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Republicans Now Have 3 Options for Dealing With Health Care
Badly wounded and humiliated by the latest turn of events, President Trump and Senate Majority Leader Mitch McConnell (R-KY) are blaming Democrats and a few disloyal Republicans who helped block action on the Senate GOP’s star-crossed plan to repeal and replace the Affordable Care Act.
In the aftermath of the devastating announcement late Monday by two conservative Republicans, Sens. Mike Lee of Utah and Jerry Moran of Kansas, that they were joining with Sens. Rand Paul of Kentucky and Susan Collins of Maine in opposing the bill, Trump and McConnell apparently are choosing retribution over statesmanship.
Related: The GOP Senate Health Bill Just Died as Two More Senators Say No
Unable to muster at least 50 of the 52 Senate Republicans to support the legislation – the bare majority they would need under budget reconciliation to pass the bill without a single Democratic vote and Vice President Pence casting the tie-breaking vote –the president and majority leader are vowing to press for action in the coming days to outright repeal the ACA while giving Congress two years in which to concoct a replacement plan.
But already there are indications that this Hail Mary pass approach will fail as well, with moderate Republicans pushing back.
Congressional Republicans and the Trump administration have argued for months that Obamacare, with its soaring premiums and diminished insurance choices, is in a death spiral and that Congress must save Americans from the ill effects of the 2010 legislation. But for all the problems of a program that has provided coverage to more than 20 million people, including expansion of Medicaid, the Congressional Budget Office (CBO) and other individual analysts say that the Obamacare markets have remained relatively stable, while polls show that voters much prefer to hang onto Obamacare than take their chances with the Republican approach.
McConnell, whose reputation as a shrewd deal maker has taken a beating in recent days, insisted Monday night and again today in a floor speech that the Republican-controlled Senate and House already approved a “repeal and delay” bill in early 2015 that President Obama vetoed, and that the two chambers could replicate that vote in the coming days.
Related: Why Trump Can’t Sell Health Care Reform – and the Price He’ll Pay for It
“Our Democratic friends have spoken a lot recently about wanting bipartisan solutions,” McConnell said. “This legislation will provide the opportunity for senators of all parties to engage with a fresh start and a new beginning for the American people.”
The president told reporters at the White House today that he wants to “let Obamacare fail” and then have the Democrats and GOP leader to “fix it.” He blamed the Democrats for putting the Republicans in an impossible position to pass comprehensive legislation and insisted that voters would ultimately hold the Democrats responsible. “I’m not going to own it,” he declared.
But in passing the repeal and delay legislation two years ago, the Republicans weren’t shooting with live ammunition: The bill was largely campaign messaging by the GOP, and everyone knew that Obama would prevent it from taking effect. Republicans blithely ignored the warning of the Congressional Budget Office (CBO) that the bill, if enacted, would result in havoc in the individual insurance market, skyrocketing premiums and out of pocket costs, and the loss of coverage for 32 million Americans by 2026.
Related: There’s a Nasty Surprise Hidden in the Fine Print of the GOP Health Care Bill
Trump’s and McConnell’s assertion that Democrats would have little choice but to join forces with the Republicans and negotiate a bipartisan compromise on replacement legislation if Obamacare were given a death sentence effective two years from now is fanciful at best. Senate Minority Leader Chuck Schumer (D-NY) says the Democrats are open for talks now on a wide range of measures to strengthen the existing law and bring down costs, but only if the Republicans abandon their insistence on repealing Obamacare.
“Make no mistake about it, passing repeal without a replacement would be a disaster,” Schumer said in a floor speech today. “Our health care system would implode, millions would lose coverage, coverage for millions more would be diminished, our health care system would be in such a deep hole that repair would be nearly impossible.”
While Republican prospects of making good on a seven-year promise to dismantle the Affordable Care Act appear next to zero at this point, the political situation remains fluid, with the outcome still very much in doubt. Here are three possible scenarios in the coming days and weeks:
Repeal and delay: Like just about everything else connected with the Senate health care deliberations, the decision to go for repeal without replacing Obamacare was made in haste by McConnell and Trump after Lee and Moran jointly announced their opposition to the Better Healthcare Reconciliation Act.
