Republicans Fail to ‘Repeal & Replace’ Obamacare: What’s Next?

After months of wrangling, Republicans in the U.S. Senate on July 18 announced more defectors who said they would not support the Senate’s current version of healthcare reform legislation. This marks yet another failure to make good on their leadership’s promise to dismantle the Affordable Care Act, or Obamacare as it’s often called.

After a plan to “repeal and replace” lost its legs when two Republican senators said they wouldn’t vote to debate it, Senate Majority Leader Mitch McConnell announced the failure of the repeal-only plan on Tuesday morning following three more Republican senators’ expression of opposition.

Healthcare Industry Reaction

The healthcare industry’s reaction was predictably as complex as the legislative twists and turns in the Senate’s answer to the House’s proposed bill, announced in May.

The American Medical Association encouraged Congress to take a bipartisan approach to improve healthcare in a statement by AMA President David O. Barbe, M.D., who seemed to indicate displeasure with the ACA, stating that “the status quo is unacceptable” yet pointing to the Medicare Access and CHIP Reauthorization Act (MACRA) and the 21st Century Cures Act as “recent examples of what can be accomplished to improve the health of the nation when Congress works on a bipartisan basis with key stakeholder groups.”

The ACA contains key implementation provisions for demonstration projects and affordable care organizations under MACRA, according to a blog post by attorneys in Mintz Levin’s healthcare practice. A full repeal of the ACA “could cripple the government’s ability to operate the demonstration projects that are the cornerstones of MACRA,” they write.

Health plan industry groups American’s Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association had written a letter to McConnell and minority leader Chuck Schumer on July 14 expressing dissatisfaction with the Senate bill’s provision that would have allowed insurers to offer ACA-compliant programs alongside noncompliant ones. “This would allow the new plans to ‘cherry pick’ only healthy people from the existing market[,] making coverage unaffordable for the millions of people who need or want comprehensive coverage,” wrote the presidents and CEOs of the two associations.

And the American Hospital Association had complained about the bill’s proposal to cut Medicaid benefits for tens of millions of Americans, encouraging the Senate to “advance a solution aimed at protecting coverage for all Americans who currently have it” in a statement.

What’s Next?

Republicans are scrambling to come up with their own version of healthcare reform. President Donald Trump tweeted conflicting plans, alternately seeming to appeal to Democrats to work with Republicans and then almost 12 hours later blaming Democrats for the Republicans’ plans falling apart. He also claimed he’d always said he thought letting the ACA fail was preferable because then Democrats would be forced to work with Republicans to replace it.

McConnell is asking Republican Senators to keep working for a vote on the earlier House bill, according to The Hill, but others say they want to start over and move the legislation through committees – something the most recent Senate bill was lacking.

The Congressional Budget Office had concluded in January that even removal of the ACA’s mandate penalties and subsidies while leaving in place its insurance market reforms would have resulted in 18 million people losing their insurance in the year following its enactment, and after the ACA’s Medicaid expansions were eliminated, up to 32 million would lose coverage by 2026.

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