- In a dramatic and surprising turn of events, the Senate voted down a bill to repeal parts of the Affordable Care Act (ACA) in the early hours of Friday morning. Three Republicans voted against the bill — Sens. John McCain of Arizona, Lisa Murkowski of Alaska and Susan Collins of Maine.
- The bill, known most commonly as the "skinny" repeal but which the GOP had dubbed The Health Care Freedom Act, would have repealed the individual mandate and the medical device tax and partially repealed the employer mandate. It also defunded Planned Parenthood, cut public health funding and made it easier for states to obtain waivers to bypass essential health benefits.
- The Health Care Freedom Act and broader efforts to repeal the ACA are not officially dead, but it’s unclear whether or how Republicans plan to proceed after this major blow. In remarks after the vote, Senate Leader Mitch McConnell said, "It’s time to move on."
It was a chaotic scene at Capitol Hill late on Thursday night and into early Friday morning. The bill to be voted on was drafted over a working lunch and the text was released at about 10 p.m., two hours before the vote was scheduled. There was no full Congressional Budget Office (CBO) score released for the final legislative text. After a flurry of last-minute lobbying on the Senate floor, the votes were cast and repeal of the ACA was set back dramatically amid multiple procedural machinations.
The healthcare industry will no doubt react happily to this news. Several organizations railed against skinny repeal, including America's Health Insurance Plans, the American Association of Retired Persons and the American Medical Association (AMA), which called the bill "a toxic prescription that would make matters worse."
The main objection to skinny repeal was the damage it was expected do to the individual insurance market. Repealing the individual mandate while still requiring insurers to cover pre-existing conditions creates an unbalanced risk pool that would result in higher premiums and deductibles, as well as most payers pulling out of markets, according to several analyses.
Republican leaders held the vote despite widespread opposition in hopes enough senators would agree to pass it and move toward a conference committee, which involves members of the House and Senate working together to draft an agreed-upon bill. It appears McCain wasn't satisfied with a tepid assurance from House Leader Paul Ryan that he wouldn't pass the bill without changes once it reached the House.
Several payers have already pulled out of the exchanges because the White House and Congress have refused to commit to funding cost-sharing reduction (CSR) payments. This issue is still not resolved and payers will be looking for some decisive action, as they have only a few weeks before they must submit rates and decide whether to participate in the ACA exchange markets. In a second statement sent after the vote, AMA President David Barbe said the status quo is still unacceptable and the "first priority should be to stabilize the individual marketplace."
President Donald Trump indicated on Twitter this is not his plan.
3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let ObamaCare implode, then deal. Watch!— Donald J. Trump (@realDonaldTrump) July 28, 2017
Although it was one of the more moderate proposals from Republicans, skinny repeal would have resulted in 16 million people losing coverage next year and premiums for the individual market rising an average of 20%, according to the CBO. Other bills the GOP have proposed would reduce the number of uninsured by up to 32 million people in the next 10 years. Those bills failed earlier this week.
While there are no assurances this is the end of Republican efforts to repeal the ACA, GOP leaders are left with few options for moving forward and are running out of time to use the budget reconciliation process that requires only a simple majority for approval.
That doesn't mean the ACA will remain unscathed. Already, the Trump administration has pulled funding for promoting the exchanges and continued to obfuscate about CSR payments. The administration could also sabotage the ACA by eliminating the individual mandate penalty and accepting more state waivers that bend the ACA regulations.
The failed vote doesn't mean much of hiatus, if any, on healthcare legislation. Reauthorization of the Children’s Health Insurance Program is set for September and could represent a vehicle for other healthcare measures.