Related: GOP Health Plan Hits Another Wall and McConnell Once Again Postpones a Vote
McConnell, 75, has few peers as a legislative strategist, and he is inclined to make split second decisions, as he did in declaring that the Senate wouldn’t consider a replacement for the late Supreme Court justice Antonin Scalia until after the 2016 presidential election, in hopes that a Republican president would make the choice.
Rather than allowing for a day or two of contemplation and consultation on how to proceed, McConnell announced that he intended to hold a vote in the coming days to take up the House-passed version of the Republican health care plan. He would seek passage of an amendment that would strip out many of the new GOP policies but eliminate major portions of Obamacare, including Medicaid expansion, insurance subsidies and fines for individuals and employers who failed to adhere to the law’s mandates.
But McConnell is likely to have as much trouble pushing through this backup approach as winning majority support for the health care reform legislation he almost single-handedly drafted.
Collins, a leading moderate in the party, denounced the approach and promised to vote against it this week or next when it is brought up. “I think [passage] would create great anxiety for individuals who rely on the ACA, I believe it would cause insurance markets to go into turmoil, and I don’t think it is the right way to proceed,” Collins told reporters today.
Related: Last Chance for the Senate GOP Health Plan: Let the Arm Twisting Begin
What’s more, moderate Sens. Shelley Moore Capito of West Virginia and Lisa Murkowski of Alaska told reporters that they too would oppose a repeal and delay approach, bringing to three the number of Republicans opposed to McConnell’s tactics and enough to stop them in their tracks.
A bipartisan deal: Feelings about health care reform are running high on both sides of the aisle, and Republican disdain of Democrats for refusing to assist in rewriting the law is matched by Democrats’ contempt for McConnell in totally shutting them out of the backroom deliberations. For those who still believe that Obama and the Democrats passed the ACA without trying to make the bill a bipartisan effort, read this piece in The Atlantic, which shows how McConnell urged Senate to stonewall any cooperation with the Obama administration.
McConnell said recently that if the Republicans couldn’t agree among themselves on legislation to supplant the ACA, they would have no choice but to seek a limited bipartisan deal with the Democrats to buttress the nation’s insurance marketplaces. Schumer has repeatedly said that he was open to talks with the Republicans over the future of Obamacare, provided they abandoned their demand for outright repeal of the law and massive cuts in Medicaid for 70 million poor and disabled people,
“We’re ready to sit down right now” and negotiate “if Republicans abandon cuts to Medicaid, abandon huge tax breaks for the wealthy and agree to go through the regular order, through the committees, with hearings, onto the floor, with time for amendments,” Schumer said in a floor speech. “That’s how we perfect legislation here. That’s how it’s been done for nearly 200 years…. Almost inevitably when you try to draft something behind closed doors and not vet it with the public, it becomes a failure – in this case, a disaster.”
Related: The Lesson of the GOP Health Care Collapse: Make America Simpler Again
Should the two sides eventually get to the bargaining table, the Democrats are likely to press for a handful of other requirements, including the guarantee of a continuous flow of federal cost-sharing subsidies to enable insurers to lower premium costs for low-income consumers, a resumption of reinsurance or “rate corridor” measures that protect the insurance industry from unexpected massive losses, and some steps to rein in the cost of prescription drugs.
Robert Laszewski, a health care consultant, wrote to his clients today, “The fact is that there is no common ground that could garner more than a handful of Republicans willing to save Obamacare. Such an effort would almost certainly now take 60 votes and would require the cooperation of the Republican leadership in both houses willing to let some of their caucus give the Democrats an enormous victory.”
Status Quo and stumbling along: A third possibility is that dysfunction in Congress and a lack of leadership from President Trump could result in a prolonged state of the current status quo. That would present its own problems because the ACA needs serious repair in order to bring premiums and deductibles down to more manageable levels.
Related: Everything You Need to Know About Your Health Savings Account (HAS)
The cutoff of some subsidy payments to insurers and the Trump administration’s purposefully vague statements about whether it intends to keep paying others has created the sort of uncertainty that either pushes insurers out of markets they would otherwise serve or forces them to raise premiums to compensate for additional risk.
