The Republican effort to repeal and replace Obamacare may have struggled in the House of Representatives, but in the Senate, it’s traveled a truly tortured path — one that reaches a critical juncture today with a vote to advance health care legislation.
For the past several weeks, the GOP’s bill, called the Better Care Reconciliation Act, has seen its fortunes rise and fall almost daily; the content of the legislation has been changed so often that even lawmakers have a hard time saying exactly what’s in it at any given moment.
Today’s vote to begin debate on a health care measure could easily fail; even if that motion does succeed, the Senate could easily vote down the legislation once debate is over. Congressional Democrats are making the case that the Senate GOP’s struggles clearly indicate their effort is doomed, and that both parties should come together to improve the Affordable Care Act.
Republicans aren’t united on what the path forward should be. Some are in favor of continuing to work on repeal and replace within their own party until they get it right, while others are more inclined to work with Democrats through the committee process to come up with fixes to the health care system that both sides can agree on.
The prevailing sentiment in both parties, though, is that it’s time for the other side to accept political reality — either Obamacare is broken or the GOP effort to kill it is — but few are willing to be the first to blink.
A tough path in the Senate
In May, Republicans in the House of Representatives were able to pass their bill, the American Health Care Act, by a four-vote margin, narrowly overcoming the 20 GOP lawmakers who voted no. Since being passed the repeal-and-replace baton, Republican leadership in the Senate has struggled to find a way forward.
With a narrow, 52-seat majority and no Democratic support for their mission of repealing Obamacare, the Senate GOP’s success has hinged on how many of its own members can get behind one piece of legislation.
The slim margin of error, combined with a wide ideological gulf between the moderate and conservative wings of his conference, has made this job very difficult for Majority Leader Mitch McConnell. For months, he and his leadership team have struggled to come up with health care legislation that satisfies enough Republicans while ensuring that no more than two Republican senators oppose it — the threshold that would kill any bill.
The original version of the Senate’s legislation, introduced in June, was immediately unpopular among the GOP’s most moderate and conservative members. Maine Sen. Susan Collins and others voiced concern that the Senate plan’s cuts to Medicaid were too severe, for example, while Kentucky Sen. Rand Paul and other conservatives slammed the bill as ‘Obamacare Lite,’ arguing it didn’t go far enough to undo the taxes and regulations the ACA established.
Outside of leadership, few rank-and-file GOP senators were eager to publicly defend the bill. Because of the lack of support, anticipated votes to advance BCRA were scuttled several times.
McConnell attempted to make concessions to moderates and conservatives to try to get them on board: a version of the bill, updated in mid-July, included increased funding to counter the opioid crisis, along with language that would allow insurers to offer consumers plans that would be cheaper, but would not include the set of health benefits that the ACA required all plans to have.
But those add-ins didn’t move the needle; shortly after the new version was released last week, a total of four Republican senators were publicly opposed to the bill, effectively killing it.
McConnell then proposed a measure that would fully repeal Obamacare, with a two-year delay for Republicans to devise a replacement. That proposal also failed to get traction, with three senators announcing their opposition shortly after McConnell floated it.
Democrats: The jig is up
Though they broadly agree that Obamacare has its issues, not a single Democrat in Congress has stepped forward to support the GOP’s plans to repeal and replace the law. Their unified opposition has put the pressure squarely on Republicans, and spotlighted tensions within the party over policy and politics.
As they watch the Senate GOP struggle to agree on a health care plan, Democrats are saying the time has come for Republicans to give up their quest, and join them in fixing issues with Obamacare.
That will be easier said than done: Though there are some areas where there’s bipartisan agreement on health care, such as tackling the high price of prescription drugs, the issue of fixing many states’ broken insurance marketplaces is far more divisive.
Currently, premiums are increasing and insurers are fleeing Obamacare’s state insurance exchanges because it has grown too costly for them to insure patients under the law’s rules, and without the support insurers thought they would get from the federal government.
Democrats are saying that this problem, sometimes called the “death spiral,” is what needs to be addressed most urgently, and most agree that insurers need to be offered financial incentives to remain in state markets to cover patients.
Sen. Amy Klobuchar told MinnPost that there’s “nowhere else to go” for the Senate GOP.
“I don’t see a path forward except one, and that path forward is [Republicans] working with us on a bipartisan solution, which is changes to the ACA,” she said. “That includes strengthening the exchanges with some proposal, a la what Minnesota did on reinsurance, but doing it nationally.”
