From full repeal to skinny repeal to no repeal.
For the time being at least, Republican efforts to undo Obamacare are toast, after Senator John McCain joined Republicans Susan Collins and Lisa Murkowski early Friday to sweep away the table scraps remaining from the party’s once ambitious plans. A vote on “skinny” Obamacare repeal, which even some of its backers opposed in principle, failed 49-51 after Vice President Mike Pence and GOP leadership spent more than a half hour trying to sway the Arizonan on the chamber floor. Collins and Murkowski were destined to cast no’s on the measure. McCain was the decider.
Earlier Thursday, he indicated that his support hinged on the opinion of his state’s governor, Doug Ducey, and whether the House could guarantee that it would negotiate compromise legislation with the Senate instead of seriously consider the Senate’s bill. McCain had been a skeptic of the process throughout the week, beginning with a speech on the upper chamber’s customs and bipartisanshipon Tuesday. He held out to the end in the wee hours Friday. McCain motioned to the clerk with a thumbs-down, prompting gasps and short-lived applause from Democrats before minority leader Chuck Schumer told them to cut it out.
There wasn’t any such energy for Mitch McConnell to tame in his caucus after the vote. The majority leader said it was “clearly a disappointing moment” for Republicans who told their constituents they would act against Obamacare. “We told our constituents we would vote that way, and when the moment came—when the moment came,” he paused, “most of us did.” McConnell challenged Democrats to present health reform ideas. Schumer, his counterpart, challenged Republicans to work with his party, mentioning proposals from Collins and Louisiana GOP senator Bill Cassidy as possible starting points.
Either way, it’s all about starting over from Friday forward.
“I’m anxious to work with anybody who’s got an idea to design a health care delivery system who looks like they designed it on purpose,” said Cassidy’s Louisiana counterpart, John Kennedy, after the vote.
The system Republicans designed and amended to oblivion this time around came together for political and procedural reasons more than policy. The Senate GOP had no desire to advocate for the unpopular American Health Care Act passed out of the House. McConnell’s team took its own approach—though it did so behind closed doors, to the chagrin of several lawmakers. The result, the Better Care Reconciliation Act, was no more regarded by the public than the House legislation. Like that bill, the Senate proposal was also changed later to satisfy Medicaid-conscious moderates and conservatives occupied by Obamacare’s mandates on insurers. But senators didn’t get around to voting until this week: voting down the BCRA, a delayed partial repeal of Obamacare, and then skinny repeal.
That final attempt was repeal on life support. As John McCormack wrote, it “would repeal the individual mandate, nix the employer mandate until 2025, extend the moratorium on the medical device tax until the end of 2020, defund Planned Parenthood for one year, increase the contribution limit of Health Savings Accounts, and modify Obamacare’s state waivers program.” But eliminating the individual mandate while leaving the law’s insurance regulations in place is incoherent policy. Senator Lindsey Graham called the whole thing “half-assed.” Ultimately, it was just doomed.
McConnell said it was time for the chamber to move on. He already was putting the Senate on track Friday to consider Congress’s annual defense policy bill next. But health reform has been a zombie. There’s no reason to believe it won’t reappear later.