A continuation of the status quo could help Republicans sell their narrative of a failed Obamacare if it drives more insurers away, but it’s unclear that it would bring lawmakers closer to a viable alternative to the ACA.
Fixing Our Most Pressing Health Insurance Problems: A Bipartisan Path Forward
With Senate Republicans mired in seemingly intractable disagreements about how to proceed with health reform—which may very well not be resolved by the latest Senate draft bill, Majority Leader Mitch McConnell suggested on July 6 that a bipartisan short-term fix may be needed for the problems of the individual health insurance market. In fact, opinion polling reveals wide public support for bipartisan health reform. And bipartisanship in health policy is not a fantasy—both the 2015 Medicare Access and CHIP Reauthorization Act (MACRA) and the 2016 21st Century Cures Act passed with wide bipartisan majorities.
How could a bipartisan solution happen? First, it must focus on the individual market, where we face an immediate crisis. Long-term changes to the employer-sponsored coverage market and the Medicare and Medicaid programs, which together cover the vast majority of Americans, can be debated, but nothing needs to change right now. Moreover, sharp ideological divisions between Republicans and Democrats (and within both parties) as to the path forward with respect to public programs and the employer market make short-term consensus unlikely.
Second, we need solutions that can be implemented immediately through existing programs. We do not have time to extensively rewrite federal regulations or implement state-based systems for providing premium and cost-sharing assistance to address pressing problems facing us now.
And third, we may need to accept short-term increases in federal spending to get us through the immediate difficulties, as we have when our country has faced other crises. In the long term, we must cut health care spending growth generally. But in the short term, simply shifting the burdens to individuals who will lose insurance coverage or face much higher deductibles and premiums is not acceptable.
The immediate problem that needs to be addressed is that it appears that individual market coverage will not be available in 40 counties in Nevada, Ohio, and Indiana for 2018. An additional 1,300 counties, representing about one-quarter of marketplace enrollees, may have only one insurer next year. The number of “bare” or single-insurer counties changes from week to week, and these numbers may improve, but it is also possible that more counties will lose insurers by 2018. Moreover, some individual market insurers are requesting double-digit premium increases for 2018 for the second year in a row.
The cause of this crisis is no secret. Insurers and insurance regulators have repeatedly pointed to the regulatory uncertainty driving insurer withdrawals and premium increases. In particular, confusing signals from the administration as to whether it will reimburse insurers for the cost-sharing reductions they are required to offer low-income consumers under the Affordable Care Act (ACA) and enforce the individual mandate has left insurers very nervous about the individual market’s future. Decreased exchange enrollment and a fear of a less healthy risk pool also have insurers feeling insecure.
What can be done? First, Congress should immediately enact a mandatory appropriation to cover the cost-sharing reduction reimbursements through 2020. Not only the major insurer trade organizations, but also the National Association of Insurance Commissioners, the National Governors Association, and the United States Chamber of Commerce have identified this as an urgent necessity. Because the cost of this initiative is already included in the budget baseline, the appropriation would not even have budget consequences.
Second, Congress should ensure coverage for bare counties. The Federal Employees Health Benefits Program (FEHBP) offers private insurance coverage from multiple insurers in every county in the nation. For 2018 and 2019 only, the largest two FEHBP insurers in any county should be required as a condition of continued participation in the program to offer at least one silver-level plan though the federal exchange in all counties that would otherwise be without coverage. These plans should be eligible for premium tax credits and could otherwise charge actuarially appropriate premiums.
Third, Congress should appropriate the short-term premium stabilization funding included in the Senate’s Better Care Reconciliation Act (BCRA), providing $50 billion in reinsurance funds directly to insurers over the next four years. Reinsurance payments of $15 billion for 2018 and 2019 could significantly reduce individual market premiums for those years, as reinsurance did in the first three years of the ACA.
Fourth, Congress should reinstitute the ACA’s risk corridor program for 2018 and 2019 for any county with fewer than two insurers. The Republican’s 2003 Medicare Modernization Act included a risk corridor program to share risk with insurers that experienced unanticipated losses. It remains in place today. Congress essentially defunded the ACA’s risk corridor program in 2015, causing insurers to experience huge losses and driving some to insolvency. The program should be reinstated and funded for 2018 and 2019. Congress should also suspend the ACA’s health insurer tax for insurers that offer individual market coverage in bare and single-insurer counties.
