Anatomy of a Republican Health Bill Failure

A largely closed process and a dramatic last-minute defection doomed the GOP's latest Obamacare repeal effort.

Sen. John McCain speaks to reporters on Capitol Hill on Thursday.
AP Photo/Cliff Owen
July 28, 2017, 2:45 a.m.

Senate Republicans failed to pass a simple, far-reaching bill repealing major provisions of the Affordable Care Act in the wee hours Friday morning, a stunning rebuke of their leaders’ strategy to deliver on a core promise made to their voters for the past seven years.

The defeat lay at the hands of every Democratic senator and Republican Sens. Lisa Murkowski of Alaska, Susan Collins of Maine, and John McCain of Arizona, who voted against the bill despite last-minute lobbying from Vice President Mike Pence and others.

“I do my job as a senator,” said McCain, who recently returned to the Senate after being diagnosed with brain cancer. “I thought it was the right vote.”

Instead of celebrating a victory on their top legislative priority, Republican senators were dispirited by a disjointed procedure that led to a bill few loved and wanted to ultimately pass. It followed a winding, six-month process that saw more ambitious proposals fail in the face of criticism from both the conservative and centrist wings of the party.

“This is a disappointment,” said Senate Majority Leader Mitch McConnell. “A disappointment indeed.”

The smaller measure was a desperate attempt by the Senate Republicans to keep the process alive. But the bill was far from ideal for many Republicans. Many of the senators who did support the legislation wanted a guarantee from the House that they would continue debating the bill, rather than pass the measure out of Congress.

The Senate bill, called the Health Care Freedom Act or the “skinny bill,” would have repealed the unpopular penalty urging individuals to purchase insurance and revise waivers under Obamacare to make it easier for states to set their own minimum benefits, among other changes. The Congressional Budget Office estimated that 16 million more people would be uninsured under this legislation.

In a process perhaps without precedent, the Republican senators tried to pass its preeminent promise without a hearing, and without the support of major industry groups affected, including doctors, patients, seniors, and—according to multiple polls—the public. The senators attempted to pass the health care bill without bipartisan support, in the middle of the night, to get to a conference with the House, a manner they criticized when the Democrats passed Obamacare.

The legislation would have increased premiums by 20 percent, according to CBO, after the GOP had pledged for years—and in recent months—that their mission was to decrease costs.

Before voting for the Senate Republican bill, some experienced legislators said they hoped Congress could return to the usual committee process, in which rank-and-file members and the public can have more power to write legislation.

“We have had seven years of almost intractable political differences of opinion,” said Sen. Lamar Alexander, the Republican chairman of the health care panel. “This may be the only way we could get a bill through the Congress that would actually repeal and replace major parts of Obamacare. But I much prefer the process that we usually use—and I hope that in the future, we resume that kind of process.”

The three Republican senators opposed the bill both for what it did and how it was made. In a statement, McCain said it would not increase competition, lower cost, or improve health care outcomes. But he also sharply criticized the process created by McConnell. “We must now return to the correct way of legislating and send the bill back to committee, hold hearings, receive input from both sides of aisle, heed the recommendations of nation’s governors, and produce a bill that finally delivers affordable health care for the American people,” he said.

Even Republican senators who voted for the bill criticized both the policy and the politics of it, saying it was an unsavory but necessary way to get to a debate with the House, when they could write something new. In a press conference Thursday, Sen. Lindsey Graham of South Carolina warned the House to not pass the bill he voted for, on the condition that the House would change it under further negotiations.

“The skinny bill as a replacement for Obamacare is a fraud,” he said. “Not only do we not replace Obamacare, we politically own the collapse of health care. I’d rather get out of the way and let it collapse, then have a half-ass approach where it is now our problem.”

On Thursday, House Speaker Paul Ryan and Republican senators said they did not want to repeat the same process on health care for future major legislation. Rank-and-file Republicans have criticized McConnell for rushing to release the Senate’s broader Obamacare replacement plan, which failed this week by a wider margin, without enough time to for the public to weigh in or for analysis from the official budget score. “This is not something I’d want to repeat,” said one GOP senator. “No.”

Congress has passed major legislation before on party-line votes, including cutting taxes in the Bush administration and aspects of Obamacare, through a process known as budget reconciliation, which limits debate.

But the Republicans’ health care process was much different than the Democratic one that lead to the passage of Obamacare. Bill Dauster, a senior policy staffer under former Senate Democratic leader Harry Reid, noted that Democrats held 60 hours of meetings among a group of bipartisan senators, spent hours revising the bill in two committees and accepted “dozens” of Republican amendments.

“All this is in contrast to Senator McConnell's mode this time, which has been hyper-partisan and secretive,” said Dauster.

After the legislation was killed, McConnell said it will be interesting to see Democratic ideas, but appeared hesitant to support them, portraying the liberal alternative as a government takeover of the health care system. “Bailing out insurance companies with no thought of any kind of reform is not something I want to be part of,” he said.

Republicans could always revisit their intraparty efforts; Sen. Bill Cassidy of Louisiana immediately touted a plan that he developed with Graham that would provide states the authority and money to build their own systems.

President Trump suggested a different strategy, reviving a threat he has made repeatedly. “3 Republicans and 48 Democrats let the American people down,” Trump tweeted. “As I said from the beginning, let ObamaCare implode, then deal. Watch!”

But Republicans will likely agree with McConnell in that “it’s time to move on.” In an interview on FOX Business Network’s Mornings with Maria on Thursday, House Speaker Paul Ryan promised that on the next major legislative battle—the first overhaul of the tax code in 30 years—Republicans would do business “better and differently.”

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