Senate Majority Leader Mitch McConnell (R-KY) asked the Senate to move on early Friday morning after the latest Republican health care bill, or the so-called “skinny repeal” bill, failed to pass. Sen. Susan Collins (R-ME), Lisa Murkowski (R-AK), and John McCain (R-AZ) voted against the bill, with a final tally of 49 to 51. An audible gasp followed McCain’s vote, along with a mild cheer from the chamber.
The text of the “skinny bill” was revealed late on Thursday. Officially named the Health Care Freedom Act (HCFA), the bill makes serious cuts to the Affordable Care Act. The bill does not accomplish the Republican party’s goals in the long term, as most provisions have an expiration date.
The Congressional Budget Office (CBO) estimated that this bill would leave 16 million people uninsured by 2026 and drive up premiums by 20 percent. Fifteen million people would have been uninsured by next year alone. (You can view a more in-depth analysis of this bill at the end of this piece under “Bills, Bills, Bills.”)
Here is how we got here:
Friday, July 28: The Senate rejected the “skinny repeal” bill.
1:55 a.m. McConnell’s effort to go to the Defense bill was blocked by Sen. Rand Paul (R-KY), which means the Senate will move on to nominations on Monday.
There will be no longer be a health care “vote-a-rama.”
1:44 a.m. The Senate will move on from health care for now. McConnell asked to put the House bill to the Senate calendar. He asked to bring a new item on the agenda Friday morning, after admitting defeat. The motion was denied by Sen. Rand Paul (R-KY).
1:33 a.m. The Health Care Freedom Act (HCFA) failed. The tally: 49 and 51.
12:24 a.m. In yet another effort to restore procedural order, Senator Patty Murray (D- WA) motioned to send the House-passed bill back to committee. The final tally: 48 to 52.
Thursday, July 27: The Senate introduced the “skinny repeal” bill text.
10:31 p.m. The Congressional Budget Office (CBO) released an estimate that the “skinny repeal” bill will leave 16 million people uninsured by 2026 and drive up premiums by 20 percent. Fifteen million people will be uninsured by next year alone.
9:55 p.m. Senate Majority Leader Mitch McConnell (R-KY) introduced the text of the “skinny bill,” called the the Health Care Freedom Act (HCFA). The vote is scheduled at midnight.
9:50 p.m. Sen. Dean Heller (R-NV) introduced an amendment that would repeal the Cadillac tax, which is a 40 percent excise tax on high-cost employer-sponsored health plans. This fig leaf amendment failed. The final tally: 48 to 52.
7:37 p.m. House Speaker Paul Ryan (R-WI) issued a statement on the Senate health legislation. Ryan said the House is willing to go to conference on the “skinny repeal” bill. He did not commit, leaving wiggle room for his caucus to pass a repeal-only bill. It’s still not clear what will happen if the Senate passes a “skinny repeal” bill, and there is no public version of the bill.
5:15 p.m. Sens. Lindsay Graham (R-SC), John McCain (R-AZ), and Ron Johnson held a press conference where they said they will vote for the so-called “skinny repeal” bill, but only if they can be assured that the bill they vote for does not become law.
5:05 p.m. The Senate voted on an amendment proposed by Senator Luther Strange (R-AL). To get around budget rules, the amendment looks to redirect premium tax credits funds through CHIP program after 2018. The goal is to apply Hyde Amendment — which blocks federal Medicaid funding for abortion services, to these funds. The final tally: 50–50.
3:10 p.m. At the Senate GOP lunch, lawmakers focused on whether House will conference a skeletal ACA-repeal only bill dubbed “Skinny Repeal.” Capitol Hill reporters are reporting that Senate Republicans don’t actually want this bill to become law, but they will vote for it anyway.
3:07 p.m. The Senate voted on a single-payer amendment introduced by Senator Steve Daines (R-MT). The GOP senator attempted to troll universal care supporters but the joke didn’t land. The final tally: 0 to 57, and 43 senators who simply responded present.
12:45 p.m. The Senate Parliamentarian ruled that state innovation waivers, violate the Byrd Rule and will not be allowed. Innovation waivers allow states to waive protections for people with pre-existing conditions, which includes waiving essential health benefits.
Wednesday, July 26: The Senate’s efforts to partially repeal the ACA fail.
7:15 p.m. Senate Minority Leader Chuck Schumer (D-NY) said Democrats will offer no more amendments until Republicans show them the contents of the “skinny” repeal bill.
