The collapse of the Senate Republican healthcare bill on Monday night left Mitch McConnell pursuing a last-ditch change of tactics: to repeal Barack Obama’s healthcare law now, then replace it later. But less than 24 hours later, his plan appears to have been thwarted.
The Republican party has mounted a seven-year crusade against the Affordable Care Act (ACA), commonly known as Obamacare. But the Senate appears to lack the votes to simply dismantle it, absent a replacement.
Late on Monday, two conservatives, Mike Lee of Utah and Jerry Moran of Kansas, announced their opposition to the Senate bill. With Rand Paul of Kentucky and Susan Collins of Maine – a moderate – already opposed, that left leadership short of the 50 votes they needed.
Moving swiftly, McConnell declared that a vote would occur in the coming days on ACA repeal, with a built-in two-year delay to afford Republicans time to build their own legislation. In doing so, he appeared to be heeding calls from Donald Trump, who tweeted: “Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!”
The situation is, of course, not that simple. The president may soon be exposed to deep divisions within the Republican party.
Several Republicans expressed reservations on Tuesday about repealing the ACA with no replacement, a move the nonpartisan Congressional Budget Office (CBO) projected would cause 32 million people to lose health insurance by 2026, including 19 million who would lose coverage under Medicaid, the program that covers the poor, vulnerable and infirm.
Insurance premiums would nearly double over a 10-year period, the CBO found, given that insurers would probably withdraw from the marketplace established by the ACA if its individual mandate ceased to apply.
Collins, the first Republican to come out against the Senate healthcare bill, has already stated her opposition to repealing without replacement. She was joined in her opposition by two of her colleagues, Senators Shelley Moore Capito of West Virginia and Lisa Murkowski of Alaska, thereby dooming any chances a repeal-only bill has of moving forward.
Other moderates are likely to follow suit, given that their opposition to the proposed bill was rooted in concerns over its gutting of Medicaid. Several senators would not commit to advancing a repeal-only measure on Tuesday when approached by reporters on Capitol Hill.
In 2015, a Republican-led Congress did pass a bill, vetoed by Obama, that would have repealed the ACA but delayed for two years its implementation. Such votes amounted to symbolism – an assurance to the Republican base that Congress was acting on campaign pledges. Now that Republicans control the presidency, too, they have learned that actual governance poses an entirely different challenge.
The collapse of the Senate bill was a blow to McConnell, whose first draft of the bill also failed to draw sufficient support from his own party.
But the debacle has arguably been most damaging for Trump, who has shown virtually no interest in policy while demanding Republicans on Capitol Hill assume responsibility. Attempts by Mike Pence and Tom Price, the secretary of health and human services, also proved insufficient, underscoring the disconnect between the White House and Congress.
Whether Republicans end up abandoning repeal efforts in favor of fixing the flaws in the existing law alongside Democrats – as the opposing party wants – remains to be seen.
Some insurers have already pulled out of the exchanges created by the ACA, citing in part a lack of commitment by the federal government to paying for cost-sharing reductions that keep the marketplace stable. Some Republicans have suggested they would be open to working with Democrats on a temporary fix before the August recess.
Republicans must also to contend with low poll numbers for their own proposals. A bill passed by House Republicans in May, which would have left an additional 23 million uninsured over 10 years, garnered just 18% support from the public. A number of polls have shown a majority of Americans believe Congress should work to improve the existing law.
On Monday, staunch conservatives signaled the internal strife to come.
“Frankly, about healthcare, [if] you can’t pass the gigantic bill, tell me what you can pass, but get something done that starts to move us away from Obamacare,” former House speaker Newt Gingrich told Fox News.
“We’ve had six months of patience. It’s time to perform.”
(TheGuardian US)