Fifth, Congress should leave the individual mandate in place until it can devise a credible replacement. The House-passed American Health Care Act would impose a 30 percent premium surcharge on people who failed to maintain continuous coverage or allow states to permit insurers to charge higher premiums to such enrollees with preexisting conditions. The Congressional Budget Office (CBO) determined that these penalties would discourage healthy consumers from enrolling, and that allowing health status underwriting would destabilize the market. The CBO also concluded that the Senate’s solution of a six-month lockout period for consumers who lacked continuous coverage would be ineffective. The ACA’s individual mandate penalty is too small, was phased in too slowly, and has not been adequately enforced, but for the time being it is all we have to encourage healthy people to enroll in coverage. Until someone comes up with a better solution, it should be left in place.
Sixth, Congress should rework the premium tax credit formula for 2018 through 2020 to allow younger enrollees to claim more generous tax credits. The BCRA would do this, but would reduce tax credits for older people, discouraging healthy boomers from enrolling. In the short term at least, insurers need all the healthy enrollees they can get, regardless of age.
Finally, every consumer should be able to fully deduct the payments they make to purchase individual market premiums (i.e., not the costs covered by premium tax credits). Self-employed individuals are already allowed to do this. Senate Republicans are reportedly considering legislation that would allow individuals to pay premiums through tax-subsidized health savings accounts, but why require a consumer to go to the trouble of establishing an account and paying associated fees when they could simply pay premiums tax free?
As Senator McConnell has acknowledged, bipartisan action may be needed to address our most pressing problems in the health insurance market. Practical solutions are available. Congress should adopt them immediately and by consensus, and then debate the longer-term future of our health care system.
As Repeal Falters, Insurers Start to Press on Subsidies
A failed Republican effort to replace Obamacare raised new concerns on Tuesday for U.S. health insurers over whether the government will continue to fund billions of dollars in medical benefit subsidies.
The healthcare bill under consideration in the U.S. Senate would have settled the funding question, but was scrapped after Republican leaders were unable to rally enough party members to win approval.
Its demise will test the ability of Republicans and Democrats to stabilize an insurance market serving some 10 million Americans in time for 2018.
Republican President Donald Trump has suggested several times that he could eliminate the so-called cost-sharing reduction subsidies, which help pay for consumers’ out-of-pocket healthcare expenses.
The administration could do so as early as August. Insurers have braced for an end to these payments, in many cases raising proposed premium prices for 2018 more than 20 percent to make up for the lost funding.
Insurers said on Tuesday they would like Congress to appropriate the funds for these payments. If that does not happen, and the Trump administration takes further measures to undermine Democratic former President Barack Obama’s healthcare law, more insurers may pull out of markets for next year ahead of a late September deadline.
That could force consumers to change plans or insurers – or leave them with no options at all.
“Our members and all Americans need the certainty and security of knowing coverage will be available and affordable for them,” said Justine Handelman, senior vice president in the Office of Policy and Representation at the Blue Cross Blue Shield Association, which represents insurers nationwide.
“We have consistently urged that there be immediate, certain funding for the cost-sharing reduction program, which helps those most in need with out-of-pocket costs when they access medical care.”
Molina Healthcare Inc (MOH.N), which provides Obamacare health plans to more than 1 million people, said the fate of cost-sharing subsidies is one of its top concerns. The Trump administration could take other steps on its own to undermine Obamacare, including refusing to enforce the individual mandate, which requires Americans to have health insurance or pay a fine.
Trump has repeatedly said Obamacare, formally known as the Affordable Care Act, is collapsing, and on Tuesday suggested letting it “fail” to force Democrats to work on a healthcare fix. Earlier this year, the administration backed off more strictly enforcing the individual mandate and pulled ads that encouraged people to sign up for health insurance.
