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Republican healthcare push is mostly dead: Republicans’ efforts to repeal and replace Obamacare were dealt a serious, and perhaps fatal, blow Monday night after GOP Sens. Mike Lee of Utah and Jerry Moran of Kansas stated they were opposed to the legislation, bringing the total number of defectors to four, when Senate Majority Leader Mitch McConnell, R-Ky., could only afford to lose two. McConnell soon acknowledged that that he didn’t have the support to pass a replacement while repealing major portions of it, so he decided to proceed with a vote that would revive the 2015 repeal bill that already had majority support, which former President Barack Obama vetoed. But now that President Trump is ready to sign it into law, centrists who voted for repeal when it was just a symbolic move a year and a half ago, are now more wary. Sen. Shelley Moore Capito, R-W.Va., who voted for the repeal bill in 2015, already has reversed herself and said she would vote against it. Sen. Susan Collins, R-Maine, already opposed the bill in 2015 so is a clear no. Sen. Rob Portman, R-Ohio, was heavily critical of passing partial repeal as a standalone bill. So, they’re already in trouble.
Repeal bill could be voted down tonight: A combination of floor schedule, Sen. John McCain’s recovery, and a temperature reading of GOP senators at today’s lunch will determine when the bill gets voted on and the ultimate outcome. McConnell had already scheduled a cloture vote on a nominee for Wednesday morning, meaning that if Republicans don’t vote tonight or tomorrow morning, the vote will have to be pushed into next week. However, the vote is unlikely to be held for McCain unless he’s the deciding vote. If Republicans meet for lunch today and three senators come out opposed to the bill, there would be no reason to wait for McCain, meaning they would be inclined to get a vote over with — meaning a vote would occur tonight or tomorrow morning that would allow senators to go on the record on repeal.
Is this the end or the end of the beginning? The big question that will linger assuming a “repeal” vote fails is whether this is the end of the process or merely McConnell’s latest tactical maneuver. Showing senators that the votes are not there to repeal the law could be part of the process of preparing them for another approach. Or it could mean that he’s determined that there is no path to getting Republicans to rally around a single bill, so he’d rather cut his losses, get a vote over with, and move onto other items on his agenda.
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A reminder of what the 2015 bill did. The bill Republicans passed in 2015 would have repealed most of Obamacare’s taxes and spending (including phasing out exchange subsidies and the Medicaid expansion over two years), scrapped the mandate penalties, and defunded Planned Parenthood for a year. It does not contain the same long-term changes to Medicaid that would alter the growth rate and result in hundreds of billions of dollars in cuts. It also does not repeal Obamacare’s regulations. Read a list of what the 2015 bill would kill and keep here.
Here’s why CBO said partial repeal would leave 32 million uninsured: The Congressional Budget Office projections for the earlier clean repeal legislation showed significantly higher numbers of uninsured than under the proposals Republicans have been struggling with in recent months. The now-defunct Senate bill would increase the number of uninsured by 22 million people over a decade, according to the CBO, but the 2015 bill, the Restoring Americans’ Healthcare Freedom Reconciliation Act, would boost the number of uninsured even more, by 32 million over that period. In the first year, the year Republicans are facing re-election, 18 million more people will be uninsured and premiums for the exchanges will rise by 20 percent, according to the CBO. The reason is that the 2015 repeal bill would eliminate Obamacare’s subsidies and mandate penalties but leave its regulations intact. Therefore, insurers would be required to cover those with pre-existing conditions, charge the same premiums regardless of health status, and provide comprehensive coverage for a set of mandated benefits. All of those regulations drive up the cost of premiums for healthier individuals, but they would no longer be forced to pay penalties for going uninsured. Meanwhile, unlike the repeal and replace bill, which would inject more money into insurance markets and maintain subsidies for individuals, the repeal only bill would not spend money on subsidizing health coverage.
Conservatives back repeal bill: Conservatives who have complained that the latest bill didn’t do enough to repeal Obamacare, including Sens. Rand Paul, R-Ky., and Mike Lee, R-Utah, have said they would support the partial repeal bill. The conservative House Freedom Caucus pounced on the potential demise of the Senate health bill by calling for a new effort to fully repeal Obamacare. “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,” tweeted Rep. Mark Meadows, R-N.C. Rep. Jim Jordan, R-Ohio, added on Twitter “no more waiting. Americans sent us here 2 repeal Obamacare.”
House GOP angry after Senate failure on healthcare. Lawmakers leaving the House GOP’s weekly conference meeting said feelings of exasperation and anger have set in, now that the Senate has dropped plans to vote on an Obamacare replacement bill this month. “There is a lot of frustration, borderline anger I guess, at what really has to be described as some level of incompetence to be able to get together and get something done,” Rep. Mark Walker, R-N.C., who heads the conservative Republican Study Committee, told the Washington Examiner. According to Walker, Ryan urged lawmakers to remain upbeat. He told them, “We’ve got to stay focused on delivering the promises we made to the American people, even though we are frustrated with the Senate’s inability to get something done.” But it was hard for House Republicans to hide their displeasure with their GOP colleagues across the Capitol, where weeks have been spent negotiating a healthcare deal that would keep both moderate and conservative wings of the Senate GOP satisfied.
Trump supports repeal and delay. With the Senate GOP’s healthcare bill lacking the votes to pass, Trump on Monday night called on Republican senators to pursue a full repeal of Obamacare. “Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate,” Trump tweeted. “Dems will join in!” The White House says it is not giving up on repealing and replacing Obamacare. “Insurance markets continue to collapse, premiums continue to rise, and Obamacare remains a failure,” a White House spokesman told the Washington Examiner. “Inaction is not an option. We look forward to Congress continuing to work toward a bill the president can sign to end the Obamacare nightmare and restore quality care at affordable prices.” Trump had been having dinner with several Republican senators when Moran and Lee announced their opposition to the Better Care Reconciliation Act.
