Ba­sic re­peal of health law fails in Se­nate

GOP again splin­ters in vote, weighs ‘skinny’ hit at ’10 act

Northwest Arkansas Democrat-Gazette - - FRONT PAGE -

WASH­ING­TON — The Se­nate re­jected a pro­posal Wed­nes­day that would have re­pealed ma­jor parts of the Pa­tient Pro­tec­tion and Af­ford­able Care Act and pro­vided a two-year de­lay for law­mak­ers to de­velop a sub­sti­tute.

The ef­fort to abol­ish much of the 2010 health law out­right ap­pealed to con­ser­va­tives but lost the back­ing of sev­eral mod­er­ates and more es­tab­lish­ment fig­ures, such as GOP Sen. John McCain, R-Ariz.

Over­all, seven Repub­li­cans voted against the re­peal pro­posal, putting the fi­nal vote at 45-55.

It was the sec­ond vote over the course of less than 24 hours in which law­mak­ers re­jected pro­pos­als to dis­man­tle the health care law. Now many Repub­li­cans are ex­press­ing will­ing­ness to pass a min­i­mal­ist mea­sure — which is be­ing dubbed “skinny re­peal” — that abol­ishes two of the Af­ford­able Care Act’s in­sur­ance man­dates and a sin­gle tax on med­i­cal de­vices.

GOP lead­ers have em­pha­sized the skinny re­peal as a way for the Se­nate to start ne­go­ti­a­tions with the House, and per­haps the one way they can sus­tain their

seven-year drive to dis­man­tle the health care law, passed un­der Pres­i­dent Barack Obama.

Sev­eral law­mak­ers ac­knowl­edged Wed­nes­day that they did not em­brace the con­tent of that pro­posal but sug­gested they could pos­si­bly back it any­way.

“It’s a ve­hi­cle to get us into con­fer­ence,” said Sen. Lind­sey Gra­ham, R-S.C. “That is not a so­lu­tion to the prob­lem.”

There did not ap­pear to be an al­ter­na­tive so­lu­tion for Repub­li­cans, who re­main deeply di­vided over how to re­vamp the na­tion’s health care sys­tem. The GOP has lit­tle mar- gin for er­ror, since just three hold­out within their ranks will de­prive them of the 50 votes they need to pass leg­is­la­tion with the as­sis­tance of Vice Pres­i­dent Mike Pence, who can cast a tiebreak­ing vote.

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. The fact that some Repub­li­cans have joined with Democrats on each of the votes so far un­der­scored the chal­lenge Se­nate lead­ers face in build­ing con­sen­sus in com­ing days.

On Tues­day, 57 se­na­tors — in­clud­ing nine Repub­li­cans — op­posed the up­dated ver­sion of the mea­sure, the Bet­ter Care Rec­on­cil­i­a­tion Act, while 43 sup­ported it. The nine dis­senters in­cluded hard-line con­ser­va­tives such as Sens. Mike Lee, R-Utah, and Rand Paul, R-Ky., as well as cen­trists such as Sens. Dean Heller, R-Nev., and Su­san Collins, R-Maine.

Open­ing the Se­nate on Wed­nes­day morn­ing, Ma­jor­ity Leader Mitch McCon­nell praised law­mak­ers for tak­ing a “crit­i­cal step” ear­lier Tues­day in open­ing the de­bate on health care. He sig­naled a dif­fi­cult road ahead in the com­ing days.

“This cer­tainly won’t be easy. Hardly any­thing in this process has been,” McCon­nell said.


The re­peal mea­sure, ad­vanced by Paul, would have re­pealed most of Obama’s health care law with a twoyear de­lay but no re­place­ment.

Congress passed nearly iden­ti­cal leg­is­la­tion in 2015 and sent it to Obama, who un­sur­pris­ingly ve­toed it. Yet this time, with Repub­li­can Pres­i­dent Don­ald Trump in the White House itch­ing to sign the bill, the mea­sure failed Wed­nes­day on the Se­nate floor.

The Repub­li­can se­na­tors who voted against the re­peal mea­sure, in ad­di­tion to

McCain, were Collins, Heller, Shel­ley Moore Capito of West Vir­ginia, Rob Port­man of Ohio, La­mar Alexan­der of Ten­nessee and Lisa Murkowski of Alaska.

The Con­gres­sional Bud­get Of­fice has es­ti­mated that re­peal­ing the Af­ford­able Care Act with­out re­plac­ing it would cost more than 30 mil­lion Amer­i­cans their in­sur­ance cover­age, and that was a key fac­tor in driv­ing away more Repub­li­can se­na­tors than McCon­nell could af­ford to lose.

The re­sult frus­trated other GOP se­na­tors, some of whom ex­pressed dis­be­lief that their col­leagues would flip-flop on leg­is­la­tion they had voted for only two years ago and long promised to vot­ers. Of the cur­rent Repub­li­can se­na­tors, only Collins op­posed the 2015 re­peal bill.

“Make no mis­take: To­day’s vote is a ma­jor dis­ap­point­ment to peo­ple who were promised full re­peal,” said Sen. Ben Sasse of Ne­braska. “We still have a long, long way to go — both in health pol­icy and in hon­esty.”

There also 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 into the bill if they gain you votes or if they re­ally im­prove the bill,” Sen. Mike Rounds, R-S.D., said af­ter Tues­day night’s vote.

