Senate GOP Votes to Open Health-Care Debate

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

25 July 17

 

enate Republican leaders secured the votes they needed on Tuesday afternoon to begin debating health-care legislation in a dramatic reversal of fortune for their beleaguered health-care effort. This puts them one step closer to actually repealing-and-replacing the Affordable Care Act, though there is still a long way to go.

The turnaround for the struggling health-care effort came after several senators said they would support launching debate on the bill — without committing to support any of the pieces of legislation that will now be debated.

Now, senators will begin a lengthy and freewheeling debate on passage of legislation that would make significant changes to Obamacare and are expected to vote sometime over the next couple of days on a straight repeal bill, the Senate GOP plan, and a “skinny repeal” measure that would make fewer changes to existing law. It’s unclear if any of those options will succeed.

Early Tuesday afternoon, several senators who were previously opposed to moving ahead with the health-care debate announced they had changed their minds and would now support a key procedural motion to consider legislation.

They included GOP Sens. Shelley Moore Capito (W.Va.) and Sen. Dean Heller (Nev.), who both have registered concerns about Senate Majority Leader Mitch McConnell’s (R-Ky.) plan to rewrite the ACA. They were helped by Sen. John McCain (R-Ariz.), who entered the chamber to cast a “yes” vote after an absence due to his recent diagnosis from brain cancer.

“Obamacare isn’t the answer, but doing nothing to try to solve the problems it has created isn’t the answer either. That is why I will vote to move forward and give us a chance to address the unworkable aspects of the law,” Heller said.

The GOP has struggled mightily to get to this point and there is no guarantee they will win final passage of a bill changing Obamacare. President Trump has been pushing aggressively for Republicans to pass a repeal-and-replace plan, and jabbed lawmakers this week by saying anyone who votes against kicking off debate is saying they are “fine with the Obamacare nightmare.”

Republican leaders now see a scaled-down version of the bill as perhaps their best chance of winning final passage on some kind of measure to overhaul Obamacare. If senators passed this stripped-down version — which some Republicans refer to as “skinny repeal” — they would set up a House-Senate conference to resolve the differences between the two proposals, buying Republicans more time.

The new strategy will allow Republicans to sustain their years-long effort to unwind the 2010 health-care law, though they have yet settle on a replacement for it. But it is also is a tacit acknowledgment that more sweeping efforts to revise or even simply repeal the law cannot succeed, even as Republicans control both Congress and the White House.

Under pressure from President Trump and determined to deliver on a promise that helped fuel their political rise, Senate Republicans have coalesced around the idea that it is worth embarking on an unpredictable series of votes rather than abandon the effort altogether.

Republicans are expected to vote on several different versions of health-care legislation before getting to a final outcome — including a straight repeal of the ACA and the bill produced by McConnell that has so far failed to gain traction among Senate Republicans.

The “skinny bill” leaders are now considering would repeal the ACA’s mandates that both individuals buy plans and that employer with 50 or more employees provide coverage, according to lobbyists and Senate aides, as well as eliminate the law’s tax on medical device manufacturers. But individuals briefed on this plan, who asked for anonymity because it had not been formally announced, said they could not predict whether it would ultimately pass.

McCain returned to Washington on Tuesday afternoon for the key procedural vote to start debate, which allowed the Senate to kick off debate. A longtime holdout, conservative Sen. Rand Paul (R-Ky.), indicated on Twitter that he was now open to the idea. That puts the leadership within range of the votes it needs, as McConnell negotiated with centrists by promising that they would ultimately like the final product.

“This morning, @SenateMajLdr informed me that the plan for today is to take up the 2015 clean repeal bill as I’ve urged,” Paul tweeted. “If that is the plan, I will vote to proceed to have this vote. I also now believe we will be able to defeat the new spending and bailouts.”

McCain, who was recently diagnosed with an aggressive form of brain cancer, will arrive at the Capitol at 2:45 p.m., according to his office. The senator, who had been recuperating from surgery and exploring treatment options in Arizona, will later deliver remarks on the Senate floor after the vote.

President Trump praised the senator for returning in an early-morning tweet Tuesday before exhorting Republicans to back the measure.

“So great that John McCain is coming back to vote. Brave — American hero! Thank you John,” tweeted Trump, who had criticized McCain during the 2016 presidential campaign.

Republican senators braced Tuesday for a long day in the Capitol. The Senate is scheduled to gavel in at noon and GOP senators will spend the early afternoon inside a weekly policy luncheon where many are hoping to gain more clarity from McConnell on what they will be asked to vote for in the afternoon or evening.

