Senate Republicans Considering One Last Effort To ‘Repeal And Replace’ Obamacare

Senate Republicans are considering one more last-ditch effort to 'repeal and replace' the Affordable Care Act.


After spending the better part of the summer in what ultimately proved to be a futile effort to pass a bill that would repeal and replace the Affordable Care Act, Senate Republicans are apparently considering making another run at the idea:

Senate Republican leaders seem increasingly focused on reviving their effort to undo the Affordable Care Act before the end of the month, asking Congress’s nonpartisan budget analysts to fast-track consideration of a plan that would devolve federal health-care spending to states.

The Congressional Budget Office is in the process of estimating the cost and coverage impact of the so-called Graham-Cassidy bill, according to a senior Senate Republican aide. The measure from Sens. Lindsey O. Graham (R-S.C.), Bill Cassidy (R-La.), Ron Johnson (R-Wis.) and Dean Heller (R-Nev.) would provide states with funding to establish health insurance programs outside ACA protections and mandates, an approach that could force millions off insurance rolls.

Republicans are facing pressure to undercut the Affordable Care Act, also known as Obamacare, with legislation as soon as possible, partially because the Senate’s ability to pass budgetary legislation with a simple majority expires Sept. 30. After that date, health-care legislation will require 60 votes to pass, making it much harder for Republicans to approve legislation that would restructure Obamacare.

Democrats are taking the latest chatter seriously, and liberal lawmakers spent the weekend slamming the bill on social media.

“The Graham-Cassidy @SenateGOP ‘health care’ bill IS Trumpcare, & it will rip health care away from millions of Americans,” Sen. Elizabeth Warren (Mass.) wrote as part of a series of tweets.

Progressive groups also spent the weekend on the warpath. Ben Wikler, the Washington director of MoveOn, told followers to be ready for a possible vote as early as Sept. 27.

Republican leaders are now trying to determine whether they have enough votes to begin debate on the bill, according to Senate aides. They are also trying to get Sen. John McCain (R-Ariz.), whose “no” vote sank the most recent Republican health-care bill in July, fully on board.

McCain has said he supports the bill in theory but wants to assess its impact on Arizona. Without prompting, he cautioned Republicans on Sunday against the instinct to “ram through our proposal” with a party-line vote

“Why did Obamacare fail? Obamacare was rammed through with Democrats’ votes only. . . . That’s not the way to do it. We’ve got to go back. If I could just say again, the way to do this is have a bill, put it through committee,” he said on CBS’s “Face the Nation.”

Senate Republicans have a very slim path to victory on Graham-Cassidy: If more than two Republicans vote no, the bill won’t pass. The math became even harder once Sen. Rand Paul (R-Ky.) announced his opposition Friday.

“I can’t support a bill that keeps 90% of Obamacare in place,” Paul tweeted.

 Cassidy replied to say the measure “repeals entire architecture of Obamacare & gives Kentucky control over its own health care.”

Compared with Paul, conservative groups have been fairly quiet on the bill. Americans for Prosperity, the Koch-funded tea party group, has said nothing about it since the group’s pivot to tax reform in August.

Heritage Action for America, which organized years of repeal rallies, echoed Paul’s worry that the bill would leave the ACA’s basic structure in place

This latest effort, which can literally be described as a last-ditch effort to pass some kind of health care reform bill this year, and possibly the final time such an effort will be possible before the 2018 midterms, comes after a saga that lasted several months only to ultimately end in failure.

After the House of Representatives passed the American Health Care Act with barely a vote to spare, the focus of the battle over health care reform shifted to the Senate. As we saw unfold through the months of June and July, this ultimately proved to be an utterly fruitless endeavor. First of all, even before the House had passed the AHCA, it was clear that the House bill stood no chance of passage in the Senate even under reconciliation rules as both conservative and moderate Republican Senators rejected the House proposal. Instead, Senate Republicans put forward the Better Care Reconciliation 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 from Democrats and, just like its House cousin, it quickly ran into roadblocks. Mitch McConnell’s plan to vote on the bill before the July 4th recess. for example, fell apart when the Congressional Budget Office released a devasting score for the bill. After that, BCRA quickly lost support and was pulled from the floor before voting could begin. 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.

All of this led to the absurdity that occurred just before the August recess when the Senate voted to proceed to debate on a bill even though they had no idea what they were voting on. After several votes on alternative proposals that failed to garner any significant support, Senate Republicans finally settled on a bill that ended up being called “skinny repeal.” This would only repeal certain parts of the PPACA such as the individual and employer mandates while leaving other parts of the law intact. The bizarre thing about this bill, though, was the fact that even Senators who announced they were voting for it said they didn’t want it to become law. Instead, the intention was to use the bill as a vehicle to get to a conference committee with the House where a joint and presumably bipartisan committee would sit down and try to hammer out something that would pass both houses of Congress. That effort, however, died in dramatic fashion when an ailing John McCain returned to the Senate to deliver a late-night thumbs down that sealed the bill’s fate. After that, a final nail in the coffin was delivered just before Labor Day when the Senate Parliamentarian ruled that the window for Republicans to use reconciliation to pass health care reform would end on September 30th. Once that window was closed the GOP would need sixty votes to pass any form of health care reform before the end of this year. Because of that. Senate Republicans came back to Congress at the beginning of the month basically saying that they were conceding defeat in the health care reform effort for now and wanted to move on to other issues, such as the budget, the debt ceiling, and tax reform.

