Outside the Beltway

Senate Cancels Vote On Graham-Cassidy Health Care Reform Bill

What was essentially the final effort to 'repeal and replace' the Affordable Care Act is officially dead.

Doug Mataconis · Tuesday, September 26, 2017 · 9 comments

In the wake of Susan Collins of Maine announcing her opposition to the latest Senate effort to ‘repeal and replace’ the Affordable Care Act, Senate Majority Leader announced this afternoon that the Senate will not hold a vote on the Graham-Cassidy bill before the expiration of the reconciliation period on Saturday:

WASHINGTON — Senator Mitch McConnell on Tuesday officially pulled the plug on the latest plan to repeal the Affordable Care Act, telling senators they will not vote on the measure and effectively admitting defeat in the last-gasp drive to fulfill a core promise of President Trump and Republican lawmakers.

Mr. McConnell’s announcement came less than 24 hours after a pivotal Republican senator, Susan Collins of Maine, declared firm opposition to the repeal proposal, all but ensuring that Republican leaders would be short of the votes they needed.

Senate Republicans already tried once this year to approve repeal legislation, an exercise that ended in defeat when Senator John McCain of Arizona gave a thumbs-down in July to kill that repeal proposal.

This time, Mr. McConnell, the majority leader, and his fellow Republicans were trying to make one more attempt at passing a bill, and a deadline was fast approaching: They have only until the end of this week to pass a repeal bill using special budget rules that shield it from a Democratic filibuster.

Mr. McConnell could afford to lose only two of his members. But when he conceded defeat on Tuesday, three members of his conference had already publicly declared their opposition: Ms. Collins, Mr. McCain and Senator Rand Paul of Kentucky.

None of the three senators seemed likely to drop their opposition: Mr. McCain detested the partisan process used to push the bill, Ms. Collins had broad concerns about the legislation’s effects on health care, and Mr. Paul objected to the fundamental architecture of the legislation.

At the White House on Tuesday, Mr. Trump expressed his displeasure.

“At some point there will be a repeal and replace, but we’ll see whether or not that point is now or will it be shortly thereafter,” Mr. Trump said. “But we are disappointed in certain so-called Republicans.”

The failure in the Senate was also a disappointment to Republicans in the House, who managed to pass a repeal bill in May after their own struggles.

“We’re a little frustrated that the Senate has not acted on a seminal promise,” Speaker Paul D. Ryan said.

In the wake of Senator Collins announcing her opposition last night, this announcement was pretty much inevitable since it was apparent that no amount of changes were going to cause her, or the other Senators who had announced their opposition to Graham-Cassidy, to change her mind without risking changes to the bills that would have cost considerably more support from the conservative side of the Republican caucus. In fact, it’s unlikely that any changes that were made to the bill at this point would have swayed either Collins or her colleague John McCain to change their minds due to the fact that their opposition was as much about the process that brought the bill to the point where it was ready to be voted on as it was about the substance of the bill itself. Specifically, both Collins and McCain took the position that any further consideration of health care reform in the Senate should follow regular order, meaning that it should go through the same committee process that most other legislation that the Senate considers goes through. This would mean holding more than just pro forma committee hearings, working in a bipartisan manner to allow Democrats to have input into the drafting process and the content of the bill, and allowing sufficient time on the Senate floor for debate to take place and appropriate amendments to be considered by the full body. Clearly, there was not sufficient time for this to happen before the expiration of the reconciliation period on Saturday. Given that, the idea that any changes to the bill would have caused either Collins or McCain to change their minds would have been fanciful at best.

As I said this morning, the failure to pass a ‘repeal and replace’ bill before Saturday likely means that the effort is dead until after the 2018 election unless Republicans are willing to work with Democrats on a bipartisan effort to fix the problems with Affordable Care Act. Since the reconciliation period ends on Saturday, Republicans would need sixty votes to invoke cloture on any future ‘repeal and replace’ effort, and they are unlikely to get that without working across the aisle even assuming they could come up with something that would get the support of the entire Republican caucus, something that the past three months seem to demonstrate would be extremely unlikely. Additionally, Republicans have already said that they intend to use the next reconciliation period to get tax reform through the Senate, and while there’s theoretically a way that they could tie tax reform and health care reform together, the odds that they’d be able to do so successfully seem slim at best. Additionally, the closer we get to the 2018 midterms the less likely it becomes that either the House or the Senate is going to want to step on the third rail that health care reform has become. Instead, both sides will likely want to use the issue to rally their respective bases for the election.

Going forward, the biggest question for Republicans going forward will be what impact this whole failed war against the Affordable Care Act will be. For seven years, Republicans have built their message on opposition to the Affordable Care Act and have promised their base that they would repeal the bill when they had control of the levers of power in Washington. The Tea Party movement was largely organized around that idea, and it was in no small part the basis for the energy that led to Republican electoral successes in 2010, 2014, and 2016 that allowed them to take control of the House of Representatives, the Senate, the vast majority of state legislatures and Governor’s Mansions, and ultimately the Presidency itself notwithstanding the fact that their 2016 candidate was seemingly the worst possible choice to lead that effort. Despite those achievements and all of the fundraising and organizing they’ve done on behalf of the GOP, the party has proven unable to come up with the votes needed to accomplish what they have promised for nearly a decade. It remains to be seen what impact that will have on the base and on potential primary challenges going foward, but it’s not likely to be pretty.