Obamacare Repeal Showdown Continues

Capitol photo by Scrumshus

This week could be decisive in determining how many of the over 20.4 million Americans and five million Californians who gained health insurance under the Affordable Care Act (ACA, or “Obamacare”) will be allowed to keep it.

In back-to-back votes Tuesday, Senate Republicans took the first steps in what only last week had seemed impossible — restarting their effort to repeal and replace Obamacare. In the afternoon, Senate Majority Leader Mitch McConnell (R-KY) had corralled enough recalcitrant Republicans to pass a key procedural hurdle that allowed debate on three possible alternatives, each potentially capable of either repealing or repealing and replacing elements of the ACA.

The motion to proceed passed 51-50, but that momentum seemed to falter later, when nine Republicans sided with Democrats to defeat a Tuesday evening vote on the Better Care Reconciliation Act, a modified repeal-and-replace measure that the Congressional Budget Office (CBO) had estimated would throw 22 million Americans off the insurance rolls. That vote, which needed 60 votes to pass, was shot down 57-43.

There are at least two more options remaining to be considered and just three more days for what will likely be a last effort at repeal this year.

Wednesday

• The Senate finishes its 20 hours of debate in legislative time.
• The Obamacare Repeal Reconciliation Act (ORRA) is scheduled for an afternoon vote. The CBO has estimated that ORRA, a retread of a 2015 repeal-only bill without a replacement, could deprive as many as 32 million Americans of health insurance. It’s expected to fail.

Thursday Night Through Friday Morning

• A series of votes on amendments to the House health care legislation from both parties along with the possibility of the introduction of other health care legislation.
• A vote on the “skinny repeal” of only the ACA’s individual mandate and its medical device tax, but whose real purpose would be to trigger a conference committee that would buy time for Senate and House Republicans to rewrite the bill into a passable repeal-and-replace bill.

To get a rough idea of what the Republicans might still have in store, Capital & Main spoke to Richard Kirsch, a senior adviser to the progressive grassroots coalition Health Care for America Now.

Capital & Main: What happened in the Senate Tuesday?

Richard Kirsch: McConnell pulled out every political chit to argue the Republican senators into at least having a motion to discuss the bill, even if there is no majority support for passing any of the things that have actually been proposed.

Which of the two remaining proposals has the best chance of getting passed?

Kirsch: The skinny repeal, [which would] fundamentally get rid of the employer individual mandate and eliminate a tax on medical devices. The individual mandate is generally unpopular with Republicans, and the medical device tax is something which that industry has lobbied really hard against. It’s the lowest common denominator that can be agreed on. By doing that, they pass something and then it can go to a conference committee with the House.

What could we see emerge after Labor Day?

Kirsch: We have no idea. It’s still possible that they’ll pull something out of the Senate that would go to the House. However, even that might have to go to conference. … But what that will be is very hard to tell, because it’s going to reflect all of the huge difficulties that Republicans have had in reconciling their far-right wing and their regular right wing. The key thing is, they’re going to keep pushing — they’re desperate to do that. They still don’t have an agreement amongst themselves in the Senate, and they’re unlikely to get it, but they’re still going to try to find a way to keep the thing going.

Should Obamacare get repealed, do you see the Democrats simply restoring ACA by a similar repeal-and-replace effort whenever they return to power?

Kirsch: Actually, we would expect if there is a Democratic Congress and President, they would certainly reverse what the Republicans are going to try to do. But I think they would go beyond the Affordable Care Act to make some larger changes in the system that would make health care more affordable and more reliable — less reliant on the private insurance industry. You could open up Medicare to everyone in the country, but also continue to offer people the choice of employer coverage as well. …This is all [speculation]. We’re still in a big fight, because they’re still going to try to pull something out of the Senate, and they’re still going to try to pull something out of conference. Even though they’re having huge problems, it’s still not over.