bill. A few minutes later, when Mr. McCain ambled over to the Democratic side of the chamber, he was embraced by Senator Dianne Feinstein, Democrat of California. A little later Senator Amy Klobuchar, Democrat of Minnesota, put her arm around Mr. McCain.
The roll had yet to be called, but the body language suggested that the Trump administration had failed in its effort to flip the Arizona senator whom President Trump hailed on Tuesday as an “American hero.”
Many senators announced their votes in booming voices. Mr. McCain quietly signaled his vote with a thumbs-down gesture.
The truncated Republican plan that ultimately fell was far less than what Republicans once envisioned. Republican leaders, unable to overcome complaints from both moderate and conservative members of their caucus, said the skeletal plan was just a vehicle to permit negotiations with the House, which passed a much more ambitious repeal bill in early May.
The “skinny repeal” bill, as it became known at the Capitol this week, would still have had broad effects on health care. The bill would have increased the number of people who are uninsured by 15 million next year compared with current law, according to the nonpartisan Congressional Budget Office. Premiums for people buying insurance on their own would have increased roughly 20 percent, the budget office said.
Unlike previous setbacks, Friday morning’s health care defeat had the ring of finality. After the result was announced, the Senate quickly moved on to routine business. Mr. McConnell canceled a session scheduled for Friday and announced that the Senate would take up the nomination of a federal circuit judge on Monday afternoon.
With so many senators in both parties railing against the fast-track procedures that Republican leaders used, a return to health care seemed certain to go through the committees, where bipartisanship and deliberation are more likely.
“We are not celebrating,” said the Senate Democratic leader, Chuck Schumer of New York. “We are relieved that millions and millions of people who would have been so drastically hurt by the three proposals put forward will at least retain their health care, be able to deal with pre-existing conditions.”
Mr. McConnell said he was proud of his vote to start unwinding the Affordable Care Act. “What we tried to accomplish for the American people was the right thing for the country,” Mr. McConnell said. “And our only regret tonight, our only regret, is that we didn’t achieve what we had hoped to accomplish.”
The new, eight-page Senate bill, called the Health Care Freedom Act, was unveiled just hours before the vote. It would have ended the requirement that most people have health coverage, known as the individual mandate. But it would not have put in place other incentives for people to obtain coverage — a situation that insurers say would leave them with a pool of sicker, costlier customers. It would also have ended the requirement that large employers offer coverage to their workers.
The “skinny repeal” would have delayed a tax on medical devices. It would also have cut off federal funds for Planned Parenthood for one year and increased federal grants to community health centers. And it would have increased the limit on contributions to tax-favored health savings accounts.
In addition, the bill would have made it much easier for states to waive federal requirements that health insurance plans provide consumers with a minimum set of benefits like maternity care and prescription drugs. It would have eliminated funds provided by the Affordable Care Act for a wide range of prevention and public health programs.
Before rolling out the new legislation, Senate leaders had to deal with a rebellion from Republican senators who demanded ironclad assurances that the legislation would never become law.
Mr. McCain and Senators Lindsey Graham of South Carolina and Ron Johnson of Wisconsin insisted that House leaders promise that the bill would not be enacted.
“I’m not going to vote for a bill that is terrible policy and horrible politics just because we have to get something done,” Mr. Graham said at a news conference, calling the stripped-down bill a “disaster” and a “fraud” as a replacement for the health law.
Mr. Graham eventually voted for the bill after receiving an assurance from the House speaker, Paul D. Ryan, that the two chambers would negotiate their differences if the Senate passed the legislation.
“If moving forward requires a conference committee, that is something the House is willing to do,” Mr. Ryan said in a statement. “The reality, however, is that repealing and replacing Obamacare still ultimately requires the Senate to produce 51 votes for an actual plan.”
But Mr. Ryan left open the possibility that if a compromise measure had failed in the Senate, the House could still pass the stripped-down Senate health bill. That helped push Mr. McCain to “no.”
Republican senators found themselves in the strange position of hoping their bill would never be approved by the House.
Here’s video of Senator McCain’s vote:
— CNN Politics (@CNNPolitics) July 28, 2017
Shortly after the vote, McCain tweeted:
Skinny repeal fell short because it fell short of our promise to repeal & replace Obamacare w/ meaningful reform https://t.co/tZISIvccOO
— John McCain (@SenJohnMcCain) July 28, 2017
And issued a press statement as well:
“From the beginning, I have believed that Obamacare should be repealed and replaced with a solution that increases competition, lowers costs, and improves care for the American people. The so-called ‘skinny repeal’ amendment the Senate voted on today would not accomplish those goals. While the amendment would have repealed some of Obamacare’s most burdensome regulations, it offered no replacement to actually reform our health care system and deliver affordable, quality health care to our citizens. The Speaker’s statement that the House would be ‘willing’ to go to conference does not ease my concern that this shell of a bill could be taken up and passed at any time.
