Senate Republicans’ healthcare plans collapse

Senate Republican leaders have suffered two defeats from within their own caucus on healthcare policy in less than a day.

The first dealt with its Affordable Care Act (ACA) replacement plan, the newest version of which had been introduced July 13. Four days later, it was declared dead, as four Republican senators had publicly announced they wouldn’t support even holding a vote on the legislation.

Senate Republicans couldn’t afford any more defections after Sens. Rand Paul, R-Kentucky, and Susan Collins, R-Maine, came out in opposition to the newest version of the Better Care Reconciliation Act (BCRA) soon after its release. They were followed on Monday by Sens. Mike Lee, R-Utah, and Jerry Moran, R-Kansas.

“There are serious problems with Obamacare, and my goal remains what it has been for a long time: to repeal and replace it,” Moran said in a statement. “This closed-door process has yielded the BCRA, which fails to repeal the Affordable Care Act or address healthcare’s rising costs. For the same reasons I could not support the previous version of this bill, I cannot support this one.”

Senate Majority Leader Mitch McConnell responded by saying the repeal-and-replace effort “will not be successful,” and signaled a return to an earlier strategy: repealing the ACA and delaying its effects for two years while a replacement is crafted.

“So, in the coming days, the Senate will vote to take up the House bill with the first amendment in order being what a majority of the Senate has already supported in 2015 and that was vetoed by then-President Obama: a repeal of Obamacare with a two-year delay to provide for a stable transition period to a patient-centered healthcare system that gives Americans access to quality, affordable care,” McConnell said in a statement.

That, too, was quickly declared dead, as three Republicans in the Senate—Collins, Lisa Murkowski of Alaska and Shelley Moore Capito of West Virginia—said they wouldn’t vote for that proposal either, dealing McConnell and ACA opponents a second defeat. Collins had voted against a very similar bill in 2015, but Murkowski and Capito voted for it when it was assured to be vetoed by then-president Barack Obama.

“As I have said before, I did not come to Washington to hurt people. For months, I have expressed reservations about the direction of the bill to repeal and replace Obamacare. 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, especially in light of the growing opioid crisis. All of the Senate healthcare discussion drafts have failed to address these concerns adequately,” Capito said in a statement.

Republicans had considered the repeal-and-delay strategy between Election Day and President Donald Trump’s inauguration. Its impact would be more severe than either the House or Senate ACA replacement bills, raising the number of uninsured by 32 million people by 2026 and increasing premiums by more than 25 percent in 2018.

Like the House and Senate bills, the healthcare industry was almost united in opposition to this strategy, often citing the estimated $1.1 trillion rise in uncompensated care costs. The American Medical Association welcomed the demise of the BCRA, but also called on quick action from Congress to “stabilize” the individual market.

“In the long term, stakeholders and policymakers need to address the unsustainable trends in healthcare costs while achieving meaningful, affordable coverage for all Americans. The American Medical Association is ready to work on short- and long-term solutions,” said AMA President David Barbe, MD.

The Medicare Access and CHIP Reauthorization Act (MACRA) passed in 2015 was cited as one such example of bipartisan cooperation on healthcare policy.

Democrats echoed those sentiments, as they’ve been saying through the repeal debate that the ACA needs some fixing and were willing to work with Republicans if they dropped their current proposals. Assuming the repeal-and-delay strategy fails, Sen. Dick Durbin, D-Illinois, the no.2 Democrat in the Senate, called on both parties to “surprise the American people and actually get something done.”

“Doing nothing is unacceptable and working together is the only way to solve the real problems facing our healthcare system,” Durbin said in a statement. “To my Democratic colleagues: this is no time for high-fives. We have work to do.”

Durbin had told HealthExec just a day earlier that there were “two to maybe three” Republicans in the Senate who were waiting on the repeal efforts to collapse before entering into bipartisan talks on fixes for the ACA.

Throwing a wrench into those plans would be actions by President Donald Trump, who reacted to the quick succession of healthcare policy shifts by saying his administration will “just let Obamacare fail.”

“We're not going to own it. I'm not going own it,” Trump told reporters at the White House. "We'll let Obamacare fail and then Democrats are going to come to us.”

Trump’s moves on the ACA, particularly the lack of clarification on whether cost-sharing reduction subsidies to insurers on the exchanges will be paid, have led to a more “fragile” market and double-digit hikes in requested premiums for 2018.