Senate Rejects Repeal of the Affordable Care Act

After a dramatic week, Senate Republicans were unable to garner enough votes to repeal the Affordable Care Act. Below, we detail the series of events:

Procedural Motion to Begin Debate: On Tuesday, the Senate held a vote on a motion to begin debate on the proposed options to repeal the ACA; the motion passed 51-50 with Vice President Mike Pence casting the tie-breaking vote.

Repeal-and-Replace Debate and Vote: The first option to be taken up for debate in the Senate on Tuesday was the repeal-and-replace option entitled the Better Care Reconciliation Act. The measure would have rolled back Medicaid expansion and capped Medicaid spending, authorized insurers to offer less comprehensive health plans, and eliminated coverage mandates for individuals and employers. The Congressional Budget Office (CBO) had not yet released a score on the latest version of the repeal-and-replace option, though a CBO score on an earlier version of the bill estimated 22 million more Americans would become uninsured within 10 years. The Senate’s ACA repeal-and-replace option, needing 60 votes to pass, was rejected on a 43-57 vote.

Repeal-Only Debate and Vote: On Wednesday, the Senate began debate on a repeal-only option of the ACA, entitled the Obamacare Repeal and Reconciliation Act. Modeled after a 2015 GOP bill that was previously vetoed by President Barack Obama, the measure would have repealed ACA coverage provisions such as the individual mandate, Medicaid expansion, and premium subsidies. The CBO estimated the repeal-only option would have resulting in an additional 32 million Americans without health insurance.  The repeal-only option, needing 51 votes to pass, failed on a 45 to 55 vote.

“Skinny” Repeal Debate and Vote: After failing to pass both the repeal-and-replace and repeal-only options, Senate Republicans took up a “skinny” repeal measure, entitled the Health Care Freedom Act, on Thursday. The proposed measure was narrower in scope and was intended to be used as a way for the Senate to work with the House in a closed-door conference committee to finalize an ACA repeal-and-replace option. The “skinny” repeal measure would have repealed the individual and employer mandates, provided more flexibility to states through federal requirement waivers, expanded health savings accounts, delayed the medical device tax, and increased funds to community health centers. The CBO estimated the “skinny” repeal would leave 16 million more Americans without insurance and increase insurance premiums by approximately 20 percent over the next 10 years.

A handful of amendments were offered as debate on the measure lasted well past midnight. In a stunning turn of events, Republican Senator John McCain casted the decisive vote against the “skinny” repeal, joining Republican Senators Susan Collins and Lisa Murkowski. Given the Republican’s slim margin of majority, Majority Leader Mitch McConnell could only afford to lose the support of two Republican senators. The “skinny” measure, needing 51 votes to pass, was rejected on a 49-51 vote. After multiple iterations and seemingly-endless legislative maneuvering, the attempts to make any major changes related to the repeal or replacement of the Affordable Care Act have been decisively defeated at this time.

After last night’s vote, it is unclear what next steps Congressional Republicans will take. For the foreseeable future, however, the Affordable Care Act is here to stay. CHEAC will remain apprised of the situation and will provide updates as action resumes.