During the second day of debate over plans to replace the Affordable Care Act, the Senate voted down a motion to repeal President Barack Obama’s signature legislation in two years while lawmakers worked on a replacement plan.
The 45-55 vote, originally scheduled for 11:30 a.m., was delayed to 3:30 p.m. following approximately six hours of debate Wednesday on the Senate floor. A majority vote was needed to move forward with the plan.
The repeal-and-delay plan, sponsored by Sen. Rand Paul, R-Ky., was modeled after legislation that both the House and Senate approved in 2015 before it was vetoed by President Obama. It would have kept the ACA in place for two years, after which time it would have removed Medicaid expansion, the individual and employer mandates, marketplace subsidies and the marketplace exchanges, as well as taxes on the wealthy and the healthcare industry, but it kept pre-existing conditions protections. It also included an amendment (PDF) by Sen. Mike Enzi, R-Wyo., which would have banned people from using subsidies to buy insurance plans that cover abortions.
Other amendments up for consideration
The Senate has approximately 12 hours left to debate proposals over the next two days. Shortly after the repeal-and-delay motion failed, they took up a vote on an amendment sponsored by Democrats to send the bill back to committee so that both parties would be able to work together on a replacement plan. That motion failed on a 48-52 vote. The Washington Post reports that senators will likely next take up bills for a “skinny” repeal and the Graham-Cassidy amendment. Hundreds of other amendments could be presented to stall a vote, Business Insider reports.
The “skinny” repeal would roll back the ACA’s individual mandate, the employer mandate and a tax on medical devices. Although they are among the healthcare reform law’s least popular mandates, the American Academy of Actuaries warns that repeal would lead to increased premiums, increased federal government costs for premium subsidies and insurance losses and solvency issues.
The Graham-Cassidy amendment proposes to repeal the individual and employer mandates and medical devices taxes under the ACA and keep requirements for pre-existing conditions. It would also keep the ACA’s taxes on the wealthy but give those funds in the form of block grants to states to administer their own health insurance programs.
Democratic senators, including Senate Minority Leader Chuck Schumer, D-N.Y., warned during the debate Wednesday that the skinny or scaled-back version of repeal is the Republican senators’ attempt to pass some sort of legislation that would lead to a full repeal. “Make no mistake about it,” Schumer said, “the skinny repeal is equal to a full repeal. It’s a Trojan horse designed to get the House and Senate into conference where the hard-right flank of the Republican caucus, the Freedom Caucus, will demand full repeal or something very close to it.”
He likened the idea for a conference with the House to a game of “hot potato” where the Republican leader in the Senate would pass the potato to the House, and the House leader would hand it back to the senate leader. “Neither wants to be responsible for what is inevitable, the demise of TrumpCare,” Schumer said.
But at the beginning of the debate on Wednesday, Senate Majority Leader Mitch McConnell said he expects the Senate to consider many different proposals and ultimately agree on legislation that will effectively end the ACA. “This certainly won’t be easy,” he said; “hardly anything in this process has been. But we know that moving beyond the failures of Obamacare is the right thing to do.”