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‘Plan C’ on Obamacare, Repeal Now and Replace Later, Has Collapsed Trump Vows Revenge After Push to Repeal Affordable Care Act Fails
(about 9 hours later)
WASHINGTON — With their bill to repeal and replace the Affordable Care Act in tatters, Senate leaders on Tuesday pushed to vote on a different measure that would repeal major parts of President Barack Obama’s health law without a replacement — but that plan appeared also to collapse. WASHINGTON — The seven-year Republican quest to undo the Affordable Care Act appeared to reach a dead end on Tuesday in the Senate, leaving President Trump vowing to let President Barack Obama’s signature domestic achievement collapse.
Senators Susan Collins of Maine, Shelley Moore Capito of West Virginia and Lisa Murkowski of Alaska, all Republicans, immediately declared they could not vote to repeal the Affordable Care Act without a replacement — enough to doom the effort before it could get any momentum. Mr. Trump declared that his plan was now to “let Obamacare fail,” and suggested that Democrats would then seek out Republicans to work together on a bill to bury the Affordable Care Act. If he is determined to make good on that pledge, he has plenty of levers to pull, from declining to reimburse insurance companies for reducing low-income customers’ out-of-pocket costs to failing to enforce the mandate that most Americans have health coverage.
“I did not come to Washington to hurt people,” Ms. Capito said in a statement. “I cannot vote to repeal Obamacare without a replacement plan that addresses my concerns and the needs of West Virginians.” “It’ll be a lot easier,” Mr. Trump said at the White House, adding: “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.”
Senator Rob Portman of Ohio hinted strongly that he too would oppose it. The fate of the repeal effort looked to be sealed on Tuesday, when a last-ditch attempt to force a vote to abolish the health law without a replacement fell short of support. The majority leader, Senator Mitch McConnell of Kentucky, seemed resolved to force senators to vote next week, but by Tuesday afternoon, it was clear he did not have 50 votes even to clear a procedural hurdle before considering a repeal-only measure.
The collapse of the Senate Republican health bill — and the failing struggle to find yet another alternative — highlighted a harsh reality for Senate Republicans: While Republican senators freely assailed the health law while Mr. Obama occupied the White House, they have so far not been able to come up with a workable plan to unwind it that would keep both moderate Republicans and conservatives on board. Senators Shelley Moore Capito of West Virginia, Susan Collins of Maine and Lisa Murkowski of Alaska, all Republicans, declared that they would not vote to repeal the Affordable Care Act without a replacement: enough to doom the effort before it could gain any momentum. Senator Rob Portman, Republican of Ohio, also rejected that path.
By midday Tuesday, the Republican Party’s seven-year-old promise to repeal the Affordable Care Act appeared broken. At the White House, President Trump said his plan was now “to let Obamacare fail,” suggesting Democrats would then seek out Republicans to work together on a health measure. The collapse highlighted a harsh reality for Senate Republicans: While they freely assailed the health law when Mr. Obama occupied the White House, they could not come up with a workable plan to unwind it that would keep both moderate Republicans and conservatives on board. It was an enormous embarrassment for a party that rode electoral waves to control first the House, then the Senate and then the White House, but has not been able to deliver a major legislative victory.
“It will be a lot easier,” Mr. Trump said, adding, “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.” “This has been a very, very challenging experience for all of us,” Mr. McConnell said. “Everybody’s given it their best shot, and as of today, we just simply do not have 50 senators who can agree on what ought to replace the existing law.”
Senator Mitch McConnell of Kentucky, the majority leader, gamely pressed forward on Tuesday even as the ground was giving way beneath him. The reaction on Wall Street was muted. Stocks spent most of the day lower as shares of health insurers declined, and the dollar, which has steadily lost ground for most of the year, slipped further.
“I regret that the effort to repeal and immediately replace the failures of Obamacare will not be successful,” Mr. McConnell said on the Senate floor on Tuesday morning. “That doesn’t mean we should give up. We will now try a different way to bring the American people relief from Obamacare. I think we owe them at least that much.” Mr. Trump has considerable leverage to gum up the works of the Affordable Care Act. He could throw insurance markets into a tailspin at any time by cutting off the subsidy payments to insurers, as he has threatened to do. He could further destabilize the markets by not enforcing the mandate that most Americans have health insurance.
