(Bloomberg) — Republicans in Congress were reeling Tuesday from the failure of their latest Affordable Care Act change bill, the Better Care Reconciliation Act bill, as President Donald Trump said he’s willing to let Obamacare fail and called on the Senate to change one of its central rules.
Senate Majority Leader Mitch McConnell said the chamber will vote on a straight repeal — with a two-year delay — a plan that likely faces even steeper hurdles than his replacement bill.
Trump said on Twitter that the Senate, controlled by Republicans 52-48, should eliminate the 60-vote threshold for advancing bills that don’t use a special fast-track procedure.
“Even parts of full Repeal need 60. 8 Dems control Senate. Crazy!” the president said on Twitter. Trump also said he was willing to “let Obamacare fail” before moving forward on a replacement.
House Speaker Paul Ryan told reporters he would like to see “the Senate move on something.” The House passed its own version of a replacement bill in May.
“I’m worried that Obamacare will continue to stand and the law will continue to collapse and hurt people in the process,” said Ryan of Wisconsin.
The inability to deliver on seven years of GOP promises to repeal and replace the Affordable Care Act would be the biggest failure yet for Trump and Republicans since they won control of Congress and the White House.
McConnell’s move came after two more Republican senators announced their opposition to the Republican leader’s plan, which he drafted largely in secret. The defections by Mike Lee of Utah and Jerry Moran of Kansas, in addition to previous opposition by GOP Senators Rand Paul of Kentucky and Susan Collins of Maine, were enough to sink the measure.
Lee and Moran said in statements they wouldn’t support McConnell’s bill because it didn’t go far enough to address the rising cost of health care.
When talking about legislation for changing the Affordable Care Act, Republican congressional leaders generally do not define the term “Obamacare.” Up till now, the Republican bills that have received active consideration, including the Better Care bill, would repeal some Affordable Care Act taxes but would not repeal much of the Affordable Care Act.
“We should not put our stamp of approval on bad policy,” Moran said in a statement on Twitter. He criticized the way the health care bill was written through a “closed-door process” and said the Senate must “start fresh” with open hearings and debate.
Lee said the latest version didn’t repeal enough Obamacare taxes and regulations or lower premiums.
Republicans are expected to discuss how to pick up the pieces on Tuesday, when they gather for their regular policy lunch, which is often attended by Vice President Mike Pence. Several senators have made clear that they want GOP leaders to pursue an alternative that would require working with Democrats.
Others embraced the repeal-first strategy.
“I think that’s a prudent step,” Sen. Tom Cotton, an Arkansas Republican, said on Newsradio 102.9 in Little Rock. Even if that fails, he said, lawmakers need to keep working on the issue of health care. “It’s too important to too many Arkansans to simply walk away from it.”
The defections of Moran and Lee, two Tea Party-backed senators, is a stunning blow to McConnell and Trump, who campaigned on a promise to repeal the Affordable Care Act, which the president repeatedly called a disaster.
“Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!” Trump said on Twitter on Monday night.
Rep. Jim Jordan, R-Ohio (Photo: Jordan)
That won’t be easy. While Congress last year passed a repeal bill, they did so knowing it would be vetoed by President Barack Obama. This year, now that it could become law, such a proposal has drawn little support among Republican senators, with the exception of those in its most conservative wing.
Such a defeat may be part of a plan by a Republican leadership team that has expressed a desire to begin moving on to other matters, including an overhaul of the tax code, a boost in the nation’s debt ceiling and next year’s spending bills.
No Clear Path
On the health bill, McConnell was left facing an increasingly narrow path, with no apparent way to win over conservative and moderate holdouts seeking to pull the bill in opposite directions.
A sizable group of Republicans from Medicaid expansion states had yet to commit to the bill either, and Lee’s push for a broader repeal of Affordable Care Act insurance regulations risked pushing away the votes of senators like Lisa Murkowski of Alaska and Bill Cassidy of Louisiana, who have been among the most vocal in pushing to continue providing protections for people with pre-existing conditions.
A straight repeal bill could look even worse for them. The Congressional Budget Office in January said repealing the Medicaid expansion and exchange subsidies while keeping other Affordable Care Act regulations intact would cause many insurance markets to implode. That would result in an additional 32 million uninsured and premiums roughly doubling, with 75% of the country lacking insurers entirely in the individual market in a decade.
Some Republicans said they were ready to redouble their efforts to repeal Affordable Care Act.
“We can because we must. This is kind of a no-fail moment,” Sen. James Lankford, an Oklahoma Republican, said Tuesday on Fox News. “Let’s get all the people that disagree in one room and let’s hammer this all out.”
House Freedom Caucus founder Jim Jordan of Ohio told CNN Tuesday that he supported voting on a straight repeal of Obamacare and dismissed the idea that such a bill lacked enough votes.
“If you just went with the conventional wisdom, the underdog would never win,” he said. “So let’s actually put it out there and see what happens when the roll call is really called.”
Democrats immediately blasted the idea. Democratic Sen. Chris Murphy of Connecticut called it “a humanitarian disaster of incomprehensible scale.” Writing on Twitter, he said, “Full repeal with no replacement will cause markets to fail. No insurer will stay in an exchange that is disappearing in 24 months.”
Other GOP senators have been talking about a new approach to health legislation, with Lindsey Graham of South Carolina tweeting again Monday about his latest proposal with Cassidy to keep most of the Affordable Care Act’s taxes in place but give states far more freedom on what to do with the money.
McConnell’s plan already was teetering on the brink after Sen. John McCain’s unexpected surgery late Friday left him one short of the votes needed to start debate this week. The majority leader had said the bill wouldn’t be considered until McCain returned.
McCain, in Arizona to recover from the operation, issued a statement saying the GOP shouldn’t repeat Democrats’ strategy of passing the Affordable Care Act without any votes from the other party.
Congress must “hold hearings, receive input from members of both parties, and heed the recommendations of our nation’s governors” to pass a health care plan, McCain said.
House conservatives Monday immediately renewed calls for both chambers to enact a straight repeal of the Affordable Care Act, and leave the replacement debate for later.
‘Full Repeal Bill’
“Expect growing calls from conservatives for Congress to take up full repeal bill that passed under Obama,” Alyssa Farah, a spokeswoman for the conservative House Freedom Caucus, wrote on Twitter.
Lee’s and Moran’s statements came shortly after Trump met privately to discuss strategy with a small group of Republican senators, including other members of McConnell’s leadership team. Trump said in a July 12 interview with the Christian Broadcasting Network’s Pat Robertson that if the measure didn’t pass the Senate, “It would be very bad. I will be very angry about it and a lot of people will be very upset.”
McConnell spoke of the potential of moving to a scaled-back, bipartisan version of health legislation last month when an earlier version of his GOP-only bill collapsed because it lacked enough support.
He told a Rotary Club in Glasgow, Kentucky, that if Republicans can’t “agree on an adequate replacement, then some kind of action with regard to the private health insurance market must occur.”
— Read 5 Tips for ACA Change Binge Watchers on ThinkAdvisor.