Uncertainty over the government’s next steps on Obamacare weighed on insurer shares on Tuesday, with Anthem Inc (ANTM.N) down 1.4 percent and Aetna Inc (AET.N) off 1.1 percent. UnitedHealth Group (UNH.N), which pulled out of the Obamacare individual insurance business, rose 0.3 percent after reporting a better-than-expected quarterly profit.
Senate Majority Leader Mitch McConnell said the Senate would vote in the coming days on a full repeal of Obamacare with no replacement, but he did not appear to have the necessary support to push it through.
Some Republicans and Democrats say they should attempt a joint fix, but the deep divisions between the two parties were on display over the subsidies on Tuesday.
Democratic Senator Patty Murray said that bipartisan work can begin by having Congress fund the cost-sharing subsidies.
“We know that’s what needs to be done,” she said in an interview. “It would send a very strong message to the market.”
Several Republican senators were quick to deride the payments.
“Those who will be interested in moving an insurance bailout later this year should be ready to explain how they want to pay for it,” said Republican Senator Orrin Hatch, chairman of the Senate Finance Committee.
Collision With Health Care Reality
The Trump administration and Republicans in Congress find themselves in a position there never wanted to be in: heading into the August recess having failed to repeal and replace the Affordable Care Act (ACA), and also without any significant legislative accomplishments since the November 2016 election.
Before charting a new course, the GOP needs to understand how they drove themselves into this political ditch.
The Initial Embrace of the Doomed “Repeal and Delay” Strategy.
In the weeks after the November 2016 election, elated Republicans planned a quick strike “repeal and delay” bill for the ACA. The idea was to follow the script the party used in 2015 to put a repeal-only bill on President Obama’s desk. With “repeal and delay,” the party could avoid the difficult internal discussions on how to reform health care and just focus on gutting the ACA, with delayed effective dates to allow time for the Congress to come up with a replacement plan later. This strategy was never going to work, but many conservatives argued that it should because of the successful test run of 2015 (a bill was sent to President Obama, who vetoed it). Conservatives made the case for months that a House or Senate member who voted for this approach in 2015 should do so again in 2017. But that is a disingenuous argument. It was obvious in 2015 that the repeal and delay bill was never going to become law, and so it was a way for the GOP to voice dissatisfaction with the ACA without having to replace its key provisions. It was clear then to anyone who paid attention that any repeal bill would have to include replacement provisions to have any chance of success because a repeal-only bill would instantly create a massive disruption in the marketplace for many millions of consumers. Still, some in the GOP who should know better convinced themselves that a repeal-only bill could work. The party wasted the first few precious months after the election on this doomed scheme.
Lack of a Clear Policy Direction from the Trump Administration Hampered the Effort.
President Trump ran successfully in 2016 without ever specifying a clear agenda, including on health care. That lack of clear direction probably helped Trump avoid needless controversy as a candidate but it has hurt the ability of the GOP to unite around a positive agenda. If Trump had been clearer about what he would do instead of the ACA, and won the election with that agenda clearly presented to the voters, it would have helped push the GOP toward a consensus. As matters stand, however, the administration has no clear positions on any of the major issues in question. Moreover, the president has made it clear in his remarks that he cares much more about something passing than what is in it. It is very difficult to pass legislation as complex and controversial as health reform without a strong push from the executive branch on key details of the overall framework.
An Entirely Partisan Approach on Health Care Was a Bad Idea.
There’s a reason that major social legislation usually passes with votes from both parties. It’s because laws that are entirely partisan engender political resentment, which leads to instability. The Obama administration pushed the ACA through Congress in 2010 with no Republicans voting in support of the final bill. Over the four ensuing election cycles, Democratic officeholders paid a heavy political price for the legislation. Moreover, the ACA is more unstable programmatically because of opposition to it from Republicans. Before the effort collapsed this week, the GOP was trying to replicate the Democrats’ strategy by relying on just Republican votes to pass legislation replacing key features of the ACA with new provisions. Even if they could pass legislation this way, they shouldn’t have tried because whatever they did would probably be reversed too when the Democrats were next in power. Of course, it is now clear that the difficulty of passing such controversial legislation is too heavy of a lift for a Republican majority with just two votes to spare in the Senate.
CBO’s Emphatic Support of the Individual Mandate Presents Challenges.