On Capitol Hill, Republicans and Democrats alike were trying to make sense of the bill’s downfall — and what comes next. On Monday night, two Republican senators, Mike Lee of Utah and Jerry Moran of Kansas, came out in opposition to the bill, leaving Republican leaders at least two votes short of those needed to start debate on the measure. And he could cancel advertising and other efforts to encourage enrollment under the Affordable Care Act when the annual sign-up period begins in November. A barrage of negative statements from the administration could project an official view that the health law is collapsing, creating a self-fulfilling prophecy.
Two other Republican senators, Ms. Collins and Rand Paul of Kentucky, affirmed their opposition to the measure last week, leaving Mr. McConnell with no room for error as he tried to move toward a vote. The lack of certainty over the subsidy payments, which go toward reducing out-of-pocket costs for low-income people, has been a major concern for insurers. The companies say premiums will be significantly higher without the funding, and some companies that have submitted rates to sell insurance in the market next year could decide to pull out.
Speaking on the Senate floor on Tuesday morning, Mr. McConnell laid out plans for a vote on a measure like the one vetoed by Mr. Obama in January 2016, which, Mr. McConnell said, would include a “repeal of Obamacare combined with a stable, two-year transition period.” “With open enrollment for 2018 only three months away, our members and all Americans need the certainty and security of knowing coverage will be available and affordable for them,” said Justine Handelman, a senior executive at the Blue Cross Blue Shield Association.
Under that bill, the Congressional Budget Office said, 18 million more people would be uninsured within a year, and 32 million fewer people would have coverage in 2026, compared with current law. Premiums, it said, would increase at least 20 percent in the first year and would double by 2026. While Mr. Trump has promised destruction, other Republicans signaled that they wanted to take a more constructive approach. Senator Lamar Alexander of Tennessee, chairman of the Senate health committee, announced that he would hold hearings in the next few weeks on stabilizing the individual health insurance market.
That bill would have eliminated the Affordable Care Act’s expansion of Medicaid and subsidies for the purchase of private insurance. But it would have left in place rules established by the Affordable Care Act that require insurers to provide specific benefits and prohibit insurers from denying coverage or charging higher premiums because of a person’s pre-existing medical conditions. Members of both parties have ideas about how to stabilize insurance markets and hold down premiums. One possible action is to provide money for the payments to insurers for reducing customers’ out-of-pocket costs. In addition, two Democratic senators, Thomas R. Carper of Delaware and Tim Kaine of Virginia, want the federal government to help pay the largest claims through a backstop known as reinsurance. Senators of both parties also want to help people in counties where no insurer chooses to offer health plans through the Affordable Care Act marketplace — a real possibility in some places next year.
Those numbers apparently chased Ms. Murkowski away. The Senate Democratic leader, Chuck Schumer of New York, implored Republicans to defy Mr. Trump and work with Democrats to strengthen insurance markets.
“There’s enough chaos and uncertainty already, and this would just contribute to it,” she said. “There’s a fork in the road for our Republican colleagues,” he said in an interview. “They can do what Donald Trump said, which is sabotage the system out of anger and out of pique,” or they can work with Democrats on improvements to the health law.
They also spooked a bipartisan group of 11 governors, led by John R. Kasich of Ohio, a Republican, and John W. Hickenlooper of Colorado, a Democrat, and including Gov. Brian Sandoval of Nevada, a key opponent of the repeal effort. “Whether they can resist Trump, I don’t know,” Mr. Schumer said.
“The Senate should immediately reject efforts to repeal the current system and replace sometime later,” said the group, which consists of five Republicans, five Democrats and one independent. “This could leave millions of Americans without coverage. The best next step is for both parties to come together and do what we can all agree on: fix our unstable insurance markets.” On Capitol Hill, Republicans and Democrats alike were trying to make sense of the repeal effort’s apparent downfall — and figure out what comes next.
The statement was endorsed by the governors of Alaska, Louisiana, Maryland, Massachusetts, Montana, Nevada, Pennsylvania, Vermont and Virginia. The beginning of the end was on Monday night, when two Republican senators, Mike Lee of Utah and Jerry Moran of Kansas, came out in opposition to the latest version of Mr. McConnell’s bill to repeal and replace the health law. That left Republican leaders at least two votes short of what they needed to start debate.
