Senate Republicans spent the last few weeks making one last desperate push to repeal Obamacare.
But as they neared a final deadline, it became clear: They were never really all that close.
Sen. Susan Collins said Monday the bill would cause too many Americans to lose insurance, while Rand Paul said it preserved too many of the federal subsidies for health care — even after the bill’s authors made a spate of last-minute changes to win them over. Their opposition followed John McCain’s declaration last week that it was too hasty and partisan, as the GOP raced to meet a Sept. 30 deadline.
Their firm stances against it — each for a very different reason — underscore the difficulty Republicans face in trying to make dramatic changes to the 2010 Affordable Care Act. Even though most Republicans relish replacing President Barack Obama’s signature achievement with something less costly and more flexible, doing so is all but impossible with wafer-thin control of one of the chambers.
Senate Majority Leader Mitch McConnell still has to decide whether to put Republicans through the spectacle of one more vote on a bill to repeal Obamacare that is doomed.
Republicans, who hold 52 seats in the chamber, are scheduled to meet for a closed-door lunch Tuesday where they are expected to discuss the next steps. They could also make another run at repeal later in the year when they try to enact a GOP tax overhaul, but that could prove even more challenging.
The bill’s backers weren’t quite ready to admit defeat. “It’s OK to vote, it’s OK to fall short,” Lindsey Graham of South Carolina said during a CNN health-care debate Monday night. “We’re going to press on.”
But health insurers now face the prospect of deciding what insurance plans to offer in the individual Obamacare markets for 2018, and how much to charge, with little certainty over how the Trump administration will run the law. The deadline for insurers in many states to sign agreements to offer coverage in the marketplace is later this week. The companies and their industry groups have warned that the uncertainty will lead to much higher premiums.
In Senate Health Committee Chairman Lamar Alexander’s home state of Tennessee, for instance, BlueCross BlueShield of Tennessee is raising Obamacare premiums by 21 percent on average. The insurer has said that if Washington committed to supporting the law, it wouldn’t have needed to increase premiums much at all.
In the short term, the top priority for insurers is for Congress to signal that the subsidies known as cost-sharing reductions will continue. In the longer term, the companies have said that a government backstop for high-cost customers, known as reinsurance, would also help stabilize the market.
Alexander had been negotiating a bipartisan deal with the top Democrat on his panel, Patty Murray of Washington, to stabilize the Obamacare markets, but said last week that the negotiations had failed. Those talks could be revived again, although such a measure still faces significant obstacles in the House.
The companies have also pushed for a repeal of a tax on health insurers that was enacted as part of Obamacare. And they want Obamacare’s requirement that all people have insurance coverage or pay a fine to be enforced, at least until Congress comes up with a replacement.
The sudden attention earlier this month to the plan authored by Graham and Bill Cassidy of Louisiana gave some Republicans hope that they could reverse the party’s embarrassing defeat in July, when an Obamacare replacement failed on a 49-51 Senate vote.
The party’s desire to deliver on seven years of promises to repeal the health-care law had many Republicans ready to back a measure they didn’t understand and was still changing. Neither the lack of a detailed analysis from the Congressional Budget Office about its effects or the surprisingly unified opposition of groups representing the nation’s doctors, hospitals or insurers appear to deter most of them.
But the three senators who effectively killed the bill made clear they were nowhere near ready to back it.
Collins, a moderate Republican from Maine who struck the fatal blow Monday evening, issued a blistering statement outlining “three major problems,” including provisions that would weaken protections for people with pre-existing conditions and reducing the number of people who have health coverage.
“It makes sweeping cuts and changes in the Medicaid program which is a vital program for our low-income, vulnerable citizens including disabled children and low-income seniors,” she told reporters.
Paul, a conservative from Kentucky, rejected it for almost the opposite reason.
“It’s fake repeal” that keeps 90 percent of the taxes, he told reporters Monday. “This is not the promise we made.”
He said he was willing to compromise, but that such a deal would mean stripping out the plan to use block grants to help states fund health coverage — a central element of the Graham-Cassidy bill.
The third hard “no” came from McCain, the Arizona Republican recently diagnosed with brain cancer. He said Friday that the rushed, partisan process made it impossible for him in “good conscience” to back the measure.
“I would consider supporting legislation similar to that offered by my friends Senators Graham and Cassidy were it the product of extensive hearings, debate and amendment,” he said in a statement. “But that has not been the case.”
Acrimony over the new Senate GOP proposal was apparent in the hours preceding Collins’s announcement.
A Senate Finance Committee hearing on the measure, planned before McCain’s announced opposition to help lure him, had to be temporarily recessed Monday when protesters shouted down Graham and Cassidy when they tried to testify.
Protesters snaked down the corridor outside the room, many in wheelchairs and shouting, “No cuts to Medicaid! Save our liberty!”
U.S. Capitol Police said late Monday night that more than 180 protesters were arrested.