WASHINGTON -- In a session that lasted into the wee hours of Friday morning, the Senate voted down a "skinny" bill to repeal the Affordable Care Act (ACA), dealing a big blow to the chamber's Republican leadership.
The vote was 49-51 to defeat the bill -- known as the -- which would have repealed the employer and individual mandates, but would have left other elements of the ACA in place. It also would have defunded Planned Parenthood and repealed the medical device tax. Along with all of the Senate's Democrats and its two Independents, three Republicans -- John McCain of Arizona, Lisa Murkowski of Alaska, and Susan Collins of Maine -- also voted against the bill.
"This is a disappointment, a disappointment indeed," Senate Majority Leader Mitch McConnell (R-Ky.) said after the vote. "I regret that our efforts were simply not enough this time."
"I imagine many colleagues on the other side are celebrating, but the American people are hurting and they need relief," he continued. "Now I think it's appropriate to say, 'What are [Democrats'] ideas?' It will be interesting to see what they suggest as the way forward." He immediately knocked down one idea: "Bailing out insurance companies with no thought of any kind of reform -- that's not something I want to be part of, and I suspect there are not many folks over here that are interested in that."
Senate Minority Leader Chuck Schumer (D-N.Y.) adopted a conciliatory tone. "I'd say to [McConnell] that we're not celebrating; we're relieved that the millions of people who would be so drastically hurt by the proposals put forward will be able to maintain their healthcare," he said. "But as I have said over and over again, Obamacare is hardly perfect. It did a lot of good things but it needs improvement."
"I would suggest we turn the page ... And I hope one part of turning the page is we go back to regular order and work [together] to improve Obamacare," he continued. "There are suggestions we're interested in that come from the other side of the aisle. So let's turn the page and work together to improve our healthcare system."
Democrats Oppose the Measure
Senate Minority Leader Chuck Schumer (D-N.Y.) urged Republicans to vote against the bill. "Listen to ; it said that skinny repeal would cause 16 million Americans to lose insurance and millions would pay 20% more for premiums starting next year -- not 3 years from now but in January," he said. "One of the promises Republicans made was to bring down premiums, but this would break that promise."
"You don't vote to advance terrible legislation and hope it gets better in conference," he added. "Let's not forget -- months ago the House voted to pass their bill because they hoped it would get better in the Senate. Well, it hasn't gotten better yet."
Sen. Sheldon Whitehouse (D-R.I.) pointed out that most medical organizations opposed the bill. "Who did the magicians who came up with this listen to? They obviously didn't listen to the doctors," he said. "The American Medical Association is opposed, the American Academy of Family Physicians is opposed to this bill ... the American Heart Association is opposed to this bill ... Rural hospitals are warning that this could end their very existence."
Single-Payer Shot Down
Before the skinny repeal bill was debated, the Senate voted on a single-payer bill introduced by Sen. Steve Daines (R-Mont.). "The amendment I'm putting forward here today is ... a carbon copy, down to every last comma and period, of Rep. [John] Conyers' [single-payer House] bill, which has 115 Democratic cosponsors as I speak."
"I believe Montanans and the American people deserve to debate different ideas," said Daines. "Earlier today Sen. [Bernie] Sanders suggested that my amendment was intended to embarrass Democrats. Sen. Sanders, my amendment shouldn't embarrass anyone; I'm trying to show the American people who is supportive of socialized medicine and who is not. Tell the American people what you think. I think we should vote No on this; what say you?"
Sanders decried Daines' move as a "political trick" to force some Democratic senators into an uncomfortable political position. "I hope this is really a breakthrough on the part of my Republican colleagues," he said. "I hope they recognize that the U.S. should join every other major country on earth in recognizing that healthcare is a right, not a privilege."
"I hope that's what Mr. Daines will be saying, but I kinda think that's not what he'll be saying," said Sanders. "If Mr. Daines is serious, let us work together, but now is not a time for political games."
Daines' bill failed 57-0, with Sanders, an independent, and 42 Democrats voting "present". Besides all 52 Republicans, those voting No included Sen. Angus King (I-Maine) and Democrats Joe Manchin of West Virginia, Jon Tester of Montana, Heidi Heitkamp of North Dakota, and Joe Donnelly of Indiana.
The Daines bill "was an explicit ruse, intended to waste some of the 20 hours of debate time and an attempt to taunt and then 'embarrass' Democrats into formally admitting that they are all socialists," said Jay Wolfson, DrPH, JD, associate vice president of USF Health, in Tampa, Fla., in an email to MedPage Today. "It was an old state legislative trick in which a member introduces a bill and then votes against it. Single-payer is not achievable in the current Congress in any event."
"Cadillac Tax" Repeal Passes
The Senate also voted down an amendment by Sen. Luther Strange (R-Ala.) to make the premium tax credits offered through the Affordable Care Act subject to the Hyde Amendment, which bars federal funds from being spent on abortion. The amendment, which required 60 votes to pass, went down by a vote of 50-50.
They did pass one amendment, which was to repeal the "Cadillac tax" on high-cost health insurance plans. The amendment passed by a vote of 52-48.
As the day wore on, some Republican senators expressed their misgivings about the skinny repeal bill. "We've been asked by the leadership ... to vote for the 'least common denominator,'" Sen. Lindsey Graham (R-S.C.) said at a news conference at which he appeared with Sen. Ron Johnson (R-Wisc.) and McCain. "The pitch is if we go to conference, we can get my [alternative] bill scored, we can get Sen. [Ted] Cruz's bill scored .... That makes eminent sense to me, with one condition -- that we actually go to conference."
On the other hand, Graham added, "The skinny bill as policy is a disaster; it's not a replacement in and of itself." He particularly objected to the bill's elimination of the employer mandate, which he said would increase premiums while keeping most of the ACA in place. "And we politically own the collapse of healthcare. So we're not going to do that with our vote. What we'll do is move the process along."
House Speaker Paul Ryan issued a statement Thursday that appeared to be intended to reassure anxious senators -- but with some caveats. "If moving forward requires a conference committee, that is something the House is willing to do," he said.
"The reality, however, is that repealing and replacing Obamacare still ultimately requires the Senate to produce 51 votes for an actual plan. The House remains committed to finding a solution and working with our Senate colleagues, but the burden remains on the Senate to demonstrate that it is capable of passing something that keeps our promise, as the House has already done. Until the Senate can do that, we will never be able to develop a conference report that becomes law."
The defeat of the Senate bill capped a difficult few days for Senate Republicans. On Tuesday, things were looking up when senators narrowly voted to proceed with a debate on a repeal bill, although it was not yet clear which bill that would be. But on Wednesday, the Senate voted down two bills -- first a bill to repeal the ACA without a replacement, and then a second bill -- the Better Care Reconciliation Act -- to repeal and replace the law.