The GOP effort to move away from key ACA provisions was dealt a series of blows when the Congressional Budget Office (CBO) released its estimates of the various versions of the legislation. With each estimate, CBO made it clear that the GOP’s desire to eliminate the tax penalties associated with the individual mandate would dramatically increase the number of Americans going without health insurance. For the House-passed bill, CBO estimated there would be an additional 23 million people without health insurance in 2026 compared to current law. For the draft Senate legislation released in June, CBO estimated the increase would be 22 million. These estimates made a deep impression on public opinion and created significant political problems for House and Senate members. Republican opponents of the mandate have never come up with a credible alternative that would ensure the marketplace would function smoothly while still providing protections to people with pre-existing conditions.
At this point, the GOP does not have much choice but to step away from the effort to roll back the ACA and reconsider its options. Republicans have squandered the most important months of a new presidency, and they have also given up significant leverage in the process. Still, there is time to proceed with a different and more promising approach if there is a desire to do so.
To get a better result with a renewed push, the GOP should include willing Democratic senators in the conversation. The party should understand that the goal should be a plan that costs less, reduces regulations, and injects serious market discipline into the system, even while ensuring all Americans have ready access to insurance. That may mean finding a compromise approach on giving individuals strong incentives to enroll in health insurance. The party should also work with GOP governors to find a reasonable and affordable compromise on Medicaid, one that provides for significant reform of the program, with more state control and clear federal budgetary restraints, while also providing a safety net to all Americans with incomes below the poverty line.
It would have been easier, and more fruitful, to pursue a bipartisan deal on this kind in the weeks after the election. That was when Republicans had the most power. But they have still have some leverage. They should use when the time is right to begin the process of moving the health policy in a direction more their liking. That will inevitably be less satisfying to some than writing a bill entirely on their own because of the compromises that will be necessary, but this kind of legislation would be far more likely to pass, and also survive when political control inevitably changes again.
5 reasons why ACA repeal and replace efforts have failed in Senate
5 reasons why GOP’s ACA repeal and replace efforts have failed in Senate
Seven years of Republican vows to “repeal and replace” the Affordable Care Act came to a crashing halt Tuesday, when it became clear that the Senate could not muster the necessary votes for any of three separate proposals that have been under consideration.
The failure, at least for now, breaks one of the key promises Republicans have made to their voters since 2010, when the ACA first became law.
“This has been a very challenging experience for all of us,” Senate Majority Leader Mitch McConnell (R-Kentucky) told reporters Tuesday afternoon. “It’s pretty clear that there are not 50 Republicans at the moment to vote for a replacement for Obamacare.”
Monday night’s declaration of opposition by conservative Sens. Mike Lee (R-Utah) and Jerry Moran (R-Kansas) effectively scotched even the chance to start debate on the version of a bill unveiled last week.
McConnell added that the Senate would vote early next week on a plan, originally approved in 2015 and vetoed by President Barack Obama, that would repeal parts of the health law. That approach would delay the effective date for two years to give lawmakers time to come up with a replacement.
However, the opposition of moderate Sens. Susan Collins (R-Maine), Shelley Moore Capito (R-West Virginia) and Lisa Murkowski (R-Alaska), ensures that vote will fail, too.
“To just say ‘repeal and trust us, we’re going to fix it in a couple of years,’ that’s not going to provide comfort to the anxiety a lot of Alaskan families are feeling right now,” Murkowski told reporters.
In retrospect, Republicans’ inability to overhaul the health law should not come as much of a surprise. Here are some of the reasons:
1. It’s hard to take things away from people
Once launched, federal programs that provide people with benefits they find important and valuable are very difficult to rescind. In the case of healthcare, people’s lives can be at stake. In the current debate, patients who feared what would happen to their health coverage made their concerns known — loudly — to lawmakers.
2. Republicans have long been divided on healthcare
Republicans’ dirty little secret the past seven years is that the only thing they fundamentally agreed on when it comes to healthcare was the slogan “repeal and replace.” There’s a reason they failed to have a plan ready when Donald Trump was elected president — all efforts to reach a consensus had thus far failed.
