WASHINGTON — Senate Republicans failed in another attempt to overturn the Affordable Care Act Wednesday, forcing them to next consider modestly scaling back the law rather than the outright repeal they have long promised.
Wednesday’s defeat made it increasingly likely that Republicans will fall short of keeping their seven-year-long promise to repeal Barack Obama’s signature health law and that large portions of it will remain in place, at least for now. Repealing the law was the central domestic policy promise of President Trump’s campaign, but it appears to be in trouble even though Republicans control the White House and both houses of Congress.
The latest attempt would have eliminated the entire Affordable Care Act in two years. Seven Republicans, however, bucked leadership and refused to support the proposal without a ready replacement. Among them were Susan Collins of Maine, the moderate who has consistently opposed the Senate’s bills, and John McCain, who returned from brain cancer treatments in Arizona to cast a pivotal vote Tuesday to start debate.
Though a similar measure passed both houses of Congress in 2015 before it was vetoed by then-President Obama, Republican’s newfound reluctance shows the degree to which governance has forced flip-flops among GOP lawmakers. Also elements of Obamacare have become increasingly popular.
Tennessee Senator Lamar Alexander, the Health Committee chairman, voted for the repeal in 2015 but against it on Wednesday. In a statement, he said his state’s situation had changed in two years and it could no longer afford a repeal without a ready replacement.
“I don’t think Tennesseans would be comfortable canceling insurance for 22 million Americans and trusting Congress to find a replacement in two years,” Alexander said. “Pilots like to know where they’re going to land when they take off, and we should, too.”
“The president is . . . very focused on repealing and replacing” the health law, said White House Press Secretary Sarah Huckabee Sanders in a press briefing Wednesday. She made no mention of the failed votes in the Senate regarding alternatives. “We’re going to continue pushing forward until we get a new and better health care plan,” she said.
The Senate had come up short in pushing another repeal and replace bid Tuesday night.
Senate Republicans will now attempt to pass what has been dubbed a “skinny repeal” of Obamacare — a measure that would likely eliminate a medical device tax and undo the law’s requirements that individuals buy insurance and large employers offer plans to workers. No bill text has been released.
The impact of the new proposal has not been measured by the nonpartisan Congressional Budget Office or formally presented to the American public, but the office has said similar ideas would result in 15 million fewer people having health insurance and increase premiums. Despite the unknowns, some Senate Republicans were already backing the proposal Wednesday as a means of salvaging a slim political victory.
“I’m voting for anything that continues the process,” said Senator Bill Cassidy of Louisiana about the prospect of “skinny repeal” during an interview with CNN. “We can’t keep spinning in no man’s land where nothing happens.’’
The House passed its version of an Affordable Care Act repeal in May, so any plan that passes the Senate would go into a conference between lawmakers from both chambers to hammer out a compromise. Some Senate Republicans, including Rand Paul of Kentucky, are openly saying that they do not believe the Senate and House could forge a deal, especially considering the Senate could not even agree on a broader repeal on its own.
“If you go back to conference committee and they stuff all the goodies and all the bailouts back in there, we’ll simply get back to where we were before and lose conservatives again,” said Paul, a self-professed libertarian.
House members are already saying they’re unlikely to back a pared-down Senate bill. Speaking to reporters, Mark Meadows, the leader of the conservative House Freedom Caucus, said there’s “zero” chance a piecemeal rollback of the Affordable Care Act would pass the House.
“The skinny version, in itself, if it came before the House, would not pass,” Meadows said Wednesday. “That’s not going to be signed into law, but that’s used as a vehicle for us to come together in conference and hopefully continue negotiation.”
Senators acknowledged they would support the pared-down Obamacare repeal in order to push the issue further down the line — not because they endorsed the policy proposals. Senator Bob Corker of Tennessee said the “content” of the latest Senate proposal is less important than its function, forcing a conference with the House.
Nevada Senator Dean Heller, largely considered the most vulnerable Republican up for reelection in next year’s midterm elections, also backed a slimmer Obamacare — at least for now. “Let’s put this behind us,” Heller added.
Also Wednesday, Governor Charlie Baker joined a bipartisan group of governors in signing a letter to Senate leaders urging them to reject the “skinny repeal’’ and work closely with governors on health care.
Policy experts say even incremental cuts to the law’s rules would seriously damage health care markets. John McDonough, a professor of public health at Harvard who was involved in drafting the Massachusetts version of health care expansion, said repealing the medical device tax and undoing the employer and individual mandates could upset insurance markets and accelerate the death spiral of Obamacare in some areas.
The mandates are necessary to ensure that healthy individuals buy into insurance marketplaces and that insurance plans don’t attract only sick people with the most expensive needs. McDonough was also skeptical that Republicans would stick with their limited repeals, once the measure made it to a conference with House members.
“The big problem is that passing a skinny repeal bill in the Senate keeps the repeal/replace process alive for further mischief,” McDonough added. “This really is a vampire bill that repeatedly keeps dying and then returning to life to threaten some more.”
This was also the argument of Democrats, who sought to drum up opposition to the new proposal by calling it a “Trojan horse” and a “zombie bill.”
On the floor of the US Senate Wednesday, Massachusetts Senator Elizabeth Warren said the true name for “skinny repeal” should be “gut and run.”
“Make no mistake, this is no moderate version of the Republicans ugly plan to repeal the Affordable Care Act,” Warren said. “In fact, this may be the worst idea they’ve had yet.”
Herndon can be reached at email@example.com.