Here's why.

By Sy Mukherjee
September 26, 2017

Obamacare repeal died, yet again, on Tuesday.

Senate Republican leaders have chosen not to vote on the Graham-Cassidy health care bill once it became apparent it simply didn’t have the votes to pass. Support for the bill began building steam earlier this month but recently sputtered as prominent GOP Senators like Kentucky’s Rand Paul, Arizona’s John McCain, Maine’s Susan Collins, and now Alaska’s Lisa Murkowski defected over various legislative process and policy concerns.

Obamacare supporters may be cheering, but the Obamacare repeal drama will never truly be over as long as its fiercest opponents hold the reins of Congress and the White House—and continue failing to deliver on a central political promise delivered to ad nauseum the GOP base over the past seven years.

“We haven’t given up on changing the American health care system,” Senate Majority Leader Mitch McConnell of Kentucky said in a statement after the bill was pulled. “We are not going to be able to do that this week, but it still lies ahead of us, and we haven’t given up on that.”

Graham Cassidy bill sponsors Sen. Lindsey Graham of South Carolina, Bill Cassidy of Louisiana, Dean Heller of Nevada, and Ron Johnson of Wisconsin vowed to press on with the quixotic effort even though it’s doomed ahead of a September 30 deadline to pass health care legislation on a strictly Republican party-line vote.

“As a result of our efforts in the last few weeks, it’s not a question of ‘if’ Graham-Cassidy-Heller-Johnson replaces Obamacare–it’s a question of when,” the legislative quartet wrote in a statement. “Due to circumstances under our control and not under our control, the process and timing of this vote did not line up this time. However, our idea of sending the power and money to the states clearly resounded with our colleagues.”

That may or may not prove to be true. Conservatives like Paul had expressed displeasure that even Graham Cassidy, by some accounts the most radical of the multiple recent Obamacare repeal efforts, didn’t go far enough to dismantle the health law; moderates like Collins and Murkowski have been dismayed over the legislation’s expected effect of fundamentally restructuring both Obamacare and the Medicaid program for the poor through big federal funding cuts and provisions which might allow insurers in certain states to charge Americans with pre-existing conditions more money.

But McCain has previously stated his main problem is with the rushed legislative process driving Obamacare repeal bills; if Republicans can hobble a number of Democratic votes after going through the committee process (admittedly a difficult proposition), it’s possible he could be convinced to change his mind.

The bigger issue is that Republicans, who control both houses of Congress and the presidency, could revive the special legislative vehicle allowing for a major bill to be passed with just 50 votes on a future budget resolution. While some lawmakers have said they’re ready to pivot to tax reform in the near future, budget fights in 2018 and 2019 could revive party-line efforts to repeal Obamacare. It’s unclear whether the opposition driven by the chaos of this year’s initial push would persist closer to a Congressional or presidential election.

And there are plenty of ways the Trump administration can undermine Obamacare without a legislative boost. For instance, the funding for outreach during Obamacare’s upcoming open enrollment season has been gutted by the administration, while President Donald Trump’s threats to end certain critical subsidies to insurers that shield some low-income consumers from high out-of-pocket medical costs have catalyzed a deluge of insurance company exits from the law’s marketplaces.

It’s even possible that Democrats and Republicans can hash out a short-term fix to shore up Obamacare’s very real problems, only to see the repeal debate come back to life down the line—after all, as Trump has pointed out on multiple occasions, the GOP has woven Obamacare opposition into the very fabric of its political being.

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