Then this morning, Trump tweeted: “We were let down by all of the Democrats and a few Republicans. Most Republicans were loyal, terrific & worked really hard. We will return!” And later: “As I have always said, let ObamaCare fail and then come together and do a great healthcare plan. Stay tuned!”
McConnell blames Dems for defeat. McConnell trained his fire on Democrats Tuesday for the collapse of the bill. “I imagine many Democrats were celebrating last night,” he said on the Senate floor. “I hope they consider what they’re celebrating.” McConnell said that Democrats didn’t want to engage “with us seriously in the process.” Now McConnell plans to bring up a bill that would gut Obamacare that Congress passed in 2015 but was vetoed by Obama. The bill would kill Obamacare’s taxes and some of the mandates but not insurer regulations. It would leave Obamacare in for two years while a replacement is crafted. “Passing this legislation will provide the opportunity for senators of all parties to engage in a fresh start and a new beginning for the American people,” he said.
After setback, Schumer challenges Republicans to work with Democrats. “This second failure of Trumpcare is proof positive that the core of this bill is unworkable,” Senate Minority Leader Chuck Schumer of New York said Monday night. “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 healthcare system.”
American Medical Association says it wants to fix Obamacare. The American Medical Association is pressing Congress for a bipartisan fix to Obamacare’s exchanges that are reeling from higher premiums and insurer defections. “The status quo is unacceptable,” AMA President David O. Barbe said. “Near-term action is needed to stabilize the individual/nongroup health insurance marketplace.” The doctors’ group was among several medical groups that opposed the Senate health bill, including the American Hospital Association.
Signs of trouble already were apparent, especially on Medicaid provisions. Wisconsin Sen. Ron Johnson said Monday that he confirmed with colleagues that Senate Majority Leader Mitch McConnell told centrists not to worry about planned cuts to Medicaid because they likely would never take effect, a revelation he said put the bill’s passage in jeopardy. According to the Wisconsin Republican, McConnell told senators regarding concerns they had about federal reductions in Medicaid funding, “Don’t worry about that, that’s too far in the future.” Johnson told reporters that he had been strongly in favor of moving forward on debating the bill until he heard those comments. “I find those comments very troubling, and I really think that puts in jeopardy the motion to proceed vote,” he said. “Last week I was strongly urging colleagues to vote motion to proceed. I’m not doing that right now.” Asked about the comments, McConnell released a statement saying, “I prefer to speak for myself, and my view is that the Medicaid per capita cap with a responsible growth rate that is sustainable for taxpayers is the most important long-term reform in the bill. That is why it has been in each draft we have released.”
Threatening note demanded Sen. Dean Heller oppose Senate health bill. The person who left the note on the door of Heller’s Nevada’s office said he would die if Heller voted for the bill, according to a report in the Nevada Independent. Heller, one of the most vulnerable GOP incumbents up for re-election next year, had not announced how he would vote.
More details emerge on Sen. John McCain’s health. Sen. Lindsey Graham, R-S.C., said Monday that the Arizona Republican had been feeling sick for a while before his surgery Friday to remove a blood clot above his left eye. “It [was] a routine check, but John had not been feeling good,” Graham, R-S.C. told CNN Monday. “He had been traveling a lot, wrote it off to being tired, but he was being forgetful and just wore himself out traveling around the world. I’m glad they found what I think was the cause.” Trump said Monday he hoped McCain would get better soon after undergoing surgery because “we need his vote” to pass the Republican healthcare bill. “I can tell you, we hope John McCain gets better very soon because we miss him. He’s a crusty voice in Washington, plus we need his vote,” Trump said at the White House.
What McCain wants for healthcare: Move on to bipartisanship. “One of the major problems with Obamacare is that it was written on a strictly party-line basis and driven through Congress without a single Republican vote,” he said in a statement. “As the law continues to crumble in Arizona and states across the country, we must not repeat the same mistakes that led to Obamacare’s failure.”
RUNDOWN
Washington Post Healthcare failed because GOP divide is too large to bridge
Axios The fallout: Amid defeat, move on to bigger defeat?
STAT News With collapse of GOP healthcare effort, Congress faces long “to do” list on health policy
Politico Five reasons why Republicans can’t pass a repeal bill
Bloomberg What Wall Street is saying about the health bill’s collapse
Reason The short, sad life of a Republican health bill
NPR The risks of repeal without replace
Wall Street Journal Dollar slumps after healthcare bill’s failure
Calendar
TUESDAY | JULY 18
House budget released. Detailed text.
Noon. National Pharmaceutical Council webinar on “Same Condition, Different Costs: Should Patients Pay Different Amounts?” Details.
2:30 p.m. New York Times Insider call on “Healthcare Conference Call: What Does Policy Actually Mean for Your Health?” Details.
WEDNESDAY | JULY 19
10 a.m. 1100 Longworth. House Ways and Means hearing on “Efforts to Combat Waste, Fraud and Abuse in the Medicare Program.” Details.
Noon. 485 Russell. The American Association for Cancer Research and the Society for Immunotherapy of Cancer will host a congressional briefing on “Progress in Immunotherapy: Delivering Hope and Clinical Benefit to Cancer Patients.”
1:45 p.m. National Press Foundation Webinar on “Preventive Health – What’s Next?” Details.
MONDAY | JULY 24
Noon. 529 14th St. NW. National Press Club lunch even with the House Freedom Caucus. Details.
TUESDAY | JULY 25
Noon. 2103 Rayburn. The American College of Preventive Medicine lunch briefing on “Transforming Medical Education to Prevent Chronic Disease.” Register.
