A dramatic vote last night ended with another significant setback for Republican hopes to repeal and replace the Affordable Care Act (ACA) as Sen. John McCain (R-AZ) cast the deciding vote against a “skinny” version of ACA repeal in a 49-51 defeat. Sen. McCain joined two other Republicans — Sens. Susan Collins (R-ME) and Lisa Murkowski (R-AK), who had also voted against a motion to proceed to the underlying legislation earlier this week — and all 48 Democrats in opposing the skinny repeal amendment that represented the best chance for a bill to make it past the Senate floor in this week’s process. Specifically, the amendment would have replaced the House-passed repeal bill, known as the American Health Care Act (AHCA), with a more limited version designed as a “least common denominator” between Republican conservatives and moderates. A timeline of developments from overnight, including analysis of the skinny proposal and the political dynamics preceding the remarkable final vote, are provided in the attached email.
The Senate will move forward in their efforts to repeal parts of the Affordable Care Act (ACA) today after failing yesterday to take up a bill that would have repealed major provisions of the bill without a contemporaneous replacement plan. The Senate voted 45-55 against an updated version of the GOP’s 2015 budget reconciliation bill that repeals most of the ACA after a two-year delay, with seven Republicans joining all Democrats in opposing the measure. Instead, the Senate will continue debate on the underlying bill — the House-passed American Health Care Act (AHCA) (H.R. 1628) — which GOP leaders ultimately hope to replace with a so-called “skinny” repeal bill that can be conferenced with the House.
Yesterday afternoon, the Senate approved the motion to proceed to the House-passed American Health Care Act (AHCA) (H.R. 1628) by a vote of 51-50, setting the stage for a debate that Senate Republican leaders hope will end with passage of a “skinny” repeal bill that can be conferenced with the House. Two moderate Republicans voted no on the motion to proceed — Sen. Susan Collins (R-ME) and Lisa Murkowski (R-AK) — and Vice President Mike Pence cast the tie-breaking vote. While Republican leaders still have significant challenges ahead in passing legislation to repeal and replace the ACA, clearing this major procedural hurdle provides a significant boost to their efforts.
- The House is expected to take up a Congressional Review Act measure that would overturn the arbitration rule that the CFPB announced two weeks ago. Also on the agenda for the floor is a “minibus” appropriations bill that includes the Defense, Legislative Branch, Military Construction-Veterans Affairs, and Energy and Water Development appropriations bills.
- The Financial Services Committee is scheduled to hold a mark-up on Tuesday. On the agenda are a series of Capital Markets measures, plus a resolution of inquiry to compel the Treasury Secretary to produce documents related to the President’s business with Russia.
- With a razor thin margin continuing to pose problems for Leader McConnell as he works to bring up the health care reform bill, the Senate is expected to spend most of the week burning floor time to move a series of nominees.
- Speaking of nominees, the Senate Banking Committee will hold a hearing on Thursday to consider the nominations of Joseph Otting to be the Comptroller of Currency and Randal Quarles to be the Vice-Chair of Supervision at the Federal Reserve.
The Senate appears to be finally be ready for a vote on the motion to proceed to the House-passed American Health Care Act (AHCA) today, which, if successful, will start floor debate on the legislation. With Sen. Susan Collins (R-ME) seemingly set in voting against the motion, Republicans can only afford one additional defection in order to move the bill forward. Sen. Rand Paul (R-KY) seems to have acquiesced after being promised that a vote will be held during the amendment process on the “repeal and delay” bill that he has backed. And while the return of Sen. John McCain (R-AZ) to Washington makes the math a little easier for the bill’s proponents, a handful of moderates that have avoided comment on the bill in the past few days – such as Sens. Dean Heller (R-NV) and Lisa Murkowski (R-AK) – could vote against the procedural vote, effectively sinking the bill before it can be altered through the amendment process.
In a recent blog published by The New York Times’ blog ‘TheUpshot,’ Thorn Run Partners’ Billy Wynne offered his expertise on the provisions that could be struck from the Senate Health Bill. Wynne was part of a panel of experts that weighed in on what might happen to questionable portions of the Senate health bills. The portions that were reviewed include: (1) Restrictions on abortion coverage; (2) a provision defunding Planned Parenthood; (3) a newly permissive state waiver process; (4) changes to rules governing insurance pricing by age; (5) funding for cost-sharing reductions: (6) elimination of the medical-loss ratio rule and; (7) the Cruz Amendment. “According to our nine experts, at least some parts of the bill are likely to be eliminated before the voting begins.”
In an op-ed published in RealClearHealth, Thorn Run's Shea McCarthy comments on the narrow path forward for the Better Care Reconciliation Act (BCRA). McCarthy notes that while Senate Majority Leader Mitch McConnel stated a repeal and replace “will not be successful,” the GOP’s most viable path forward in passing healthcare reform remains the BCRA. “The 49 GOP senators who met over lunch at the White House last Wednesday left the meeting encouraged, and negotiations among undecided senators continued at a Members-only meeting Wednesday night,” said McCarthy. McCarthy also highlighted the unfeasibility of a “repeal and delay” tactic that would likely alienate moderates and stall healthcare reform altogether. “The likely absence of Sen. McCain this week and the intransigence of Sen. Collins will make threading the legislative needle a difficult — almost impossible — task for GOP leaders. But the BCRA could make one last gasp for revival before we finally write its eulogy. And if Leader McConnell writes the right prescription, it has an outside chance at survival.”
Once again, the fierce negotiations on the Republican plan to repeal and replace the Affordable Care Act (ACA) are scheduled to come to a head this week with Senate floor consideration of the House-passed American Health Care Act (AHCA). While every weekly preview for the past month has seemingly promised that event, Senate Majority Leader Mitch McConnell (R-KY) and Republican leaders appear to be set on using this week as a do-or-die period for the health care overhaul. A vote on the motion to proceed to the bill could come as early as tomorrow, but it remains unclear exactly what package Republican leaders ultimately want to move forward after last week’s collapse in support for the Better Care Reconciliation Act (BCRA) as originally drafted. The two apparent options are 1) a “repeal and delay” bill that would more completely repeal the ACA after a two-year period in order to provide Republicans time to design a replacement, or 2) a revised version of the BCRA that would include further changes designed to convince skeptics on both the moderate and conservative side of the spectrum.
The Week in Review
It was an immensely tumultuous week for the Republican plan to repeal and replace the Affordable Care Act (ACA). The bill was seemingly dead after Sens. Mike Lee (R-UT) and Jerry Moran (R-KS) announced that they would oppose a motion to proceed early in the week, but further negotiations have resurrected the package and it may yet be considered on the Senate floor. A full breakdown on the developments is included below.
Both chambers are out today ahead of what is expected to be a momentous week starting Monday. The top story will be whether Senate Republicans can resurrect their bill to repeal and replace the Affordable Care Act (ACA), which has been on life support all week after an announcement from Sens. Mike Lee (R-AZ) and Jerry Moran (R-KS) that they would oppose a previous version of the legislation. The Senate Budget Committee posted the latest version yesterday (TRP note attached), which would add additional opioid and market stabilization funding, but notably excludes the Cruz amendment. A Congressional Budget Office (CBO) score on the bill also released yesterday suggests that by 2026, 22 million fewer people would have insurance as compared to current law and premiums would increase by about 30 percent.