July 28, 2017

Senate Fails to Repeal Affordable Care Act

In a dramatic vote cast in the early morning hours of July 28, Sen. John McCain (R-AZ) joined fellow Republican Sens. Lisa Murkowski (R-AK) and Susan Collins (R-ME) in opposing the Health Care Freedom Act, colloquially referred to as a “skinny” repeal of the Patient Protection and Affordable Care Act (PPACA). It appears that the failed vote on the Health Care Freedom Act marks the final attempt by the Senate GOP to eliminate PPACA, also known as “Obamacare,” for the foreseeable future.

Senate Majority Leader Mitch McConnell (R-KY) publicly released the text of the Health Care Freedom Act only a few hours before the Senate scheduled a vote on this bill. The “skinny repeal” bill sought, among other things, to permanently zero out the individual mandate, delay enforcement of the employer mandate through 2024, suspend the medical device tax through 2020, eliminate funding for Planned Parenthood for one year and provide states with greater flexibility to pursue waivers from existing PPACA insurance regulations.

Republicans only have a slim 52-48 majority in the Senate making repeal and replace of PPACA via reconciliation, an arcane parliamentary procedure that prohibits a Senate filibuster and allows select bills to pass with a simple majority, a major challenge to the GOP. The politics surrounding the effort to repeal and replace Obamacare remained fluid throughout the week and it became increasingly clear that Majority Leader McConnell would struggle to corral the 51 votes needed to pass any legislation under reconciliation.

On July 25, Senate Republicans passed a “motion to proceed,” or an agreement for the Senate to begin debate on the House passed American Health Care Act (AHCA), by a bare 51-50 vote. In fact, Vice President Mike Pence was forced to cast the tiebreaking vote on the motion to proceed.

Because of minimal support for the AHCA in the Senate, McConnell immediately brought various different proposals crafted by the Senate to repeal and replace PPACA to the floor for votes. First, Senate Republicans attempted to pass a modified version of the Better Care Reconciliation Act (BCRA), a comprehensive bill to repeal and replace PPACA, but this vote failed by a wide margin. On July 26, the GOP pivoted to consideration of the Obamacare Repeal and Reconciliation Act (ORRA), legislation that eliminated the vast majority of PPACA effective in 2019 but did not include any provisions to immediately replace the eliminated sections of Obamacare with any Republican policy proposals. ORRA ultimately failed by a wide margin as well.

Consideration of a “skinny” Obamacare repeal bill was designed to be a compromise to appease both conservative and moderate Republicans. Despite its unpopularity, the majority leader pleaded with Senate Republicans to pass an imperfect bill that repealed portions of PPACA in hopes of forging a conference committee with the House of Representatives. Republicans hoped final consensus around a comprehensive package to repeal and replace Obamacare would be forged through a bicameral conference committee.

The failure of the Health Care Freedom Act marked the culmination of a wild week on Capitol Hill. It is unclear whether Republicans and Democrats will begin working on a bipartisan solution to stabilize the individual insurance market and improve other aspects of Obamacare. The American College of Radiology’s Government Relations Office will continue to monitor the latest developments surrounding PPACA in the coming days and weeks.