Outside the Beltway

Latest Effort To ‘Repeal And Replace’ Affordable Care Act Basically Dead

The latest effort to 'repeal and replace' the Affordable Care Act appears to be dead.

Doug Mataconis · Tuesday, September 26, 2017 · 4 comments

The latest effort to ‘repeal and replace’ the Affordable Care Act, in the form of a last-minute bill proposed by Republican Senators Lindsey Graham and Bill Cassidy, appears to be dead after fellow Republican Susan Collins announced her opposition to the bill:

WASHINGTON — A last-ditch attempt by President Trump and Senate Republicans to dismantle the Affordable Care Act appeared to collapse on Monday as a pivotal senator announced her firm opposition to the latest repeal plan, virtually ensuring that Republicans would not have the votes they need for passage.

The announcement by the senator, Susan Collins of Maine, effectively dooms what had been a long-shot effort by Republicans in the Senate to make one more attempt at repealing the health law after failing in dramatic fashion in July.

The demise of the latest repeal push means that Republicans are now all but certain to conclude Mr. Trump’s first year in office without fulfilling one of their central promises, which the president and lawmakers had hoped to deliver on quickly after Mr. Trump took office.

For seven years, Republicans have said they would repeal President Barack Obama’s signature domestic achievement and replace it with a new health care system more palatable to conservatives. But they were never able to formulate a replacement that was both politically and substantively viable.

Ms. Collins, one of three Republican senators who opposed the last repeal attempt in July, described the latest plan as “deeply flawed.” She expressed concerns about cuts to Medicaid as well as the rolling back of protections for people with pre-existing medical conditions.

“Health care is a deeply personal, complex issue that affects every single one of us and one-sixth of the American economy,” Ms. Collins said in a statement, lamenting the rushed process and the content of legislation that has shifted as Republican leaders scrambled for votes. “Sweeping reforms to our health care system and to Medicaid can’t be done well in a compressed time frame, especially when the actual bill is a moving target.”

The Senate majority leader, Mitch McConnell of Kentucky, now faces the unpalatable choice of admitting defeat or moving ahead with a vote that appears certain to fail.

Republican leaders in the Senate can afford to lose only two of their members, and they now have three firm opponents within their ranks: Rand Paul of Kentucky, John McCain of Arizona and Ms. Collins. Additionally, Senator Ted Cruz, Republican of Texas, has withheld his support and requested changes to the bill.

(…)

Ms. Collins’s announcement came three days after Mr. McCain said that he could not “in good conscience” support the latest repeal proposal, written by Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana.

“We’re going to press on,” Mr. Graham said hours later, during a Monday night CNN debate on health care. He raised the possibility of still holding a vote, even as he acknowledged it might fail: “It’s O.K. to vote. It’s O.K. to fall short, if you do, for an idea you believe in.”

The senators released a revised version of their bill on Monday morning, hoping to win over holdout Republicans in part by shifting more funds to states like Alaska and Maine. The bill would take money provided under the Affordable Care Act for insurance subsidies and the expansion of Medicaid and send it to states, with vast new discretion over how to use it for health care or coverage.

But writing a repeal bill that could win over at least 50 of the 52 Republican senators has proved extraordinarily difficult, and putting together a complicated bill against the backdrop of a ticking clock only added to the challenge. Insurers, hospitals, doctors and patient advocacy groups assailed the proposal, as did the late-night talk show host Jimmy Kimmel.

The Capitol complex looked at times like a hospital ward on Monday as patients swarmed through the corridors, pleading with senators not to take away their health insurance. Some wore T-shirts that said, “I Am a Pre-Existing Condition.”

The Senate Finance Committee held a hearing on the repeal bill on Monday, and it was immediately disrupted by people in the audience shouting opposition to the proposal. “No cuts to Medicaid,” they chanted. “Save our liberty!” Capitol police officers removed the protesters, some of whom were in wheelchairs.

As Mr. Cassidy and Mr. Graham revised their bill to try to build support, critics asserted that their last-minute changes further weakened protections for patients, including those with cancer and other pre-existing conditions.

