The Senate on Wednesday rejected Senate GOP leaders' "repeal-and-delay" measure, and Senate Democrats signaled they would not offer any amendments until Senate GOP leaders unveil their proposal for the final bill.
Details on Wednesday's votes
The repeal-and-delay proposal, called the Obamacare Repeal Reconciliation Act of 2017, would have repealed major Affordable Care Act (ACA) provisions immediately, including the law's coverage mandates and some of the law's tax increases. In 2020, it would have eliminated funding for the law's Medicaid expansion and insurance premium subsidies—with the idea that Congress would use the delay to pass a broader reform measure.
The Congressional Budget Office (CBO) last week projected that the bill would have left 32 million more U.S. residents uninsured and cause premiums in the non-group health insurance market to rise by about 50 percent by 2026 when compared with current law.
Seven GOP senators joined all Democrats in voting against the repeal-and-delay measure: Sens. Susan Collins (Maine), Dean Heller (Nev.), John McCain (Ariz.), Shelley Moore Capito (W. Va.), Lisa Murkowski (Alaska), and Rob Portman (Ohio).
The Senate also voted 48-52 yesterday to reject an amendment by Sen. Joe Donnelly (D-Ind.) that would have sent the House-passed American Health Care Act to the Senate Finance Committee for consideration.
The votes came one day after nine GOP senators joined all Democrats in voting against the broader Better Care Reconciliation Act (BCRA), an alternative GOP proposal. And two Republicans, Murkowski and Collins, opposed the initial motion to begin debate on health reform.
Reports suggest that Murkowski in particular is taking heat from the Trump administration for her initial no vote. Alaska Sens. Dan Sullivan (R) and Murkowski both received calls from Department of the Interior Secretary Ryan Zinke, according to Alaska Dispatch News, saying that Murkowski's "vote had put Alaska's future with the administration in jeopardy."
Sullivan, who voted in favor of opening the health reform debate, described the call as a "troubling message," adding, "I'm not going to go into the details, but I fear that the strong economic growth, pro-energy, pro-mining, pro-jobs and personnel from Alaska who are part of those policies are going to stop."
Democratic senators change tactics
The Senate on Thursday is expected to begin the so-called "vote-a-rama," a process during which senators from both parties can offer an unlimited number of amendments, as long as they are "germane" to the bill.
However, questions remain about what Senate GOP leaders' final health reform plan will look like now that their first two options have been rejected. And Senate Democrats said they will not offer any of their planned amendments during the vote-a-rama until details on that final bill are released.
Senate Minority Leader Chuck Schumer (D-N.Y.) Wednesday night said, "Democrats are not going to participate in this one-sided and broken process," adding, "Once the majority leader shows his hand, reveals what his bill will actually be, Democrats will use the opportunity to try and amend the bill."
Senate Republican leaders reportedly are eyeing a narrower "skinny repeal" proposal, repealing only the ACA's individual and employer mandates and some of its taxes. However, so far no legislative text for that measure has been released.
Industry weighs in
The American Medical Association (AMA) and the Blue Cross Blue Shield Association separately released statements Wednesday criticizing the Senate's ongoing health reform debate.
AMA President David Barbe in a statement said, "To date, the amendments proposed to repeal or replace the Affordable Care Act ... would harm vulnerable patients in every state." He added, "We again urge the Senate to engage in a bipartisan process—through regular order—to address the shortcomings of the Affordable Care Act and achieve the goal of providing access to quality, affordable health care coverage to more Americans."
The BCBSA also raised concerns about the potential "skinny" repeal bill, which would repeal the ACA's mandate requiring individuals to purchase health coverage or pay a fine. "If there is no longer a requirement for everyone to purchase coverage, it is critical that any legislation include strong incentives for people to obtain health insurance and keep it year-round," said the association in the statement. "A system that allows people to purchase coverage only when they need it drives up costs for everyone" (Frieden/Firth, MedPage Today, 7/26; Kliff, Vox, 7/26; Martinson, Alaska Dispatch News, 7/26; Lee, Modern Healthcare, 7/26; Kaplan, New York Times, 7/26; McIntire, CQ News, 7/26 [subscription required]; Kaplan, New York Times, 7/27; Min Kim, Politico, 7/26).
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