“I did not come to Washington to hurt people,” said Capito in a statement. “I have serious concerns about how we continue to provide affordable care to those who have benefited from West Virginia’s decision to expand Medicaid.”
But the more conservative members, notably Sen. Rand Paul (R-Kentucky), have other priorities. “All of us promised we would repeal Obamacare,” Paul told reporters Tuesday. “If you’re not willing to vote the way you voted in 2015 then you need to go back home and you need to explain to Republicans why you’re no longer for repealing Obamacare.”
3. Presidential leadership on hard issues is important
President Trump has been all over the place in what he said he wanted from a health bill. It was his original insistence that “repeal and replace” happen simultaneously that moved Congress away from its 2015 strategy of repealing first and replacing later. He hosted a celebration in the White House Rose Garden when the House passed its bill, then subsequently called the measure “mean” during a strategy meeting with Senators.
When it became clear Monday night that the Senate effort was foundering, Trump tweeted: “Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate.” But within hours he instead suggested, “As I have always said, let ObamaCare fail and then come together and do a great healthcare plan.”
The president “gave them an impossible assignment with his promises (more, better, cheaper for all) and neither policy nor bully pulpit help at crunch time,” said Len Nichols, a professor of health policy at George Mason University. “And now he’ll blame them for failing.”
Added Thomas Miller, of the conservative American Enterprise Institute: “We now have a randomized clinical trial that proves one cannot lead and govern via Twitter.”
4. Healthcare is complicated. Really.
Healthcare has not traditionally been a major voting issue for Republicans, and thus it has been a low priority — compared with issues like taxes and trade — for the officials they elect.
Adding to the complexity is that the Republicans’ bench is nowhere near as deep as the Democrats’ when it comes to health policy expertise. Democrats have toiled on these issues for years. Even before the Affordable Care Act, many had served in Congress for decades and learned from the mistakes that were made on efforts like the failed health bill under President Bill Clinton.
5. Some parts of the ACA really are popular, even among Republicans
The requirement for most people to have insurance or else pay a fine — the individual mandate — has consistently been unpopular among voters of all political stripes. But many other major provisions of the health law, such as guaranteeing coverage for people with pre-existing conditions, remain broadly popular.
In fact, in recent months, the Affordable Care Act has been growing in popularity. Most polls show it more than twice as popular as GOP efforts to overhaul it.
“Republicans have to admit that some of the things in the ACA, we actually liked,” said Murkowski.
That left a huge gap between Republicans who wanted to maintain the popular benefits and those who wanted to repeal the law entirely. A gap that, so far, Republicans have been unable to bridge.
Straight repeal plan is a no go with 3 “no” votes
https://www.axios.com/repeal-then-replace-plan-is-a-no-go-with-3-no-votes-2461490907.html
Three GOP senators — Shelley Moore Capito, Susan Collins, and now Lisa Murkowski — all will vote “no” on the new plan to repeal and then replace the Affordable Care Act.
Why it matters: This guarantees what was already widely expected: that Senate Republicans wouldn’t be any more successful with a straight repeal plan, without a replacement, than they were with the repeal-and-replace legislation that stalled yesterday. Republicans could only lose two votes.
What’s next: Senate Republicans are still likely to schedule the vote — even if it fails — because they have to prove to conservative groups (and President Trump) that they’ve tried everything.
Trump says he’ll ‘let ObamaCare fail’
President Trump on Tuesday said he was disappointed in the Senate’s failure to repeal and replace the Affordable Care Act and argued that Republicans should now let the law fail on its own.
In his first on-camera remarks about the stalemate in the Senate, Trump said it “will be a lot easier” to allow ObamaCare to falter on its own.
“I think we’re probably in that position where we’ll let ObamaCare fail,” he told reporters in the Roosevelt Room. “We’re not going to own it. I’m not going to own it. I can tell you the Republicans are not going to own it. We’ll let ObamaCare fail and then the Democrats are going to come to us.”
Venting his frustration with Congress, Trump talked of how he had heard lawmakers for seven years talk about the need to repeal and replace ObamaCare.
Given the chance to do so, “they don’t take advantage of it,” he said.
“I’m sitting in the Oval Office right next door, pen in hand, waiting to sign something,” Trump added.
