A vote delay doesn't necessarily mean demise.
Republicans appeared to face a devastating setback when Senate Majority Leader Mitch McConnell yanked the GOP health care bill from a planned vote this week after defections from a number of critical lawmakers. But that setback could very well prove to be temporary. In fact, a number of relatively minor tweaks may give reluctant Senators the political cover they’re seeking to ultimately carry the Obamacare repeal legislation over the finish line.
The Senate’s Better Care Reconciliation Act (BCRA), the somewhat-more-moderate sidekick to the House-passed American Health Care Act (AHCA), drew fire from conservative and moderate Senators alike. Moderates like Nevada’s GOP Sen. Dean Heller and Maine’s Susan Collins hated its deep cuts to Medicaid, a federal-state partnership program which provides insurance to tens of millions of the nation’s poorest people. Conservatives like Kentucky’s Rand Paul and Utah’s Mike Lee didn’t think it went far enough in dismantling Obamacare. The Congressional Budget Office’s (CBO) verdict that the legislation would lead to 22 million fewer insured Americans didn’t help matters, either.
Click here to subscribe to Brainstorm Health Daily, our brand new newsletter about health innovations.
But even more ostensible defections emerged after McConnell delayed the Senate health bill vote to after the July 4th holiday. Ohio’s Rob Portman (who hails from a state which has benefited greatly from Obamacare’s Medicaid expansion), said he wasn’t a fan of the legislation on Tuesday evening. Perhaps a bit more surprisingly, blood-red Kansas Sen. Jerry Moran expressed his own opposition.
Moran’s reluctance largely centers on how the bill would cut back assistance to rural hospitals (many of which depend on Medicaid and a number of other Obamacare public health provisions). Other Senators have decried both the Medicaid cuts and the BCRA’s potential hacksaw to funding combating the opioid addiction crisis. Those are issues that deeply affect West Virginia GOP Sen. Shelley Moore Capito, Alaska’s Lisa Murkowski, and Wisconsin’s Ron Johnson, too.
But the House’s American Health Care Act was also pulled from that chamber’s floor before it ultimately passed on a 217-213 vote last month. The major factor that reversed its prospects? An amendment to add just $8 billion in funding to fund coverage for Americans with pre-existing conditions in states that could choose to opt out of Obamacare’s protections for the medically needy under the AHCA. Many major public health experts and economists have argued that’s not nearly enough money—it was, however, enough political capital to get the House bill approved.
It’s not difficult to imagine a similar scenario playing out in the Senate. Add several billions in rural hospital funding here, an opioid addiction fund there, and perhaps tweak the Senate bill’s Medicaid cuts to a formula that still guts the program, but just not as quickly (by tying caps to the growth in medical inflation rather than regular consumer inflation, as the BCRA currently does).
Of course, the bill could still flame out. Senators have a far larger constituency pool than House members do, and many crucial votes are based in states that expanded Medicaid (for instance, Ohio Gov. John Kasich has been a vocal opponent of the Senate bill, which may play a part in Sen. Portman’s considerations). And if the bill were to move in a way that appeases moderates, it could very well alienate conservatives like Paul even more. But Trumpcare is by no means dead—it’s just on a very temporary hiatus.