Congressional Republicans’ efforts to repeal and replace the Affordable Care Act came to an end in the wee hours of July 28 with the narrow defeat of an amendment that would have repealed several components of the ACA, scuttling the latest effort by GOP leadership to capitalize on a years-long political promise.
The defeat led congressional taxwriters to immediately turn their attention to tax reform, which they hope to build a case for during the August recess.
Senate Majority Leader Mitch McConnell, R-Ky., offered the Health Care Freedom Act as an amendment to the House-passed American Health Care Act (H.R. 1628, AHCA) late July 27. The vote failed 49 to 51, with three Senate Republicans joining Democrats in voting against the measure.
“This is certainly a disappointing moment,” McConnell said on the floor following the vote and after returning the AHCA to the Senate calendar and ending the debate process. “I regret that our efforts are simply not enough this time.”
President Trump shared his thoughts on Twitter shortly following the results, highlighting GOP senators who voted down the measure: “3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let ObamaCare implode, then deal. Watch!” Trump wrote.
Health Care Freedom Act Details
The eight-page amendment would have effectively repealed both the individual and employer mandates, and extended the moratorium on the medical device excise tax, delaying its enactment until 2021. The legislation also would have expanded health savings accounts, increasing annual contributions and limiting out-of-pocket expenses for three years from 2018 to 2021.
The Congressional Budget Office found that the Health Care Freedom Act amendment would reduce the federal budget deficit by $178.8 billion over the next decade, and would result in 15 million more people at risk of being uninsured compared with current law by 2026.
Extending the medical device tax moratorium from 2018 to 2021 would have reduced revenues by $5.8 billion, about $4.4 billion more than current law, and the expansions to HSAs would cost $5 billion, according to the CBO.
Together, repealing the employer and individual mandates would reduce revenues by almost $92 billion, the CBO found.
Before McConnell brought up the new repeal option, the Senate adopted an amendment to the AHCA that would have effectively repealed the 40 percent excise tax on employer-sponsored high-cost health plans otherwise known as the Cadillac tax, offered by Senate Finance Committee member Dean Heller, R-Nev. Democrats Martin Heinrich of New Mexico and Catherine Cortez Masto of Nevada voted for the amendment, while Bob Corker of Tennessee was the lone GOP member to oppose the proposal. The AHCA would have delayed the Cadillac tax until 2026.
Before the vote on the Cadillac tax amendment, Schumer told his Republican colleagues on the floor that Democrats support the repeal of the provision, but that most would not support Heller’s amendment because of the broader legislation being considered.
Senate Floor Fireworks
Democrats railed against the legislation during two hours of debate, bashing the process Republican leadership took developing the proposal behind closed doors, without bipartisan discussions, and often without input from their own rank-and-file members. A motion to refer the latest amendment to the Senate Health, Education, Labor, and Pensions Committee offered by Sen. Patty Murray, D-Wash., failed on a party-line vote.
The procedural vote was held open as McConnell, Senate Republican leadership, and Vice President Mike Pence spoke on the floor with several GOP senators who had reported concerns about the legislation, notably Sens. John McCain of Arizona and Lisa Murkowski of Alaska. McCain earlier in a July 27 press briefing said he would not vote for the pared-down repeal bill unless he could be assured the legislation would go to conference, while Murkowski had voted down every previous iteration of the Senate GOP’s healthcare bill.
Senate Republicans McCain, Murkowski, and Susan Collins of Maine voted with all 46 Democrats and two independents to strike down the Health Care Freedom Act. Pence was not present in the chair.
Future for Healthcare Uncertain
In a statement following the vote, McCain said he did not believe the pared-down repeal bill could be salvaged, and echoed sentiments from his floor speech two days earlier. “From the beginning, I have believed that Obamacare should be repealed and replaced with a solution that increases competition, lowers costs, and improves care for the American people. The so-called ‘skinny repeal’ amendment the Senate voted on today would not accomplish those goals.” McCain continued to say the Senate should work on the issue in regular order, hold hearings in committee, and “receive input from both sides of the aisle.”
McConnell conceded to Democrats, but suggested Republicans may need to try a different approach to healthcare reform. “Now, I imagine many of our colleagues on the other side are celebrating. Probably pretty happy about all this, but the American people are hurting, and they need relief. . . . It’s time for our friends on the other side to tell us what they have in mind, and we’ll see how the American people feel about their ideas,” he said.
Senate Minority Leader Charles E. Schumer, D-N.Y., said Democrats felt more relieved than celebratory that the healthcare bill failed, but also acknowledged McConnell’s call for ideas. “We are relieved, not for ourselves, but for the American people. But as I said, over and over again, Obamacare was hardly perfect. It did a lot of good things, but it needs improvement, and I hope one part of turning that page is that we go back to regular order, work in the committees together to improve Obamacare,” he said.
Following the vote, Finance Committee Chair Orrin G. Hatch, R-Utah, issued a statement that included no mention of a future bipartisan effort toward healthcare reform.
“It is deeply regrettable that the Senate was unable to come together to repeal Obamacare and to provide Americans who have suffered under this unworkable law the relief they desperately need. . . . This likely means more federal spending, continued federal mandates, and more federal regulation in the long-term, leading to one final outcome: A socialized healthcare system run by the federal government. Moving forward, I will continue my efforts to replace this flawed law with patient-centered reforms that will actually improve the healthcare system for all Americans,” Hatch said.
The Senate adjourned until July 31 following the vote, without addressing the next steps for its healthcare reform effort.
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