Last week, the Senate debated and voted upon legislation (1) to repeal-and-replace the Affordable Care Act (ACA); (2) to repeal the ACA without a replacement; and (3) to repeal-and-replace the ACA in a more limited—or “skinny” way. None of these proposals garnered 50 votes in the Senate. Following the last vote in the Senate, to defeat the “skinny bill,” Senate Majority Leader Mitch McConnell (R-KY) said, "it's time to move on.” President Trump tweeted right after the vote “let ObamaCare implode, then deal” and later urged Republican Senators to find a path to 50 votes, stating “Repeal & Replace is not dead!” It is unclear exactly what the next steps will be. There have been reports of bipartisan discussions among House and Senate members on ways to stabilize the individual insurance market, and President Trump is expected to decide early this week whether the administration will make ACA cost-sharing reduction (CSR) subsidy payments.
The House of Representatives has begun its August recess and will not return until September 5. The Senate is scheduled to be in session for the next two weeks. While discussions in Washington about the future of healthcare will continue, it may be instructive to review the events of the past week.
Last Tuesday afternoon, the Senate voted 51-50 in favor of the motion to proceed to debate H.R. 1628, American Health Care Act of 2017, with Senator John McCain (R-AZ) flying back to Washington after being diagnosed with brain cancer and with Vice President Pence casting the tie-breaking vote.
Over the course of the week, the Senate voted 43-57 against the ACA repeal and replace Better Care Reconciliation Act (with nine Republican Senators voting against), and voted 45-55 against the ACA repeal-only bill (with seven Republican Senators voting against). Following the failure of amendments both to repeal and replace and to repeal-only, it was expected that the Senate would vote on Thursday evening on a more limited ACA repeal and replace bill nicknamed the “skinny bill,” to be followed by a “vote-a-rama” session in which senators may introduce an unlimited number of amendments and vote immediately on these amendments. There is no time limit to a “vote-a-rama,” so senators were preparing for an all-night voting session.
On Thursday afternoon, Senators McCain, Lindsay Graham (R-SC), Ron Johnson (R-WI), and Bill Cassidy (R-LA) held a news conference to announce that they would not vote for a “skinny bill” unless they were assured by the House of Representatives that there would be a conference on the House-passed and Senate-passed health care bills. House Speaker Paul Ryan (R-WI) issued a statement indicating that the House would proceed to a conference on the health care bill, stating, “if moving forward requires a conference committee, that is something the House is willing to do.”
On Thursday evening, the eight-page “skinny bill,” a scaled back version of ACA repeal, was released. The “skinny bill” proposed to eliminate the individual mandate and repeal the employer mandate for three years. Under the “skinny bill,” Planned Parenthood would be defunded for one year, the medical device tax would be suspended for three years, States would be granted waivers to develop their own healthcare approaches, and contribution limits to health savings accounts would be increased. Before midnight, the Congressional Budget Office (CBO) released its estimate that the “skinny bill,” as compared with current law, would result in 16 million more Americans uninsured, a 20-percent increase in premiums, and a reduction of the deficit by $180 billion over a decade.
However, early Friday morning, by a vote of 49-51, the “skinny bill” was defeated, with Senators McCain, Lisa Murkowski (R-AK), and Susan Collins (R-ME) joining all of the Senate Democrats in opposing the bill. McCain returned to Arizona to begin treatment for his cancer and is not expected to return to Washington until September.
