Senate Moves to ACA Repeal Only

July 18, 2017

On July 15, Senate Majority Leader Mitch McConnell (R-Ky.) announced that the Senate was delaying a vote on the second iteration of the Republican health care bill–formally known as the Better Care Reconciliation Act of 2017 (BCRA)–until Senator John McCain (R-Ariz.) returned to work after recovering from surgery.

Republicans had hoped to vote on the health care bill next week, but following Leader McConnell’s announcement, Republicans Mike Lee (Utah) and Jerry Moran (Kansas) said they could not support the current bill. They joined Sen. Susan Collins (Maine) and Sen. Rand Paul (Ky.) in opposition, denying Republican leadership the support to even bring the bill to the floor and upending Republicans’ seven-year goal of repealing and replacing the Patient Protection and Affordable Care Act (ACA). Sen. McCain, who is recovering from surgery, also issued a statement advising the party to start over with a bipartisan approach.

In an attempt to continue the momentum he already started, Leader McConnell quickly stated that he plans to hold a vote in the coming days to take up the House-passed bill to replace the 2010 health law and then call up an amendment to eliminate major parts of the ACA, such as the Medicaid expansion, insurance subsidies and fines for the employer and individual mandates. Republicans passed a similar bill to effectively repeal the ACA in 2015 under reconciliation — the fast-track budget procedure the Republicans are using to thwart a Democratic filibuster — but it was vetoed by then-President Barack Obama.

McConnell added that the repeal-only bill is ‘what a majority of the Senate has already supported in 2015,’ but Republican lawmakers have voiced severe doubts that such a plan can win the 50 votes necessary this year given the uncertainty it would throw onto insurance markets. The 2015 vote was viewed as mostly symbolic at the time given Obama’s certain veto.

Since members of his own caucus spoiled McConnell’s attempt to repeal and replace the ACA simultaneously and at the prodding of the president, the Majority Leader is now going to force his caucus to go on the record on health care. If the Senate does vote to open debate on the House bill, which is not guaranteed, the repeal-only bill would be the first amendment. But senators would still be able to offer unlimited amendments to the bill, leading the Republican leadership down an uncertain road once the process began.

Even before debate can begin, leadership needs to secure a simple majority for a Motion to Proceed, and then McConnell will bring the House repeal bill — the shell they were always going to use. The 2015 reconciliation bill, which repealed major parts of the ACA, would be offered as the first amendment and replace the House-passed text.

President Donald Trump also called for the Senate to repeal the ACA and deal with a replacement later.

Meanwhile, if the Republican ACA repeal effort fails, the Senate HELP Committee will quickly hold hearings on potential bipartisan solutions for people who could have no insurance options next year. Senate HELP Committee Chairman Lamar Alexander (R-Tenn.) said he wants the Senate to vote “promptly” on the ACA repeal bill. He stated, “I will set those hearings after we vote on the bill, whenever that is, but we’ll have those hearings before we go home.” The Senate is set to adjourn for August recess on August 11.