The Uncertain Future Of The Affordable Care Act
The Obamacare repeal effort is far from dead
Like Caesar in the arena, Senator John McCain dramatically flashed a thumbs down early Friday, killing the Republican Party’s best chance to repeal Obamacare in seven years. If 2017 was a TV show, no one would buy this plot.
Media coverage has rightly given credit to Senators Collins and Murkowski for sticking by their “no” votes in the face of immense pressure. On the other side of the aisle, Democratic Senators stood unified and “blue dot” Democratic activists and organizations applied enormous pressure on their Republican Senators. At that dramatic and crucial moment, however, it was Senator McCain who voted “no.” A “no” that some regions of the internet suggest was calculated to put a stake through the heart of Obamacare repeal for the remainder of this year, and perhaps all of President Trump’s first term.
Much of speculation surrounding Sen John McCain’s purported legislative brilliance revolves around the claim that the AHCA (the Healthcare repeal act passed by the House back in May), once voted on, cannot be considered again this legislative year. If this were the case, by voting yes on the Motion to Proceed and then voting no on the “skinny” repeal bill, Senator McCain neatly torpedoed Mitch McConnell. Because Republicans can only pass major legislation in the Senate through budget reconciliation, the procedure prevents them from doing so more than once each budget and therefore ACA repeal cannot be passed this year. Let us examine this claim.
Is ACA Repeal Dead?
Simple Answer: No
Complex Answer: Reconciliation is a procedure that uses a fiscal year’s budget (in this case FY2018) as a vehicle to lower the threshold to 51 votes needed pass budget related laws. Vice-President Pence would cast the 51st vote to break the tie. It is true that reconciliation can only be used once per budget. So at first glance, it appears that McCain might be a genius.
Let’s return to the scene on CSPAN Friday morning. Senator McCain votes no on “skinny” repeal and the crowd outside the Capitol goes wild. Senator McConnell gives a pained concession speech and Senator Schumer pleas for a bipartisan solution to fix problems with the ACA. McConnell then retakes the podium and talks about calendars and motions and blah blah (90% of legislating is parliamentary procedure in my experience). It was during these procedure remarks that Senator McConnell asks to return the bill to the calendar and where things get more complicated.
Vote #1 (7/25/17): The Motion to Proceed to debate of the AHCA bill passed by the House in May. The vote is 51–50, with McCain casting deciding voice. 20 hours of discussion and amendments began. In reality, these amendments are substitutions allowing McConnell to gut the AHCA and replace it with an entirely new bill. Voting then began on three proposed swaps for the AHCA. After a replacement amendment/bill was agreed upon, then the ‘AHCA’ that had been magically transformed into something else would be voted on.
Vote #2 (7/25/17): BHCA (amendment), this was the bill crafted in the Senate by 13 men behind closed doors. It did not come close to passing.
Vote #3 (7/26/17): ‘Clean Repeal’, this was the vote hard-line Conservatives wanted to take to show their constituents they had tried to repeal the ACA. It did not come close to passing.
Vote #4 (7/27/17): ‘Skinny Repeal’, this was to be the one, the amendment McConnell thought he could get his Senate colleagues to support. It dramatically dies Friday 49–51.
Never in this course of events was the AHCA actually voted on. After vote #4, McConnell returns the AHCA to the legislative calendar, a parking lot for bills where they wait for Senate leadership to feel confident they can be passed. ACA repeal can still be brought up again this year. Senator Lindsey Graham is already pushing for his version of a healthcare repeal bill to be considered.
Is McCain A Hero?
Senator McCain has been considered a hero by many in this country for his life of service. Despite the AHCA living in limbo, McCain made legislative repeal of the ACA very difficult to achieve this year. The FY2018 budget being used as a vehicle must be passed before October or the government shuts down and there is very little time to make another push before that deadline. If the Republicans want to disrupt essential services and military funding to make another stab at repeal, they invite the wrath of the American people. The Republicans could use next year’s (FY2019) budget in March or May to start again on ACA repeal, but this is unlikely. Provoking the sort of public backlash we have seen over healthcare during an election year would be…unwise. Is McCain a brilliant hero? That’s for you to decide.
Horrah! Our Healthcare Is Saved!
No. If the Republican party cannot repeal the ACA it appears they will break it so badly that voters finally ask for it to be repealed. President Trump has threatened multiple time to cease paying cost sharing subsidies. These are essential for the stability of individual markets. Certainty and stability are the two factors that are required to keep prices in the individual markets reasonable. Stability, a requirement of successful governance, is not a strength of the Trump administration and may not even be achievable given what we have seen from this White House over the last six months.
The fight over the fate over the ACA is shifting from Congress into a murky and litigious battlefield in which the Trump administration hopes will play to the strengths of their President. A well deserved moment of victory, however, is to be cherished with the demise of the AHCA. A respite has been bought that many hope will last until next year’s midterm elections. If a new Congress is elected that is more focused on the needs of those unable to protect themselves from the school yard bully in Washington, healthcare has a hope of stabilizing.
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