7:13 p.m. The Senate voted on an amendment offered by Sen. Dean Heller (R-NV) that “advocates” for the Medicaid expansion. The showboat amendment is dubbed the “Sense of the Senate.” This failed. The final tally: 10 to 90.
6:38 p.m. The Senate voted on a motion to send the bill back to committee to review how the House-passed bill affects people with disabilities; this motion to commit was proposed by Sen. Bob Casey (D-PA). The Americans with Disabilities Act celebrates its 27th anniversary Wednesday, July 26. This failed. The final tally: 48 to 51.
4:30 p.m. The Senate voted on a provision proposed by Sen. Joe Donnelly (D-IN). The Donnelly motion looked to send the House-passed bill back to committee and report back without the Medicaid coverage provisions. This failed. The final tally: 48 to 52.
4:11 p.m. The Senate voted first on the Obamacare Repeal Reconciliation Act (ORRA), with an amendment from Sen. Rand Paul (R-KY) that would ban federal funding of abortion. This failed. This is a proxy vote on repealing the Affordable Care Act and defunding Planned Parenthood. Both live to see another day. The final tally: 45 to 55, with seven Republicans and all of the Democrats opposing.
Tuesday, July 25: The ACA repeal and replace bill fails.
The Senate voted against a version of the Better Care Reconciliation Bill (BCRA), which included a revised amendment by Senator Ted Cruz (R-TX). The procedural vote was technically on whether the amendment complies with the budget act. The failed vote means that the Senate cannot pass BCRA as is, with a simple majority. Repeal and replace is not dead, but it’s definitely on life support.
The tally: 43 to 57, with nine Republicans and all of the Democrats opposing.
The Senate will be voting on a ton of bills that will amend the House health care bill this week. It’s important to keep in mind that if something passes on Friday, it will likely be one of three proposals:
1. ACA Repeal and Replace
There have been several iterations of the BCRA. All BCRA versions drastically change the ACA marketplace and Medicaid program. All versions also change benchmark plans offered, so that insurance companies pay less out-of-pocket costs. This means costlier copays and deductibles for the average American than under current law. States have the option to waive market regulations, which means people who buy insurance will buy plans that cover the bare minimum. Lastly, all versions cut Medicaid expansion and gut federal spending to the program overall.
The Congressional Budget Office (CBO) has not scored every version of BCRA. It is working to score the version of BCRA that includes the Cruz amendment. Under two versions the CBO has scored, 49 million would be uninsured in 2026, 22 million more than under current law. People on Medicaid insurance will be the largest group affected.
This bill also has many reconciliation problems. As of now, the revised bill cannot pass with simple majority because it breaks a lot of Byrd rules. On Thursday, the Senate Parliamentarian ruled that state innovation waivers, which allow states to waive essential health benefits for people with pre-existing conditions, violate the Byrd Rule.
2. ACA Repeal-only
There is only one public version of the Obamacare Repeal and Reconciliation Act (ORRA). This bill partially repeals provisions of the ACA like the insurance mandate, Medicaid expansion, and ACA marketplace premium subsidies. It keeps marketplace patient protections.
The CBO estimated that 32 million people would lose insurance under ORRA, the most of any of the Republican proposals.
3. ACA “Skinny Repeal”
The text of this bill was released late on Thursday. It’s called the Health Care Freedom Act (HCFA). It repeals the individual mandate effective immediately, the employer mandate until January 2025, and one ACA tax on medical devices until 2020. It bans federal payments to Planned Parenthood for one year. Additionally, the bill increases funds to health care savings accounts (HSA) and to Community Health Center Funding by $422 million for 2017.
A minor victory: States can no longer waive some consumer benefits, like the 10 essential benefits afforded by the ACA. However, it still requires Health and Human Services and the Internal Review Service to give states approval for these waivers — changing the language “may” approve in the ACA to “shall” approve. This is significant.
The Congressional Budget Office (CBO) estimated that this bill will leave 16 million people uninsured by 2026 and drive up premiums by 20 percent. Fifteen million people will be uninsured by next year alone.
The bill could break budget rules. Senate Democrats are arguing on the Senate floor that the provision relating to Planned Parenthood does not adhere to reconciliation rules.
This is a developing news story and will be updated periodically.
Thanks to Casey Quinlan for contributing to this story.