Senate Republicans decided Tuesday not to hold a vote on unwinding the Affordable Care Act, preserving the landmark 2010 law for the foreseeable future even as they suggested they may withhold crucial funding for it.
The move leaves the GOP — once again — short of fulfilling a signature promise, which some Republicans worried could inspire a backlash among their base heading into the 2018 midterm elections.
Several senators said they instead plan to move onto other issues now that the party’s latest proposal, authored by Republican Sens. Lindsey O. Graham (S.C.) and Bill Cassidy (La.), had failed to garner sufficient support
“Where we go from here is tax reform,” Senate Majority Leader Mitch McConnell (R-Ky.) told reporters after holding a closed-door policy lunch with members of his caucus.
Meanwhile, Republican lawmakers voiced little interest in shoring up the existing ACA insurance market, sowing apprehension among insurers and state officials just weeks before consumers must start enrolling in plans for next year.
While some GOP lawmakers expected consumers could experience major problems in the months ahead, they argued that the ongoing instability would backfire on Democrats and build momentum for the ACA’s eventual repeal.
“I personally think it’s time for the American people to see what the Democrats have done to them on health care,” said Senate Finance Committee Chairman Orrin G. Hatch (R-Utah). “They’re going to find they can’t pay for it, they’re going to find that it doesn’t work. . . . Now that will make it tough on everybody. Maybe that’s what it take to wise people up.”
Wednesday is the deadline for insurers to sign contracts with the federal government so that they can sell health plans on the ACA marketplaces for 2018. Many companies are hiking these rates by double digits, but they have suggested they would curb such increases if they had assurances that the federal government would provide cost-sharing reduction payments for all of next year. Those subsidies provide discounts to lower-income customers for their health plan’s deductibles and other out-of- pocket costs.
Republican leaders could call on Sen. Lamar Alexander (R-Tenn.) to revive negotiations with Sen. Patty Murray (D-Wash.) on a bipartisan package to stabilize the current insurance marketplaces. The pair had appeared to be reaching an agreement on a plan to guarantee the cost-sharing subsidies for at least a year in exchange for limited waivers to give states more flexibility in how they spend that money. Those talks stalled when Alexander stepped aside to allow GOP leaders to focus on securing votes for Graham-Cassidy.
“I would imagine that Senator Alexander is going to continue to work on that, and hopefully Senator Murray will as well,” said Sen. Roy Blunt (R-Mo.) Tuesday.
At the moment, the Trump administration is only covering cost-sharing payments on a month-to-month basis; a White House official confirmed Tuesday that it had made a payment for September. Asked what the president intended to continue making payments going forward, the aide said officials have not yet decided what to do.
Trump has suggested on several occasions that if a replacement bill does not pass Republicans should let the current system fail, forcing Democrats to negotiate.
It is unclear how much appetite there is for a stabilization bill among Republicans in the Senate, let alone in the House. Aides to House GOP leaders said they did not see a bill providing billions in ACA subsidies as viable in the lower chamber, and that House Speaker Paul D. Ryan (R-Wis.) had conveyed that to GOP senators.
Democrats, meanwhile, reiterated their interest in striking a deal Tuesday, with Murray saying that while “damage has been done” by delaying an agreement, “let’s pick back up right where we left off, and let’s do it right now.”
“The clock is ticking, Democrats are at the table, and I hope Republican leaders will now allow us to get back to work on lowering costs for patients and families and stabilizing the markets,” the senator said. “We don’t have a minute to spare.”
Some congressional Republicans — such as Rep. Carlos Curbelo (R-Fla.), who represents a swing district — echoed that call.
“I think the time for partisan health-care reform has passed, and we should focus on a bipartisan package that provides some regulatory relief, especially on the employer mandate,” Curbelo told reporters, “and also guarantees [cost-sharing subsidies] for the most vulnerable people.”
Lanhee Chen, a research fellow at the Hoover Institution, said in an interview that he had initially hoped the Graham-Cassidy bill would have allowed Republicans to move past their policy divisions on health care.
“I thought at least every Republican, or every conservative, would agree with the idea that when it came to health care, it would make sense to give states the freedom and flexibility to pursue a path that would work best for their residents,” said Chen, who also directs domestic policy studies at Stanford University’s public policy program. “That was a principle I was pretty certain could garner the vast majority of Republicans in the Senate.”
But even that sort of consensus seemed elusive, Chen said, and the fact that Republicans are rushing to pass the bill by the end of the month has produced “a flawed process” that has allowed some critics to sidestep more serious questions, such as the long-term sustainability of the Medicaid program.
Speaking to reporters Tuesday, Trump said he was “disappointed in certain so-called Republicans” who would not back the Graham-Cassidy bill.
The president declined the speculate Tuesday morning on whether he wanted lawmakers to actually vote on the measure, saying, “We’ll see what happens.”
“It’s going along and at some point, there will be a repeal and replace,” Trump added. “But we’ll see whether that point is now or whether it will be shortly thereafter.”
Two GOP senators — Rand Paul (Ky.) and John McCain (Ariz.) — already had come out last week against the measure and were not swayed by a new draft that emerged after the weekend. Monday evening, after the Congressional Budget Office projected that “millions” if Americans would lose insurance if the Graham-Cassidy bill was enacted, Sen. Susan Collins (R-Maine) announced that she could not support it.
Republicans hold a 52-to-48 advantage in the Senate; they can lose only two votes from their party and still pass legislation with the help of a tiebreaking vote from Vice President Pence.
A fourth Republican, Sen. Ted Cruz (Tex.), indicated through his aides Monday that he would not back the bill in its current form because it would not go far enough in repealing the 2010 law.