ACA Repeal-and-Replace Effort Stalls Out in Senate

Alicia Ault

July 18, 2017

Faced with increasing opposition — even from within his own party — Senate Majority Leader Mitch McConnell has cancelled a vote on the Better Care Reconciliation Act (BCRA), and may soon have to give up on the straight-up repeal vote he had called for instead.

With the defections of Senators Mike Lee of Utah and Jerry Moran of Kansas on July 17, and at least two other senators having already said they would not vote for the latest revision of the Affordable Care Act (ACA), it was clear that the legislation would not get the 50 votes needed to pass.

"Regretfully, it is now apparent that the effort to repeal and immediately replace the failure of Obamacare will not be successful," said Senator McConnell in a statement issued late last night.

Repeal First, Replace Later?

McConnell had put colleagues on notice that, as an alternative, he will hold a vote this week on the House-passed bill to revise the ACA. In addition, said McConnell, the first amendment to be offered would be "what a majority of the Senate has already supported in 2015 and that was vetoed by then-President Obama: a repeal of Obamacare with a two-year delay to provide for a stable transition period to a patient-centered health care system that gives Americans access to quality, affordable care."

A vote on a straight repeal of the ACA would likely please Senate conservatives like Rand Paul of Kentucky and Lee, who have said they did not think the revised proposal went far enough.

But a proposed repeal vote was immediately opposed by three Republican Senators — Susan Collins of Maine, Shelley Moore Capito of West Virginia, and Lisa Murkowski of Alaska — again making it impossible to achieve a clear majority.

Other Senate moderates — including Bill Cassidy of Louisiana, who has fashioned his own replacement proposal that merely tweaks the original law — are also likely to be wary of taking part in completely overturning the ACA.

As of late today, though, Politico is reporting that McConnell has not pulled the plug on the plan yet, scheduling a vote for early next week to set the stage for a full ACA repeal — despite the current opposition.

Fix, Not "Fail"

In January, the Congressional Budget Office estimated that 18 million people would lose health insurance coverage in the first year of a repeal.

Senator John McCain of Arizona — whose recent surgery to remove a blood clot had initially been given as the reason for a delayed vote — issued a statement calling for a more bipartisan process going forward. "The Congress must now return to regular order, hold hearings, receive input from members of both parties, and heed the recommendations of our nation's governors so that we can produce a bill that finally provides Americans with access to quality and affordable health care," he said.

Physician groups also urged a bipartisan do-over instead of an outright repeal. "It's time for the Senate to end — once and for all — the misguided effort to repeal the ACA's essential coverage expansions and consumer protections, cap and cut Medicaid, and limit women's access to essential health services," said American College of Physicians (ACP) President Jack Ende, MD, in a letter to McConnell. "The Senate should instead commit to developing bipartisan legislation through regular order (including hearings and opportunities for organizations like ACP to offer our advice and expertise)," he wrote.

David O. Barbe, MD, president of the American Medical Association, said in a statement, "Congress must begin a collaborative process that produces a bipartisan approach to improve health care in our country." And, Dr Barbe noted, doing nothing is not an option, either. "Near-term action is needed to stabilize the individual/nongroup health insurance marketplace," he said.

But President Donald Trump is now apparently urging Congress to do just that — nothing. "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," he said, after it was apparent that an outright repeal vote was not likely to succeed, either, according to the New York Times.

President Trump has been one of the more vocal supporters of an ACA repeal. Earlier in July, he urged the Senate to completely repeal the bill if they could not come to an agreement on how to replace it.

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