Republican leaders in Congress originally intended to proceed with a similar “repeal and delay” strategy in January. But Mr. Trump, among others, insisted that the repeal and replacement of the law be simultaneous. Two other Republican senators, Ms. Collins and Rand Paul of Kentucky, had objected last week.
It was unclear whether Mr. McConnell would even be able to clear a procedural hurdle to get to a vote on the repeal-only measure. He faced the same math problem as with his own bill: He can afford to lose only two Republican senators, with Vice President Mike Pence breaking the tie. Mr. McConnell responded by outlining plans for a vote on a measure like the one vetoed by Mr. Obama in January 2016, which Mr. McConnell said would consist of a “repeal of Obamacare combined with a stable, two-year transition period.”
Not only has he apparently lost three, Senators Collins, Murkowski and Capito, but he must wait for the return of an ailing Senator John McCain, Republican of Arizona. Republican leaders had originally intended to proceed with a similar “repeal and delay” strategy after Mr. Trump won the presidency. But in January, Mr. Trump made clear he wanted a simultaneous repeal and replacement of the law, and congressional Republicans decided to follow that path.
Ms. Collins said she would vote against the procedural step. A repeal-only route would have been disruptive. The Congressional Budget Office said in January that enacting the vetoed bill would increase the number of uninsured Americans by 18 million in the first year and 32 million by 2026, compared with current law. Premiums, it said, would increase 20 to 25 percent in the first year and double by 2026.
“I do not think that it’s constructive to repeal a law that is so interwoven within our health care system without having a replacement plan in place,” she said. “We can’t just hope that we will pass a replacement within the next two years. Repealing without a replacement would create great uncertainty for individuals who rely on the ACA and cause further turmoil in the insurance markets.” That bill would have eliminated the Affordable Care Act’s expansion of Medicaid and subsidies for the purchase of private insurance. But it would have left in place the law’s requirement that insurers provide specific benefits, and the prohibition on denying coverage or charging higher premiums because of a person’s pre-existing medical conditions.
Mr. Portman all but joined her. The repeal-only idea quickly ran into a wall on Tuesday.
“If it is a bill that simply repeals,” Mr. Portman said, “I believe that will add to more uncertainty, and the potential for Ohioans to pay even higher premiums, higher deductibles.” “I did not come to Washington to hurt people,” Ms. Capito said in a statement, taking issue with both Mr. McConnell’s bill and the idea of repealing the health law “without a replacement plan that addresses my concerns and the needs of West Virginians.”
Dr. David O. Barbe, the president of the American Medical Association, which opposed Mr. McConnell’s bill, urged lawmakers to pursue a bipartisan approach on health care, saying, “The status quo is unacceptable.” Ms. Murkowski said, “There’s enough chaos and uncertainty already, and this would just contribute to it.”
The Senate Democratic leader, Chuck Schumer of New York, invited Republicans to work with Democrats to improve the health law. He warned that passing a repeal-only measure “would be a disaster,” saying it would cause millions of people to lose coverage and, in many ways, would be worse than Mr. McConnell’s original bill. The idea of repealing the health law without providing a replacement also spooked a bipartisan group of 11 governors, including Brian Sandoval of Nevada, an influential Republican critic of Mr. McConnell’s bill.
“It’s like if our health care system was a patient who came in and needed some medicine,” Mr. Schumer said. “The Republicans proposed surgery. The operation was a failure. Now Republicans are proposing a second surgery that will surely kill the patient.” “The Senate should immediately reject efforts to ‘repeal’ the current system and replace sometime later,” said the group, which included five Republicans, five Democrats and one independent. “This could leave millions of Americans without coverage. The best next step is for both parties to come together and do what we can all agree on: fix our unstable insurance markets.”
Mr. McConnell appears determined to drive the effort to a final public showdown with a procedural vote that would let the Senate consider the repeal-only measure. He can afford to lose only two Republican senators, with Vice President Mike Pence breaking the tie. But he already appears to have lost at least three: Ms. Collins, Ms. Murkowski and Ms. Capito.
More could still defect, unwilling to be recorded voting for a procedural step in what is all but certain to be a doomed exercise. But that could be an awkward stance for Republicans who voted for the repeal bill that the Senate passed in 2015 and Mr. Obama vetoed.
“If you’re not willing to vote the same way you voted in 2015,” Mr. Paul said on Tuesday, “then you need to go back home, and you need to explain to Republicans why you’re no longer for repealing Obamacare.”