Senate Embarks on New Round of Voting to Peel Back Affordable Care Act

By Kelsey Snell, Juliet Eilperin and Sean Sullivan, The Washington Post

26 July 17

 

enate Republicans planned to forge ahead with proposals aimed at revamping the Affordable Care Act Wednesday, hoping to produce some sort of legislation that could garner enough support to serve as the basis of negotiations with the House.

But after winning a key procedural victory with the help of Vice President Pence’s tiebreaking vote Tuesday, it appeared unclear what sort of health-care rewrite could gain traction. On Tuesday night, just hours after opening debate, Senate Republican leaders were unable to pass a bill that they had spent weeks crafting but that never gained sufficient traction with the rank-and-file.

Fifty-seven senators — including nine Republicans — opposed the updated version of the measure known as the Better Care Reconciliation Act (BCRA), while 43 supported it, portending a difficult road ahead for the GOP rollback effort.

The nine Republicans who opposed the repeal-and-replace legislation late Tuesday underscored the challenge Senate GOP leaders face in building consensus in coming days. The group included hard-like conservatives like Sens. Mike Lee (R-Utah) and Rand Paul (R-Ky.) as well as centrists like Sens. Dean Heller (R-Nev.) and Susan Collins (R-Maine).

Given all the disagreement, Republicans are focused on passing narrower changes to current law by the end of the week, known as “skinny repeal,” in hopes of keeping the debate alive in a House-Senate conference.

There is some hope that the debate can begin anew, and perhaps include consideration of measures rejected on the Senate floor this week.

“When you get all done with it in a conference committee, you can come back in and take the most popular items that are out there and put them back in to the bill if they gain you votes or if they really improve the bill,”’ said Sen. Mike Rounds (R-S.D.) after Tuesday’s vote.

Several senators emphasized they feel a strong imperative to deliver some sort of health-care accomplishment, after vowing for seven years to unwind the law former president Barack Obama ushered into law with only Democratic support.

Sen. Bill Cassidy (R-La.), who had raised objections earlier this month about Senate leaders’ proposal to make deep cuts in Medicaid, said he could back a more modest measure as long as he thought it represented some sort of improvement over the current law.

The “skinny repeal” option would repeal the ACA’s mandates that individuals buy plans and that employers with 50 or more employees provide coverage, said lobbyists and Senate aides, as well as eliminate the law’s tax on medical device manufacturers.

“My endgame is to have something that is fair to patients across the country,” Cassidy told reporters Tuesday night. “Now, I’m not quite sure how we get there, but I am all for anything that gets us one step closer to that end game.”

Still both supporters and critics of GOP leaders’ strategy said there was no way to predict what sort of legislation would come out of the series of votes underway this week. Sen. Lisa Murkowski (Alaska), one of just two Republicans to vote against the motion to proceed with the health-care debate, said late Tuesday that “there’s been a lot of discussion about” about a scaled-back bill, but no definitive proposal.

“We’ll try to get down to where we can find that agreement, but I don’t know if any of us have identified what that may be,” she said.

President Trump, for his part, took to Twitter Wednesday morning to criticize Murkowski for not voting to start debate. “Senator @lisamurkowski of the Great State of Alaska really let the Republicans, and our country, down yesterday. Too bad!” he tweeted.

On Tuesday the Senate is scheduled to vote on at least one repeal proposal, by Sen. Rand Paul (R-Ky.) that would eliminate large parts of the ACA and impose restrictions on federal funding for abortion services. It is also expected to consider an amendment by Sen. Joe Donnelly (D-Ind.) that would send health-care legislation back to committee for further consideration.

Democrats hope the vote on their amendment will give particular discomfort to Republicans like Sen. John McCain (Ariz.), who complained that the GOP bill was written in secret by a small number of senators.

Republicans warned that the voting schedule could change at any time, however.

Trump has been pushing aggressively for Republicans to pass a repeal-and-replace plan, saying opposing the procedural motion to proceed with debate would be tantamount to endorsing the law known as Obamacare.

Speaking at a joint news conference in the Rose Garden on Tuesday, the president said he is “very, very sad” for the Republicans who opposed the motion but “very happy with the result” of the vote.

“Now we’re all going to sit together and try to come up with something really spectacular,” he said. “It’s a very, very complex and difficult task, something I know quite a bit about.”

Tuesday’s proceedings were marked by high drama, including the return of Sen. John McCain (R-Ariz.) to the Capitol just 1 1/2 weeks after he underwent surgery related to his recent diagnosis of brain cancer, and Pence’s move to cast the tiebreaking vote. The intensity of the debate, including protesters who yelled “Kill the bill!” in the Senate chamber after the voting had begun, underscored the stakes involved in overhauling a health-care system that affects one-sixth of the U.S. economy and how tens of millions receive medical care.

All 48 members of the Democratic caucus voted against the procedural motion to start debate, along with two GOP centrists, Murkowski and Susan Collins (Maine).

Republicans have struggled mightily to get to this point, and there is no guarantee they will win final passage of the bill. In a sign of how muddled the situation remains, McCain took to the floor after voting to move ahead and declared, “I will not vote for the [BCRA] as it is today. It’s a shell of a bill right now.”

Sen. Jerry Moran (R-Kan.) echoed these sentiments, tweeting, “I support a full repeal of Obamacare & will continue to oppose the BCRA.”

Democrats signaled that they won’t stand in the way of plans to vote on different versions of the legislation.

“These votes, frankly, are a lot tougher for them than they are for us. They are squeezed in both directions,” Senate Minority Leader Charles E. Schumer (D-N.Y.) told reporters.

Sen. Richard J. Durbin (D-Ill.), the party’s top vote-counter, acknowledged that some Democrats might support GOP-written amendments to the bill that have bipartisan support. But he said Democrats will focus mostly on process over policy, and keep pushing Republicans to return the legislation to committee and proceed with regular procedure. There have been bipartisan complaints that the legislation was drafted — by McConnell and a handful of leaders — without enough transparency.

Recognizing their lack of leverage in the chamber, Senate Democrats decried Republicans’ policies and procedural approach in a rally with supporters outside the Capitol. “How about we fill the streets outside every Republican office in America?” said Sen. Jeff Merkley (D-Ore.).

Several patient-advocate organizations and progressive groups decried the vote, warning that it could open the door to rollbacks in the expanded coverage the ACA has provided through new benefits requirements and greater federal support for insurance coverage.

“Republican leaders are using undemocratic and unprecedented means to rob coverage and critical services from millions of women, sending them back to a time when Women’s Health Care Services were not considered essential,” Nancy Northup, president and chief executive of the Center for Reproductive Rights, said in a statement.

Meanwhile, Nathan Nascimento, vice president of the conservative group Freedom Partners, urged senators to use the votes to partly repeal the law and then keep pushing for full repeal. “And then use the next available opportunity to keep their promise by repealing the rest of Obamacare, including its costly regulations and choice-stifling mandates,” he said.