Obamacare repeal fails again in Senate; McCain key ‘no’ vote

The 49-51 defeat – capping hours of drama on the Senate floor - left open the question of whether congressional Republicans can carry through with a key 2016 key promise to repeal the law known as Obamacare.

Sens. Lisa Murkowski, R-Alaska and Sen. Susan Collins, R-Maine, joined McCain in voting against the measure. Their votes were less surprising – both have been consistent critics of the GOP proposals. Sen. Sherrod Brown, D-Ohio, opposed the bill and Sen. Rob Portman, R-Ohio supported it.

The vote – which began shortly before 1:30 a.m. Friday – capped a dramatic week that included a press conference late Thursday where three Republican senators – including McCain - essentially pleaded that the Republican legislative package not become law.

Calling the Senate proposal “a fraud” and “a disaster,” Sen. Lindsey Graham of South Carolina said he was prepared to vote for the Senate package only if House Speaker Paul Ryan promised not to pass make that bill a law. The Senate bill, he said, “was never sold to be the final product” – only as a means to get something passed so that House and Senate negotiators could work out the final details. He was joined McCain and Ron Johnson of Wisconsin.

“Politically, this would be the dumbest thing in history to throw this out there, collapse the individual market and own the problem when Obamacare is collapsing,” Graham said.

Ryan responded hours later, saying “If moving forward requires a conference committee that is something the House is willing to do.” A phone call between Ryan, Johnson and Graham at around 9:45 p.m. Thursday sealed the deal: Graham and Johnson would vote for the Senate plan after all, if only to move the repeal of the bill forward.

McCain, recently diagnosed with brain cancer and recovering from a surgery, resisted.

Providing less suspense to the negotiations, Portman, R-Ohio, announced early Thursday afternoon that he would support the scaled-back bill, which on Capitol Hill quickly was dubbed a “skinny repeal.” Portman said “we need to repeal and replace” Obamacare, saying “this law isn't working for Ohio families and small businesses who've seen their premiums and deductibles skyrocket.”

The bill would have repealed for eight years the requirement that employers provide health care, repealed the medical device tax for three years and defunded Planned Parenthood for a year. It would also have ended the requirement that people buy health insurance or pay a fine.

From the beginning, Republican senators acknowledged that they were only backing the most recent Senate plan to keep the process alive.

“If there was a health-care bill which couldn't get 51 Senate votes, why would lawmakers assume that a conference committee will magically come up with a solution that the Senate will pass?” said Brian Riedl, a former chief economist for Portman and now a senior fellow at the Manhattan Institute, a conservative nonprofit in Washington.

Medical organizations, meanwhile, warned that without the fines for not buying coverage, the already fragile federally subsidized marketplaces established by Obamacare could collapse.

“Eliminating the mandate to obtain coverage only exacerbates the affordability problem that critics say they want to address,” said David O. Barbe, president of the American Medical Association. “Instead, it leads to adverse selection that would increase premiums and destabilize the individual market.”

As Senate GOP leaders struggled to craft their scaled-down package, sullen conservatives already were blaming more-moderate Republicans for the inability to act on campaign promises during the past seven years to scrap Obamacare and devise a more market oriented alternative.

“This process was always going to be difficult—no consensus was built over the past seven years—but this week’s gamesmanship on the Senate floor highlights why conservatives are justifiably frustrated with the obstinacy of their more moderate colleagues,” said Michael Needham, chief executive officer of the Heritage Foundation, another conservative nonprofit in Washington.

Because details of the package weren’t made public until late Thursday, it was difficult to calculate how many Americans would lose coverage. Democrats passed around a report suggesting more than 500,000 people in Ohio would lose insurance coverage and premiums in the individual market could rise by $550 per person.

Brown cited an analysis by a former insurance company CEO who is now a Case Western Reserve University professor showing "the so-called 'skinny repeal' would lead to millions losing coverage while driving up insurance costs on middle-income Americans and leaving taxpayers with a larger bill to cover."