The Washington Post’s Amber Phillips argues that this final effort to ‘repeal and replace’ Obamacare was likely doomed from the start, and she’s largely correct. In much the same manner as the three previous attempts that the Senate has made in this regard in June and July, it’s clear that Graham-Cassidy was nothing more than a rushed last-minute attempt to pass something, anything, that Senate Republicans could point to in response to the argument that they spent seven years talking about ‘repeal and replace’ and yet failed to actually do anything once they gained control of not just both houses of Congress but the Presidency as well but didn’t deliver on what had become their core issue since winning control of the House in 2010. In their haste to do so, though, Republicans didn’t bother to consider whether the alternative they were providing would actually be better than the status quo under the PPACA, or how it would address issues such as coverage for persons with pre-existing conditions and the expansion of Medicaid to cover millions of people otherwise financially unable to afford health care insurance. As a result, every one of the proposals that Republicans put forward this year, both in the House and the Senate, have been overwhelmingly unpopular. Given that, the failure of these measures to get to President Trump’s desk was entirely foreseeable.

Collins, of course, joins Senators John McCain and Rand Paul in opposition to the bill, giving opponents of Graham-Cassidy a sufficient number of votes to block passage of the bill even under the Senate’s relaxed budget reconciliation, which would allow Republicans to pass the bill with as few as fifty votes, which would be joined by Vice-President Pence’s tie-breaking vote to pass the bill. In addition to these three Senators, Ted Cruz announced over the weekend that he would be a likely no vote unless changes were made to the bill similar to those demanded by Senator Paul in exchange for his support. In addition, Alaska Senator Lisa Murkowski, who spent the weekend in her home state discussing the bill with voters and with Governor Bill Walker, who opposes the bill, was also being counted as a likely no vote based on her comments about Graham-Cassidy and the fact that she has been a consistent no votes on the other Senate proposals, which were arguably more moderate in the changes they would have made to the Affordable Care Act.  The Collins announcement also came just hours after the Congressional Budget Office released a preliminary score for the bill that stated that millions of people would lose coverage under the bill, although the office cautioned that it could not provide a complete analysis of the bill before the expiration of the budget reconciliation deadline on Saturday.

As noted, the question now is what Senate Majority Leader Mitch McConnell will do now that it is clear that Graham-Cassidy will not pass the Senate and that the effort to ‘repeal and replace’ the Affordable Care Act is effectively dead for what could be a considerable period of time. The easiest option, of course, would be to admit defeat and pull the bill from the floor, a move that would avoid the embarrassing spectacle that Senate Republicans went through just prior to the August recess when what seemed then like their last-ditch effort at health care reform went down to defeat thanks to a dramatic “thumbs down” vote from John McCain, who returned to Washington to vote just days after being diagnosed with cancer. Alternatively, McConnell could decide to let the vote go forward notwithstanding the inevitable outcome simply in an effort to show the GOP base that they did make an effort to do something and to give members of the GOP Senate Caucus what would likely be their last chance before the midterms to vote on health care prior to the 2018 midterm elections. We could find out McConnell’s plans by the end of the day today since the future of the bill is likely to be the main topic of discussion at the weekly Caucus lunch that both parties in the Senate hold on Tuesday afternoons.

Effectively, this likely means that any effort to ‘repeal and replace’ the Affordable Care Act before the midterm elections is dead on arrival. If the Senate were to attempt to vote on a measure such as Graham-Cassidy after the reconciliation deadline expires on Saturday, Republicans would need to convince at least eight Democrats, and possibly more, to go against their party and side with Republicans to reach the sixty vote threshold required under normal Senate rules. That quite simply isn’t going to happen unless the bill in question is a result of a bipartisan process that would likely amount to an effort to amend the PPACA rather than do away with it entirely. Of course, such an effort would likely cause conservative Senators and Members of Congress to turn away from such a proposed bill, thus making any effort at health care reform difficult if not impossible at this time. Theoretically, Republicans in the Senate could attempt to reset the reconciliation clock in an effort to save face on health care, but that’s unlikely since they’ve already made clear that they want to use the next reconciliation period as a vehicle to pass tax reform and the process can only be used on one bill at a time. Additionally, the closer we get to the midterm elections, the less likely it is that anything as controversial as health care reform will pass either house of Congress. That puts the next likely time during which Republicans could realistically attempt to ‘repeal and replace’ the PPACA would be after the new Congress sits in January 2019. Of course, the makeup of Congress at that point could be quite different than it is today.