Health vote falls into disarray
‘Skinny repeal’ meets with harsh criticism
WASHINGTON — Senate Republican leaders on Thursday trimmed their vision of legislation to undo the Affordable Care Act to a skeletal plan that would repeal a few parts of the health law. But they faced a rebellion from Republican senators who demanded assurances the legislation would never become law.
After three days of debate, Republican leaders had little to show for it and were struggling to devise even a stripped-down plan on which at least 50 of the 52 Senate Republicans could agree. The Senate majority leader, Mitch McConnell of Kentucky, was doing whatever he could to secure votes and win Senate approval on Friday for a bill that would repeal at least a few provisions of the Affordable Care Act.
That raised the spectacle of senators pressed by their leaders to vote on legislation that some of them despise, with a promise that a “yes” would not re-
ally be approval, just a vote to start House-Senate negotiations on something better.
Sens. Lindsey Graham of South Carolina, John McCain of Arizona and Ron Johnson of Wisconsin, all Republicans, simply demanded ironclad assurances from House leaders 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,” Graham said, calling the stripped-down bill a “disaster” and a “fraud” as a replacement for the health law.
On Thursday night, the House speaker, Paul Ryan, tried to reassure senators, as he goaded them to act.
“If moving forward requires a conference committee, that is something the House is willing to do,” he 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 Ryan did leave open the possibility that if a compromise measure fails in the Senate, the House could still pass the stripped-down Senate health bill.
McCain took advantage of an afternoon news conference to call again for a bipartisan approach to health care.
Johnson said the bill “doesn’t even come close to honoring our promise of repealing Obamacare” because it would do virtually nothing to address “the challenges, the problems, the damage done” by the Affordable Care Act.
Repeal of mandates
Not even the party leadership in the Senate would promote the merits of the scaled-back bill, which would eliminate the requirement for most Americans to have health insurance but would not replace it with other incentives for people to obtain coverage — a situation that insurers say would leave them with a pool of sicker, costlier customers. This “skinny repeal” would also repeal the mandate that larger employers provide insurance for their employees and could roll back the ACA’s tax on medical devices.
It would eliminate funds provided by the ACA for a wide range of prevention and public health programs. The money is being used for programs to immunize children, combat smoking and prevent diabetes, heart disease and stroke.
The bill also would cut off federal funds for Planned Parenthood for a year, a decision that could cost crucial votes.
“It unfairly singles out Planned Parenthood for elimination of funding under the Medicaid program,” said Sen. Susan Collins, R-Maine.
Sen. John Cornyn of Texas, the No. 2 Senate Republican, said the “skinny repeal” bill was “a vehicle to get to conference” with the House, which in May passed a more ambitious bill that would repeal much of the 2010 health care law and make deep cuts in projected Medicaid spending.
That was an unusual pitch, considering that in normal House-Senate conferences each chamber advocates its version of a bill.
“The skinny plan manages to anger everyone — conservatives who know it’s a surrender and know it doesn’t come close to the full repeal they promised, and moderates who know it will be terrible for their constituents,” the Senate Democratic leader, Chuck Schumer of New York, said. He added, “You don’t vote to advance terrible legislation and hope it magically gets better in conference.”
‘Markets may collapse’
Many Republicans seemed to agree.
“It may very well be a good vehicle to get us into conference, but you got to make sure that it’s not so good that the House simply passes it rather than going to conference,” said Sen. Michael Rounds, R-S.D. Rounds, who built a successful insurance business in his home state, said he was concerned that “the markets may collapse” if the Senate bill ever took effect.
But that does not mean it will not happen. If an assurance came from Ryan that the bill would be revised in negotiations, Graham said he would vote for it.
No such assurances from Ryan were immediately forthcoming, although two influential House conservatives made clear that they did not want to simply pass the Senate bill. Rep. Mark Walker, R-N.C., chairman of the conservative Republican Study Committee, said he favored a conference, calling the bill “ugly to the bone.”
And Rep. Mark Meadows, RN.C., chairman of the hard-line Freedom Caucus, said that for many conservatives, it would be a “nonstarter” to send President Donald Trump a bill that has “gotten so skinny that it doesn’t resemble a repeal.”
But senators had at least some reason to be nervous. The House majority leader, Kevin McCarthy of California, notified House members that “pending Senate action on health care,” the House schedule could change, and that “all members should remain flexible in their travel plans over the next few days.” That did not sound like a man preparing for protracted House-Senate negotiations.