Sev­eral se­na­tors said they feel a strong im­per­a­tive to de­liver some sort of health care ac­com­plish­ment af­ter vow­ing for seven years to un­wind the health care overhaul that Obama ush­ered into law with only Demo­cratic sup­port.

The skinny re­peal op­tion would re­peal the Af­ford­able Care Act’s man­dates that in­di­vid­u­als buy plans and that em­ploy­ers with 50 or more em­ploy­ees pro­vide cover­age, as well as elim­i­nate the law’s tax on med­i­cal de­vice man­u­fac­tur­ers.

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.

“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 endgame.” Still, sup­port­ers and crit­ics of GOP lead­ers’ strat­egy said there was no way to pre­dict what sort of leg­is­la­tion those lead­ers could pro­duce.

Asked by re­porters Wed­nes­day whether enough Repub­li­cans could sup­port a scaled-back bill at the end of the ex­tended vot­ing process, Se­nate Ma­jor­ity Whip John Cornyn, R-Texas, replied, “We’ll find out.”

“This is a high-wire act — the whole thing,” Cornyn said.


The mood among Repub­li­cans, mean­while, was far from the buoy­ant ex­cite­ment that some ex­pected to ac­com­pany the first votes to ful­fill their long-stand­ing prom­ise to re­peal the Af­ford­able Care Act.

In­stead, GOP se­na­tors de­scribed feel­ing frus­trated and un­happy with the leg­isla­tive op­tions at hand.

“The mood is noth­ing,” Sen. Bob Corker, R-Tenn., told re­porters af­ter Tues­day’s failed vote on the Se­nate GOP health care bill. “It’s per­func­tory.” Sen. James Lank­ford, R-Okla., put it: “There’s not a good op­tion that’s sit­ting in front of us.”

And the Repub­li­can in­fight­ing that has dom­i­nated the health care de­bate showed no signs of abat­ing. Murkowski, one of just two Repub­li­cans to vote against the mo­tion to pro­ceed, said late Tues­day that “there’s been a lot of dis­cus­sion 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.

Trump, for his part, took to Twit­ter on Wed­nes­day morn­ing to crit­i­cize Murkowski for vot­ing against be­gin­ning de­bate. “Sen­a­tor lisamurkowski of the Great State of Alaska re­ally let the Repub­li­cans, and our coun­try, down yes­ter­day. Too bad!” he tweeted.

Later, Murkowski re­marked to re­porters, “I don’t re­ally fol­low Twit­ter that much.” Se­na­tors are work­ing their way through 20 hours of de­bate. At week’s end, rapid-fire vot­ing on a moun­tain of amend­ments was ex­pected be­fore mov­ing to fi­nal pas­sage — of some­thing.

Sen. John Booz­man, R-Ark., said the Se­nate leg­is­la­tion he has sup­ported seeks to roll back the Af­ford­able Care Act “as much as we can.”

If any of the pro­pos­als pass the Se­nate, they will go to a House-Se­nate con­fer­ence com­mit­tee where law­mak­ers will fur­ther re­fine the leg­is­la­tion. But for now, he said, Repub­li­cans are just try­ing to come up with a ver­sion that can pass.

In­ter­nal GOP dif­fer­ences re­main over how broadly to re­peal the law, how to re­im­burse states that would suf­fer from the bill’s Med­i­caid cuts and whether to let in­sur­ers sell cut-rate, bare-bones cover­age that falls short of the re­quire­ments.

“We re­ally don’t know what this bill is go­ing to look like,” Booz­man said. “It might be very broad, it might be fairly nar­row in scope.”

“Ul­ti­mately, this is not go­ing to fix Oba­macare, no mat­ter what the re­sult is. We’re go­ing to need ad­di­tional leg­is­la­tion,” he said. “We have many, many in­di­vid­u­als who are in a sit­u­a­tion where they have very high pre­mi­ums, very high de­ductibles — $5,000-$10,000 de­ductibles. In Arkansas we’ve seen our in­sur­ance go up in the last four years 128 per­cent. These are se­ri­ous prob­lems that sim­ply have to be fixed.”

The Se­nate mi­nor­ity leader, Charles Schumer of New York, com­mented on the lack of a pre­cise plan. “It seems the Repub­li­can ma­jor­ity is no clearer on what the endgame is, be­cause there’s no good way out of this,” Schumer said. In­for­ma­tion for this ar­ti­cle was con­trib­uted by Kelsey Snell, Juliet Eilperin, Sean Sul­li­van, Amy Gold­stein, Ed O’Keefe, David Weigel and Paige Win­field Cun­ning­ham of The Wash­ing­ton Post; by Er­ica Wer­ner, Alan Fram, Stephen Oh­lemacher and Ricardo Alonso-Zal­divar of The As­so­ci­ated Press; by Thomas Ka­plan and Eileen Sul­li­van of The New York

Times; and by Frank E. Lock­wood of the Arkansas Demo­crat-Gazette.


“This is a high-wire act — the whole thing,” Se­nate Ma­jor­ity Whip John Cornyn said of ef­forts to re­write the health care law, dur­ing a meet­ing with re­porters Wed­nes­day out­side his Capi­tol Hill of­fice.

The New York Times/TOM BRENNER

Sen. Rand Paul, R-Ky., heads to the Se­nate floor Wed­nes­day for a vote on health care leg­is­la­tion. A mea­sure Paul spon­sored to re­peal the cur­rent health care law was re­jected.

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