The Senate just voted 51–50 on the motion to proceed — with Vice President Mike Pence breaking the tie — on legislation to be finalized later that will repeal parts of or all of the Affordable Care Act, or Obamacare.
This was dramatic news, not only because Sen. John McCain (R-AZ) entered the Senate chamber fresh off a flight from his home where he is undergoing cancer treatment, but also because several Republican senators voted yes despite their previous statements indicating they would not vote to open debate with the legislation in such mysterious chaos.
The most likely path forward on this legislative efforts, according to Senate Republicans, is “skinny repeal,” which means lawmakers would vote to hobble Obamacare by repealing the individual and employer mandates as well as the medical device tax. Doing this, according to the Committee for a Responsible Federal Budget’s analysis of prior Congressional Budget Office scores, would hike premiums 20 percent and increase the number of people without insurance by 15 million. It would also save hundreds of billions of dollars as millions of Americans stop receiving subsidies and Medicaid benefits.
Here’s a reminder of what some senators promised their constituents they would do on health care policy before casting Tuesday’s vote.
Sen. Shelley Moore Capito (R-WV)
Last week, when Sen. Capito came out against the latest version of the Senate health care bill, she said she had “serious concerns” about providing affordable care to those who gained coverage through West Virginia’s Medicaid expansion. She said that, until she saw a discussion draft that addressed these concerns, “I cannot vote to repeal Obamacare,” adding that she “did not come to Washington to hurt people.”
My latest statement on the Senate health care bill & planned vote to repeal Obamacare: pic.twitter.com/yAVIxgptCu
— Shelley Moore Capito (@SenCapito) July 18, 2017
MORE: I will only vote to proceed to repeal legislation if I am confident there is a replacement plan that addresses my concerns.
— Shelley Moore Capito (@SenCapito) July 18, 2017
No matter what path the GOP ultimately pursues, it will result in some Medicaid coverage losses. Nevertheless, on Tuesday, Capito voted to begin debate to repeal and replace Obamacare before there is a clear plan to preserve Obamacare’s Medicaid expansion.
My statement on motion to proceed: pic.twitter.com/j7sdmIW79L
— Shelley Moore Capito (@SenCapito) July 25, 2017
Sen. Bill Cassidy (R-LA)
Sen. Cassidy became famous on late-night television when he promised ABC talk show host Jimmy Kimmel that he would not support a health care bill that didn’t ensure sick family members could get medical care because they can’t afford it — something Cassidy dubbed “the Jimmy Kimmel test.”
Kimmel had previously opened his show with a monologue describing how his son, born with a congenital heart condition, got the care he needed and that he didn’t want anyone else to be denied non-emergency care because they could not afford it. Obamacare removed the lifetime caps on insurance spending that existed before the legislation became law, as well as providing other protections to the insured.
Cassidy said in late June that he believed a draft being considered by Senate Republicans passed this test. But different Republican proposals in the House and Senate threatened these protections, and there is nothing in the current discussion drafts of the GOP repeal efforts that indicate they pass the Jimmy Kimmel test either.
Reminder for Sen @BillCassidy: Kimmel test is "No family should be denied medical care, emerg or otherwise, because they can’t afford it"
— Jimmy Kimmel (@jimmykimmel) June 25, 2017
Sen. Cassidy, like all but two of his Republican colleagues, voted “aye” on Tuesday.
Sen. Dean Heller (R-NV)
Sen. Heller said in a June news conference that he could not support Majority Leader Mitch McConnell’s health care bill because it endangers the care Nevadans receive through the state’s decision to expand Medicaid under Obamacare.
“I cannot support a piece of legislation that takes away insurance from tens of millions of Americans and hundreds of thousands of Nevadans,” he said.
Heller changed his tune on Tuesday, after refusing to comment on the motion to proceed vote for days. He said in a statement that he would vote to move forward because “Obamacare isn’t the answer, but doing nothing to try to solve the problems it has created isn’t the answer either.”
He did say that, “If the final product isn’t improved for the state of Nevada, then I will not vote for it; if it is improved, I will support it.”
But no drafts of the various repeal efforts leave Medicaid unscathed.
Sen. John McCain (R-AZ)
Sen. McCain said last week that he could not support the ACA repeal bill because of its dramatic cuts to Medicaid. If the Senate did not accept his amendments that address concerns “about the bill’s impact on Arizona’s Medicaid system,” then McCain said he believed the Senate should “return to regular order” and pass a bill with input from both parties.
Though McCain told the Senate after Tuesday’s vote that he would file amendments to address these concerns, and that he plans to oppose the bill if these amendments fail, he still voted on Tuesday to begin a process outside of regular order, full of proposals that would result in cuts Medicaid.
Sen. Rob Portman (R-OH)
Sen. Portman has expressed doubts about the different GOP repeal drafts because of their impact on Medicaid recipients and people suffering with opioid addiction — a huge issue in the Buckeye State.
Last week, Portman said he would not vote for an Obamacare repeal bill without a replacement plan.
We must do more than just repeal, we must have a replacement solution in place as well. https://t.co/lmZNuUkmZH
— Rob Portman (@senrobportman) July 18, 2017
However, he voted yes on the motion to proceed on Tuesday, without a fleshed out replacement plan prepared.
— Rob Portman (@senrobportman) July 25, 2017
He touted an amendment of his that would help ease people off Medicaid — but amendments like those will need 60 votes to pass and are expected to fail. Portman’s concerns would almost certainly not be addressed by a “skinny” repeal, which is the most likely path forward that only needs 50 votes under the Senate’s reconciliation rules.
UPDATE: On Tuesday night, Sens. Capito, Cassidy, McCain, and Portman joined just 39 of their Republican colleagues to vote for BCRA, a modified version of the larger repeal-and-replace bill. The bill would have cut the law’s tax subsidies and Medicaid. Sen. Heller joined eight other Republicans and all Democrats to vote nay and defeat the bill.
This article has been updated to clarify that under the “skinny” repeal bill, there will be fewer people who gain coverage through Medicaid without the individual mandate.