At this point, it’s far too early to tell whether or not this latest effort will amount to anything, or whether it will even go forward. For one thing, beyond the general descriptions that have been put forward by its sponsors, the details of the bill are not available and it’s difficult to make any judgments about it from a policy perspective. To some extent, that will become clearer after the Congressional Budget Office releases its score of the proposed bill, but it’s unknown when that might occur or whether an actual bill has been submitted to the CBO to make a score possible. Additionally, it appears from the reporting in The Washington Post and elsewhere that the proposal does not have even the fifty votes it would need to pass under the Senate’s relaxed reconciliation rules and that it likely won’t even be brought to the floor unless Mitch McConnell is fairly confident that he can get those fifty bills before the end of the month when the period during which it would be eligible to be considered under those rules would come to an end. If that doesn’t happen, then the bill would likely die just as previous efforts have. We should get a better idea of that after tomorrow’s conference meeting, but time is running short and the history we’ve seen so far doesn’t bode well for this effort either.

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Doug Mataconis
About Doug Mataconis
Doug Mataconis held 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 and contributed a staggering 16,483 posts before his retirement in January 2020. He passed far too young in July 2021.


  1. Just 'nutha ig'nint cracker says:

    Well, I only have one question left–the one I had at the beginning. Some seven or so years back, the GOP told us that they had a better plan available to hit the ground running only they didn’t want a n!&&#3r Democrat to get the credit for being able to enact it. Where’s that plan? Or were y’all lying from day one?

    Senator McCain? Any comments? Maverick? Maverick? Do you copy?

  2. grumpy realist says:

    @Just ‘nutha ig’nint cracker: It’s about the same way the Brits are now scrambling to decide exactly what IS in this Brexit thing, anyhow…while the EU sits on the other side twiddling their thumbs and pointing out that the clock is licking VERY loudly.

    As the man says, the devil is in the details. A hoary old rule that seems to have been forgotten by everyone.

  3. Sleeping Dog says:

    Axios has a map showing the winners and losers from Graham-Cassidy. Difficult to imagine a Repug Senator from a Medicaid expansion state voting for this turd, particularly if the the governor is also a Repug

  4. SKI says:

    To recap what we do know:

    CBO won’t have time to score the impact on coverage (aka how many millions will lose coverage) or premiums or the deficit

    No public hearings or mark-ups or Amendments

    Not only rewards states that failed to expand Medicaid but severely punishes those states that did.

    90 seconds (or 2 minutes? – I’ve heard both) set aside for “debate” on a matter that impacts 1/6th of the US economy.

    No individual ore employer mandate.

    No subsidies for individuals who are lower middle class to buy insurance.

    States can waive the requirement for insurance to cover pre-existing conditions

    States can also change what constitutes an “essential health benefit” – aka what is actually covered – and what is subject to a lifetime cap.

    Disparity in community rating expands from max of 3x to 5x for older Americans.

  5. SKI says:

    @Sleeping Dog: And yet… Arizona.

  6. SKI says:

    The Center on Budget and Policy Priorities actually just released an analysis: “Commentary: Rushed Senate Consideration of Cassidy-Graham Would Be Designed to Hide Bill’s Severe Flaws”

    Cassidy-Graham is in many ways as bad as — or worse than — previous repeal bills that have failed to pass Congress this year.[2] It would repeal both the ACA’s Medicaid expansion and the subsidies that help people purchase coverage through the insurance marketplaces, replacing them with a deeply insufficient block grant that would disappear entirely in 2027.[3] It would allow states to eliminate or weaken protections for people with pre-existing conditions, enabling insurers to once again charge higher premiums based on health status and exclude essential health benefits.[4] And it would cap and cut the underlying Medicaid program (on top of ending the Medicaid expansion), threatening coverage for tens of millions of people with disabilities, seniors, and families with children. Yet the process that Congress would take to pass the bill would be designed to hide the damaging impact of those changes.

  7. Kylopod says:

    I am 40 and do not currently suffer from any serious health problems. (My brother, on the other hand, nearly died at 35 from not having health insurance courtesy of a preexisting condition.) I must say, however, that I have a feeling what the Republicans have been doing all year is giving me a severe case of hypertension.

  8. al-Ameda says:

    We know well from recent history, that Republicans never let anything lie.

    They opened investigation after investigation of Hillary Clinton on the Benghazi and EMail Server “scandals’ because they did not like the result of any previous investigation. They were determined to, if not fix the result, at least hold investigations open in order to severely compromise Hillary Clinton’s.

    The same is true for ‘Repeal & Replace.” – Each successive Republican proposal has been a terrible alternative to ACA, yet all but 3 senators voted for it. Clearly, the betting is that McCain will finally fold up and give Republicans what they want – millions off insurance and pass this off to the states, the great majority of which are dominated by Republican legislators who are hostile to ACA and any replacement alternative.

    It’s never over until it’s over for these people.

  9. An Interested Party says:

    We know well from recent history, that Republicans never let anything lie.

    Indeed, they keep trying and trying to pass a bill that will let plenty of people die…