Senate Votes Down 'Skinny' Repeal of ACA

July 28, 2017

UPDATED July 28, 2017 // The Senate early this morning narrowly defeated a "skinny" repeal of the Affordable Care Act (ACA) that called for just a few changes to the embattled law, but one of those was big — the elimination of the individual mandate to obtain health insurance coverage.

It was the third time this week that Senate Republicans failed to undo the signature legislation of the Obama administration. Three Republicans — Sen. John McCain (R-AZ), Sen. Lisa Murkowksi (R-AK), and Sen. Susan Collins (R-ME) — joined 46 Democrats and two independents in voting 51 to 49 to reject the measure.

The bill, called the Health Care Freedom Act (HCFA), is technically an amended version of a more ambitious House bill that repeals and replaces the ACA. If it had passed, the HCFA would have gone back to the House.

Yesterday, House Speaker Paul Ryan (R-WI) said House Republicans were "willing" to turn the bill over to a House-Senate conference committee to forge a compromise measure instead of voting on it as-is. Skinny repeal was advertised all along as a starter kit, not a final piece of legislation, and a handful of Senate Republicans, including McCain, had vowed that they would not support the HCFA unless they received assurances that a conference committee would take it up.

With 52 votes in the Senate, Republicans could afford to lose only two and still pass the HCFA, with Vice President Mike Pence available to break a 50-50 tie. GOP leaders anticipated that Murkowski and Collins might defect. McCain’s decisive "no" vote — delivered with a downward flip of his hand while he stood on the Senate floor — triggered a ripple of applause among Democrats that was quickly stifled by the waving arm of Senate Minority Leader Chuck Schumer (D-NY).

Afterwards, McCain explained that Ryan’s statement about a willingness to go to conference still left room for the House to pass the HCFA in its current "shell" form.

"From the beginning, I have believed that Obamacare should be repealed and replaced with a solution that increases competition, lowers costs, and improves care for the American people," McCain said in a news release. "The so-called ‘skinny repeal’ amendment the Senate voted on today would not accomplish those goals." He urged his Senate colleagues to "return to the correct way of legislating" and run the original House bill through the committee process with hearings and bipartisan input.

CBO: Skinny Repeal Would Have Added 15 Million to Ranks of Uninsured Next Year

What a legislative week it was. On July 25, the Senate voted down its own full-fledged version of ACA repeal and replacement. The next day saw the defeat of a repeal-only measure with some elements delayed until 2020.

What the HCFA would have done was far less extensive. Chiefly, it would eliminate the penalty for not obtaining health coverage, effectively killing the individual mandate. The bill also would:

  • Through 2024, eliminate the penalty for employers with 50 or more workers that do not offer them insurance.

  • Allow individuals with tax-exempt health savings accounts to contribute more money to them for 3 years.

  • Repeal the tax on medical device makers for 3 years.

  • Cut off Medicaid reimbursement of Planned Parenthood services for 1 year.

  • Eliminate the Prevention and Public Health Fund in 2019.

  • Increase funding for community health centers that provide primary and preventive care for low-income Americans.

  • Give states more flexibility in obtaining waivers under the ACA to implement their own healthcare reforms.

The Congressional Budget Office (CBO) on Thursday night said that under the HCFA, the number of uninsured Americans would increase by 15 million in 2018 compared with the current law's trajectory. By 2026, there would be an additional 16 million uninsured. The CBO has said that eliminating the individual mandate would destabilize the individual insurance market by reducing the number of young healthy people who buy coverage, forcing insurers to raise premiums for a sicklier, costlier risk pool and making insurance increasingly more unaffordable — the so-called death spiral.

Last night, David Barbe, MD, the president of the American Medical Association, released a statement urging the Senate to reject the HCFA, calling the bill "a toxic prescription that would make matters worse."

"Again, we urge Senators to oppose the 'skinny' bill and to pivot to a bipartisan effort, working through appropriate committees of jurisdiction and regular order to fix problems and gaps in current law to enable Americans to obtain quality, affordable health insurance," Dr Barbe said.

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