On the Senate floor, McConnell called the procedural vote “a critical first step” in unwinding the landmark 2010 health care law.

As the scheduled vote neared, McConnell said Republican senators had a chance to follow through on a seven-year promise to repeal the Affordable Care Act. He also repeated the thinly-veiled threat Trump leveled in a speech a day earlier: a vote to block debate on repeal is a vote to save Obamacare.

“Any senator who votes against starting debate is telling America that you’re just fine with the Obamacare nightmare,” McConnell said. “I would urge them to remember the families who are hurting under this collapsing law.”

McConnell is planning to file motions to bring up the House-passed health bill and modify it in several ways, according to several individuals briefed on the plan who asked for anonymity to discuss private conversations, with several types of amendments. These amendments are expected to include some version of a more recent Senate health care bill with modifications by both Sen. Ted Cruz (R-Tex.) and Sen. Rob Portman (R-Ohio). A separate vote would be held on version of a 2015 bill repealing the law outright after a two-year transition.

The Cruz proposal would allow insurers to offer coverage on the ACA market that does not include all the benefits required under the law, as long as they provided one fully-compliant plan. The Portman amendment would add an additional $100 billion in flexible spending under Medicaid, according to these individuals.

Even with McCain in the Capitol and voting to start debate — and it’s not yet certain he will support doing so — McConnell can only lose two of the other 50 Republican senators. All 48 Democrats plan to vote no.

To win over a handful of centrist senators, who have expressed concern about the bill’s deep cuts to Medicaid and its phaseout of the program’s expansion under the ACA, top administration officials have promised lawmakers more flexibility and extra funding to help transition millions of low-income Americans onto private insurance.

McConnell and his deputies were still bartering with a handful of GOP holdouts throughout Monday evening and into Tuesday morning, according to several GOP aides. Leaders argued skeptics should vote to start debate on the grounds that they would be happy with the final bill, without revealing exact details of what the legislation would include.

Seema Verma, director of the Health and Human Services Department’s Centers for Medicare and Medicaid Services, has provided some Republicans an analysis of how the bill would affect people covered by the expansion in their states, according to individuals briefed on the matter. They said Verma has suggested that money in the bill could help state residents pay premiums to obtain the lowest-level plans on the ACA-market, known as “bronze” plans and has promised up to $100 billion in flexible Medicaid funding.

Several of these Medicaid expansion-state GOP senators, including Lisa Murkowski (Alaska), Cory Gardner (Colo.), Todd C. Young (Ind.) and Rob Portman (Ohio), held one of their regular meetings on Monday night. Portman left the session and headed straight to McConnell’s office to discuss the health-care proposal.

Vice President Pence and White House legislative affairs director Marc Short plan to attend Tuesday’s lunch, Short said Tuesday. He said the president has been placing calls “to a couple of members” in hopes of rounding up the votes to proceed to the bill. He said the administration has also serves as a resource to provide “technical assistance” to senators looking to get policy questions answered as they make up their minds.

On Tuesday a coalition of medical and consumer groups reiterated their intense opposition to all the health-care plans Senate Republicans have been considering, calling on them to drop those bills and begin anew with a bipartisan process that includes standard committee hearings.

In a conference call, David Barbe, the president of the American Medical Association and part of the coalition, challenged the claims Senate GOP leaders have made about their main legislation to dismantle large parts of the Affordable Care Act.

“It does not make care more affordable to low-income Americans,” Barbe said. “It does not reduce out-of-pocket costs. It could trigger substantial increases for patients with preexisting conditions.”

Only one senator, centrist Susan Collins (Maine) has said publicly she would not vote “yes” to move forward on any of the plans that have been floated so far.

On Twitter Tuesday morning the president described the procedural vote that would allow debate on health-care legislation to begin as a crucial litmus test for his party.

“After 7 years of talking, we will soon see whether Republicans are willing to step up to the plate!” Trump wrote, adding in another, “Obamacare is torturing the American People. The Democrats have fooled the people long enough. Repeal or Repeal & Replace! I have pen in hand.”

Democrats are eyeing the developing GOP tactics nervously. A bill repealing only the ACA’s most unpopular parts could prove more attractive to Republican moderates. But once the Senate and House go to conference on health-care legislation, more conservative House members will likely try to expand its provisions repealing key elements of the existing law.