“I’ve stated time and time again that one of the major failures of Obamacare was that it was rammed through Congress by Democrats on a strict-party line basis without a single Republican vote. We should not make the mistakes of the past that has led to Obamacare’s collapse, including in my home state of Arizona where premiums are skyrocketing and health care providers are fleeing the marketplace. We must now return to the correct way of legislating and send the bill back to committee, hold hearings, receive input from both sides of aisle, heed the recommendations of nation’s governors, and produce a bill that finally delivers affordable health care for the American people. We must do the hard work our citizens expect of us and deserve.”
On multiple levels, the circus that came to an end early this morning brought to light several truths that have been apparent for seven years at least. For years, the GOP and the organizations that support it have run on the promise of repealing and replacing the Affordable Care Act, and it proved to be an unqualified success. In 2010, Republicans rode the issue to a historic victory that returned control of the House to the GOP after four years of Democrats being in charge and significantly undercut the Democratic advantage in the Senate. Over the next several years, Republicans in the House passed party-line votes to repeal the PPACA more than five dozen times, all of which died an expected death in the Senate as long as it remained in Democratic hands. While many people mocked these votes from the sidelines, they served the primary purpose of keeping the base, which had been taken over by the so-called Tea Party movement, mollified and making sure that their anger against the Obama Administration, the media, and the so-called “Establishment” GOP was stoked and on maximum. At one point, they even engaged in an utterly pointless and futile government shutdown in what was claimed to be a last-minute attempt to prevent the PPACA from going into effect. While the party was not successful in using the issue to unseat the President in 2012, they did manage to grab control of the Senate in 2014. That led to a 2015 effort to repeal the PPACA yet again, only this time it managed to make it to the President’s desk. The important fact, of course, is that Republicans in both the House and Senate knew that their vote on repeal was meaningless because they did not have the votes necessary to override the inevitable Presidential veto.
At no point during this whole seven-year process did we see any serious proposals from Republicans when it came to the ‘replace’ part of ‘repeal and replace.’ Instead, what we usually saw were vague talking points that hit on themes that have been part of GOP rhetoric on this issues for awhile now, such as allowing health insurance plans to be sold across state lines, tort reform, and the incredibly vague, and largely without specifics, idea of returning to a “free market” health care system that ignored the fact that what existed prior to the PPACA was hardly a free market of any kind. This meant that the GOP was largely caught with its pants down when, to everyone’s surprise including their own, they managed to win control of the White House last November.
Much of this goes a long way toward explaining why the health care “reform” efforts in both the House and the Senate proved to be such utter failures. In both cases, Republicans were confronted with the realization that, this time, they couldn’t just pass a meaningless symbolic bill meant to keep the base happy. This time, all of the responsibility would be on them to actually pass something that would make a system that everyone admits is flawed better while decreasing costs of health care providers, insurers, and most importantly patients while ensuring continued access to high-quality medical care when necessary. Neither the House bill nor the multiple versions of reform proposed by the Senate came close to achieving that goal, and none of them came close to addressing any of the numerous flaws that remain in the PPACA, Medicare, or Medicaid. That led to the desperation of last night, and the absolutely absurd idea of “Skinny Repeal.” In the end, this final proposal was a joke, a fact that was made clear when it became apparent that most of the Senators voting for it were doing so despite the fact that they didn’t actually want it to become law. At the end of the day, Republicans finally revealed that seven years of rhetoric on repealing and replacing the PPACA was nothing more than a way to separate gullible fools from their money and line the pockets of the political professionals behind the so-called “grassroots” Tea Party and the politicians it supported.
Where we go from here is hard to say. For the moment at least, it does appear that the ‘repeal and replace’ effort is dead in the water, but that whole idea has proven to be so central to conservative rhetoric over the past seven years that it’s hard to believe that they’ll abandon it entirely. The only question is whether we see an immediate effort to revive the debate, or whether it’s delayed in favor of concentrating on other issues. As things stand, the current effort can only really survive until the end of September due to the way that reconciliation works in the Senate. Given that, it’s possible that there may be some effort to tie ‘repeal and replace’ to the budget for the new Fiscal Year that could force the Federal Government into a shutdown in October. If that doesn’t happen, then the entire process has to start over again, and who knows how long it might take to pull something workable together again, especially given the fact that we’re closing in on the time when Congress will begin focusing on the 2018 midterms and any deal on health care, or any other issue, will become increasingly unlikely. With all that being said, it’s more likely than not the PPACA will be around for some time to come and that Congress will continue to twiddle its thumbs while the problems with the health care system continue to fester.