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July 18, 2017

GOP abandons health bill, doesn't have votes for 'repeal and delay'

Daily Briefing

Senate Majority Leader Mitch McConnell (R-Ky.) late Monday announced that the Senate would no longer pursue the Better Care Reconciliation Act (BCRA), its bill to overhaul Medicaid and repeal and replace the Affordable Care Act (ACA).

Instead, McConnell said the Senate would pursue a measure that would immediately repeal the ACA's coverage mandates and taxes, but would delay repeal of its coverage expansions by two years, with the hopes of passing a replacement plan in the interim.

However, on Tuesday three GOP senators, Susan Collins (Maine), Lisa Murkowski (Alaska), and Shelley Moore Capito (W. Va.), came out against McConnell's repeal-and-delay plan, meaning the bill appears to be dead for now.

Following those announcements, President Trump on Tuesday said, "I think we're probably in that position where we'll let ObamaCare fail," adding, "We're not going to own it. I'm not going to own it. I can tell you the Republicans are not going to own it. We'll let ObamaCare fail and then the Democrats are going to come to us."

This is a developing story.

BCRA short of votes it needs

McConnell's decision to abandon the BCRA came in response to growing opposition to the revised bill. Collins and Sen. Rand Paul (Ky.) last week said they would not support a motion to proceed with the revised BCRA, and on Monday night, Sens. Mike Lee (R-Utah) and Jerry Moran (R-Kan.) said they, too, would vote no to proceed with the bill. Collins had raised concerns about the bill's Medicaid cuts and its potential effect on the uninsured rate and premiums. Paul, Moran, and Lee each said they felt the revised measure did not go far enough to repeal the ACA.

Moran in a statement said the revised BCRA "fails to repeal the [ACA] or address health care's rising costs. For the same reasons I could not support the previous version of this bill, I cannot support this one."

Lee in a separate statement said of the bill, "In addition to not repealing all of the Obamacare taxes, it doesn't go far enough in lowering premiums for middle-class families; nor does it create enough free space from the most costly Obamacare regulations."

Lee's and Moran's opposition left McConnell two votes short of being able to pass the motion to proceed to debate, and with an uncertain path forward to striking a deal between moderate and conservative GOP senators. As a result, McConnell said the Senate GOP's "effort to repeal and immediately replace the failure of Obamacare will not be successful."

McConnell eyed repeal and replace later plan

Instead of continuing negotiations on the BCRA, McConnell said he planned to move forward with an ACA "repeal-and-delay" measure (HR 3762) that passed the GOP-controlled Congress in 2015 but was vetoed by former President Barack Obama.

That measure would immediately repeal major ACA provisions, including the law's coverage mandates and tax increases, and after a two-year delay it also would eliminate funding for the law's Medicaid expansion and insurance premium subsidies. The idea would be that Congress would pass an ACA replacement plan in the interim. The repeal-and-delay measure, unlike BCRA, would not institute a per-capita cap on federal Medicaid funding.

The repeal-and-delay plan had garnered support from Trump and several conservative GOP lawmakers.

Prior to McConnell's announcement, Trump tweeted, "Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!"

House Freedom Caucus Chair Mark Meadows (R-N.C.) who played a key role in brokering a deal on the House-approved American Health Care Act also tweeted his support for repeal and replace later, saying, "Time for full repeal of #Obamacare—let's put the same thing on President Trump's desk that we put on President Obama's desk."

Path forward was uncertain

However, the repeal-and-delay plan faced an uphill battle to get the 51 votes needed to proceed to debate, as several senators had previously voiced concerns about the effects of repeal-and-delay legislation.

The Congressional Budget Office (CBO) and Joint Committee on Taxation (JCT) estimated the 2015 repeal-and-delay measure—if not accompanied later by a replacement plan—would result in 32 million U.S. residents losing coverage by 2026, including 18 million in the first year following the repeal of the ACA's individual and employer mandates. The report also found in the first year after repeal, about 10 percent of U.S. residents would be living in an area with no insurers participating in the individual market and individual health plan premiums would increase by between 20 and 25 percent from current rates. By 2026, the report estimated that about 75 percent of U.S. residents would be living in an area with no insurers participating in the individual market and that individual health plan premiums would double.

Paul, Lee, and Moran said they would support a vote to consider the repeal-and-delay measure.

However, Collins, Capito, and Murkowski all said on Tuesday they would vote no on a motion to proceed to debate due to their opposition to the repeal-and-delay measure.

Other Republican senators—including Sens. John McCain (R-Ariz.), who is at home recovering from surgery, and Moran—said lawmakers should go back to the drawing board and craft a new bill through an open legislative process. Meanwhile, Sen. Lindsey Graham (R-S.C.) offered his and Sen. Bill Cassidy's (R-La.) alternative proposal that would maintain most of the ACA's taxes and direct that money back to states.

No matter what happens in the Senate: Get the clinical leader's resource guide

Senate Minority Leader Chuck Schumer (D-N.Y.) also called on his Republican colleagues to start over and, this time, work with Democrats on a solution to improve health care. "This second failure of Trumpcare is proof positive that the core of this bill is unworkable," Schumer said, adding, "Rather than repeating the same failed, partisan process yet again, Republicans should start from scratch and work with Democrats on a bill that lowers premiums, provides long-term stability to the markets and improves our health care system."

(Kaplan, New York Times, 7/17; Owens, Axios, 7/18; Lawler, Axios, 7/17; AP/STAT News, 7/17; Carney, The Hill, 7/17; Pramuk, CNBC, 7/17; Scott, Vox, 7/18; Everett/Haberkorn, Politico, 7/18; Dennis tweet, Bloomberg, 7/18; Scott tweet, Vox, 7/18; Litvan/Dennis, Bloomberg, 7/18; Kaplan; New York Times, 7/18; Fabian, The Hill, 7/18).

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