Republican leaders were stung by another defeat Wednesday when the Senate rejected a repeal of the Obamacare law and its mandates on coverage, taxes and Medicaid expansion.
The Senate voted 55-45 against the repeal bill.
Seven Republicans, including Sen. Dean Heller, R-Nev., voted against repeal of the Affordable Care Act, known as Obamacare, leaving in doubt what GOP leaders will be able to cobble together in a final bill this week.
“Today’s vote to fully repeal Obamacare without an immediate replacement plan would create more uncertainty in Nevada’s already fragile market and is not in the best interest of my state,” Heller said.
In addition to Heller, GOP senators from other Medicaid expansion states voted against the repeal, including Sens. Rob Portman, R-Ohio, Shelley Moore Capito, R-W.V., Lisa Murkowski, R-Alaska, John McCain, R-Ariz., Susan Collins, R-Maine, and Lamar Alexander, R-Tenn.
The repeal bill was the same one passed by Senate Republicans in 2015, when President Barack Obama was in the White House and vetoed the legislation. Heller and other Republicans voted for repeal in 2015.
A vote on the legislation Wednesday was delayed over a provision on abortion. The vote was taken later, along with one on a Democratic amendment to write a health care bill in committee. That measure died on a straight party-line vote.
A recent analysis by the Congressional Budget Office found that the repeal-only bill would have resulted in 32 million additional people without insurance over a 10-year period.
But Sen. Rand Paul, R-Ky., said the Affordable Care Act, has failed to live up to its promises and instead expanded an entitlement program, Medicaid, and increased the debt.
“The question isn’t ‘Do you want to help people?’ It’s ‘How are you going to pay for it?’” Paul said.
Broad measure also fails
A more broad measure to repeal portions of Obamacare failed in the Senate on Tuesday, just hours after debate began.
That bill, the Republican repeal and replace legislation that was written behind closed doors, would have left some Obamacare mandates and taxes in place, but would have ended Medicaid expansion in several years and cut the Medicaid program by $756 billion.
Heller also voted against that amendment, saying it would jeopardize “too many Nevadans’ health care coverage.”
But Heller said he remained open to Republican legislation overhauling Obamacare if states “are given the flexibility to build on their successes and ensure protection for those who are currently covered.”
Nevada was one of 31 states and the District of Columbia that expanded the Medicaid program under the ACA, resulting in coverage for 11 million people nationwide, including more than 200,000 in Nevada, according to the Kaiser Family Foundation.
A symbolic, non-binding Senate resolution offerred by Heller to affirm Medicaid expansion died on a 10-90 vote, drawing support from only those GOP lawmakers from whose states took federal funding to broaden the program, including Portman, Collins, McCain and Capito.
Senators will now continue debate on a health care bill that could leave most of the Obamacare provisions intact.
The Blue Cross Blue Shield Association warned Wednesday that repealing, or eliminating the Obamacare mandate that everyone purchase insurance would have dire consequences.
“A system that allows people to purchase coverage only when they need it drives up costs for everyone,” the association said.
Blue Cross Blue Shield also called for final legislation to include dedicated funds to be made available to people with significant medical conditions.
Bipartisan approach urged
Democrats have balked at Republican efforts to repeal Obamacare, and have instead urged a bipartisan approach that would shore up public insurance exchanges that provide coverage to those without government- or employee-sponsored plans.
Several Republicans, including Alexander and Collins, also favor a more broad, bipartisan approach to address the problems with the nation’s health care law, most notably rising premiums and costs shouldered by small businesses to provide plans.
The Senate voted 51-50 on Tuesday, with Vice President Mike Pence casting the tiebreaking vote, to begin debate on a health care plan.
The Senate took up a bill passed earlier by the House, legislation that President Donald Trump praised in a Rose Garden ceremony before calling the bill “mean.”
Trump has warned Senate Republicans of political consequences if GOP lawmakers fail to repeal a law that they have campaigned against for seven years.
Heller, considered the most vulnerable Republican up for reelection in 2018, is being attacked on the right and the left.
A pro-Trump PAC aired TV ads attacking Heller for his opposition to the first Senate Republican health care bill, before the effort was criticized by Republican leaders and the ads discontinued.
Heller is also being targeted by national Democrats in a state that Hillary Clinton won in the 2016 presidential election.
One prominent Democrat, Rep. Jacky Rosen, D-Nev., is seeking the Democratic nomination to challenge Heller.
Rep. Dina Titus, D-Nev., also is exploring a bid for the Senate, but has not announced her intentions.