Despite the defeat on healthcare reform, Trump cast his presidency as a string of victories, saying the United States was winning in the war of terrorism and that it would secure an overhaul of the tax code.
Congress has not moved forward with Trump’s tax reform agenda so far, largely because of the time spent working on healthcare reform.
Trump promised to win repeal of ObamaCare upon his election, and the defeat is a significant loss for the White House.
Legislation to repeal and replace ObamaCare was approved by the House in May and was celebrated in a Rose Garden ceremony by Trump.
But it has come to a complete standstill in the Senate, where GOP leaders do not even have the votes to bring legislation repealing ObamaCare to the floor.
While Trump took a shot at Congress, he said he does not blame Senate Majority Leader Mitch McConnell (R-Ky.) for the defection of two Republican senators that effectively killed the measure.
Trump said he was “very surprised” that conservative Sens. Jerry Moran(Kan.) and Mike Lee (Utah) came out against the bill, evidence of the disconnect between the White House and Capitol Hill that has helped stymie the president’s agenda.
The White House and its allies have periodically lashed out at GOP opponents of the healthcare measure, reportedly threatening to back a primary challenge of Arizona Sen. Jeff Flake and to run attack ads against Nevada Sen. Dean Heller, both of whom are up for reelection next year.
But Trump said Tuesday the key to advancing his priorities was expanding the GOP’s 52-seat majority in the Senate.
“We’re going to have to go out and get more Republicans elected in ’18,” he said. “I’ll be working very hard for that to happen. It would be nice to get Democrat support but really they are obstructionists. They have no ideas.”
Some Republicans, however, believe the president is at fault. They say he failed to master the details of the healthcare initiative, did little to sell it and sent mixed messages about his desired outcome.
That was on display in the past 24 hours. Trump on Monday night called on the Senate to repeal ObamaCare and then pass a replacement later.
“Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!”
But on Tuesday morning, he tweeted out a completely different proposal — letting former President Obama’s law fail on its own.
“As I have always said, let ObamaCare fail and then come together and do a great healthcare plan. Stay tuned!” he wrote.
GOP’s repeal-and-delay plan flops after 3 senators oppose it
Three moderate Republican senators now oppose a plan to repeal the Affordable Care Act and replace it later, leaving Senate Majority Leader Mitch McConnell lacking the votes he’d need to move the measure forward.
With the Better Care Reconciliation Act scuttled following news late Monday that two more senators would oppose it, McConnell said Tuesday that the Senate would vote on an ACA repeal measure “combined with a stable, two-year transition period” during which it will craft a replacement.
But the measure’s chances quickly died after Alaska Sen. Lisa Murkowski became the third GOP senator to announce her opposition to the bill.
“I cannot vote to proceed to repeal the ACA without reform that allows people the choice they want, the affordability they need and the quality of care they deserve,” she said in a statement posted on Twitter. Instead, she called for the Senate to undertake a bipartisan effort to fix the ACA exchanges.
Sen. Shelley Moore Capito of West Virginia was the first to announce her opposition to a repeal-and-delay plan. “As I have said before, I did not come to Washington to hurt people,” she said in a statement.
Maine Sen. Susan Collins—who was one of the four “no” votes that led to the demise of the BCRA—also quickly came out against McConnell’s new strategy.
“I will vote no on the motion to proceed to repeal the Affordable Care Act without a replacement,” she said.
“We can’t just hope that we will pass a replacement within the next two years,” Collins added. “Repealing without a replacement would create great uncertainty for individuals who rely on the ACA and cause further turmoil in the insurance markets.”
As with the BCRA, McConnell could only afford to lose two votes on a repeal-and-delay bill tailored to pass the chamber through the fast-track budget reconciliation process, given that such a measure was not expected to attract any Democratic support.
The White House, meanwhile, said it is willing to back whichever strategy results in repealing the ACA—whether that’s a repeal-and-delay bill or a “return to the legislation carefully crafted in the House and Senate,” Vice President Mike Pence said at a National Retail Federation event Tuesday.
“Inaction is not an option,” he added. “Congress needs to step up, Congress needs to do their job and Congress need to do their job now.”
HENRY KOTULA 