Updated July 17, 2017, 4:15 pm
At the end of the day, a band of conservative GOP lawmakers thrust one of the final stakes through the heart of the Senate's health care bill. But the saga of Republicans' efforts to repeal Obamacare isn't over yet. (UPDATE: Now, it may be. Three Republican moderates—West Virginia's Shelley Moore Capito, Alaska's Lisa Murkowski, and Maine's Susan Collins are now on the record against Majority Leader Mitch McConnell's latest drive to revive the Senate's health care bill via a "repeal-and-delay" strategy, according to Politico. That could effectively kill the effort once and for all, although McConnell is signaling that he may still hold a vote.)
Senate Majority Leader Mitch McConnell on Monday night confirmed what many had suspected—that even a revised version of the Better Care Reconciliation Act (BCRA), which would gut many Obamacare provisions and take a hacksaw to Medicaid, didn't have the support of the requisite 50 Republicans to pass.
Conservative Senators Jerry Moran of Kansas and Mike Lee of Utah joined with already-declared holdouts Rand Paul of Kentucky and moderate GOP-er Susan Collins of Maine to state their opposition in separate statements Monday. The three conservatives didn't believe the Senate health bill dismantled enough of Obamacare; Collins expressed concerns about its cuts to Medicaid and other provisions that could potentially roil insurance markets.
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But as McConnell made clear in his statement, the Senate is still poised to vote on Obamacare repeal legislation. This time, it'll take the shape of a 2015 bill that actually reached President Obama's desk (and was promptly vetoed)—one that's come to be known as "repeal-and-delay" because it, well, sets a two-year timetable for Obamacare repeal. The theory goes that this "delayed repeal" would give Republicans enough time to craft an alternative to the health law.
But that is far easier said than done, as the GOP Congress has learned over the course of the last six months. There are still deep divisions within the party over a rollback of Obamacare's Medicaid expansion, regulations that could undermine protections for Americans with pre-existing conditions, funding for Planned Parenthood, and numerous other provisions.
And it's unclear that McConnell's repeal-and-delay gambit would garner 50 votes, either. Previous analyses of that effort suggested it would cost even more losses in health care coverage (to the tune of 32 million fewer insured by 2026, according to the Congressional Budget Office) compared to the Senate's current bill and foster sharp premium spikes. And while a straight repeal may be able to win back some of the conservative defectors, moderates like Sen. Rob Portman of Ohio and West Virginia's Shelley Moore Capito (in addition to Collins) have already expressed concerns that a repeal-only strategy without a replacement would wreak even more havoc and uncertainty on Obamacare's individual insurance marketplaces. (This post has been updated to reflect late-breaking developments on this front.)
Still, it's possible the McConnell can cobble up the votes given the mountainous political pressure on the GOP to fulfill its nearly decade-long promise to scuttle the health law. Even if he does, a new round of political wrangling will open up as the Senate will have to proceed to negotiations with the House to iron out the differences between their very different bills.
President Donald Trump, meanwhile, is pressuring the Senate to pass a repeal-and-delay bill. And insurance companies are still in uncertain limbo over what future regulations will hold.