Klobuchar pointed to McConnell’s public consideration of shoring up the ACA’s state insurance exchanges if the GOP’s efforts fail. (In the past, however, McConnell has held out the prospect of working with Democrats as something of a threat to members of his own conference.)
“The most damaging thing right now is that we’re not making the changes we need to make,” Klobuchar said. “There are always problems with major pieces of legislation, so that’s what really bothers me, is they’re stopping us from making even common-sense changes that Republican governors and Republican legislatures have supported within the states.”
In June, Sen. Al Franken told MinnPost that, if the GOP effort goes down in flames, he would expect Republicans to come to the table and work with Democrats to shore up the state exchanges.
In the House, Minnesota Democrats were not exactly optimistic that they will soon be working alongside their Republican counterparts on a bipartisan health care fix, but they did say that the Senate’s failure to pass a bill could move them closer to that goal.
First District Rep. Tim Walz said, “This had to happen to them to now come back, and I think we should willingly lock arms to try to find a solution.”
“I don’t think now is the time to say, they’re floundering, that’s wonderful,” he told MinnPost. “It’s not wonderful. People’s premiums are going up; we need to address that.”
Seventh District Rep. Collin Peterson, one of the three remaining House Democrats to have voted against the ACA in 2010, said Democrats are ready to work with Republicans, and the ball is in the GOP’s court.
“This is not going to get fixed, in my opinion, until you get both parties at the table so both parties are culpable,” Peterson said. “Because whatever we do, it’ll be screwed up to some extent, and it’s going to have to be fixed. It’s not going to be enough just to have 10 Blue Dog Democrats, you need to have both parties at the table.”
To 5th District Rep. Keith Ellison, both parties being at the table isn’t a good result on its own — he’s more interested in what those bipartisan talks would produce.
“Bipartisanship is fine, but it doesn’t have merit for its own sake,” Ellison said. “It has merit if it benefits the people.”
He said regardless of how the Senate proceeds, Democrats “should continue to build a national coalition to make sure health care gets to every single person. … I hope Republicans want to be a part of that.”
On Tuesday, reports indicated that McConnell is considering advancing legislation that would repeal Obamacare’s individual and employer mandates, along with the medical device tax, allowing the House and Senate to go to conference to craft a compromise bill.
If that narrow repeal is advanced today, the Senate would proceed to 20 hours of debate on the measure before voting on it — which would present an entirely new challenge.
Elements of the congressional GOP believe that they should press on with repealing and replacing Obamacare, no matter the outcome of today’s vote.
South Dakota Sen. John Thune, the No. 3 Republican in the Senate, said on Sunday that Obamacare will go — it’s simply a matter of when, not if.
Some in his conference do not agree. Maine Sen. Susan Collins, a moderate who has consistently and vocally opposed the GOP health care plans, said Republicans need to work with Democrats to stabilize the insurance markets. That process, she said, should start over at the committee level — a key step in the legislative process that McConnell, to this point, has bypassed.
There’s pressure from influential senators to jump-start that process. Tennessee Sen. Lamar Alexander, who chairs the Senate health panel, has called for hearings to explore solutions to the “death spiral” and to help the insurance exchanges function.
Still, the turn of events in the Senate is a huge disappointment to 2nd District Rep. Jason Lewis, the freshman Republican who has been the Minnesota delegation’s most vocal supporter of GOP plans to repeal and replace Obamacare. (Reps. Tom Emmer and Erik Paulsen declined to comment on the issue before the Senate votes.)
“It’s a shame,” Lewis told MinnPost last week. “We did our jobs. … To see it get squandered away over there, I’ll be blunt, I think it’s horribly disappointing and irresponsible.”
He argued that working with Democrats would only extend the failures of the ACA; the federal funding to offset insurers’ losses in the early years of the law, called the “risk corridors,” is tantamount to an insurer bailout, Lewis said.
“We’ve already done that, and it’s failed,” he added. “Now they want more money. That’s not the way to fix the system.”
Lewis wouldn’t say whether he agreed with President Donald Trump, who proclaimed that Republicans could easily allow Obamacare to fail, which Democrats which would then own, eventually forcing them to the negotiating table.
“I do think that we were sent here to actually make the health care market work, and to the degree we don’t get that done, we’ll get some blame for that,” he said.
Indeed, Republicans control both chambers of Congress and the White House; Obamacare is a law designed by Democrats. Rep. Walz said both parties have to shoulder the burden. “The repeal and wait, the irresponsible ‘let it fail,’ none of us can say that,” he said. “If any Democrat would say, ‘Well the Republicans own this, let it fail,’ I disagree with that, too.”
“We all own this.”