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After fellow Republicans kill his bill, McConnell adopts an idea he had dismissed: repeal Obamacare now, replace it later

By Al Cross
Kentucky Health News

With his health-insurance bill killed by fellow Republicans late Monday, Senate Majority Leader Mitch McConnell quickly adopted a version of idea he had dismissed: repealing the Patient Protection and Affordable Care Act, but with a two-year delay.

McConnell did not follow through on the warning he gave Republicans last month, that if they couldn’t pass a comprehensive bill on their own, they would have to join with Democrats to stabilize the market for private health insurance.

Instead, McConnell will use the bill the House passed May 4 as a vehicle for a repeal-now, replace-later strategy like that advocated by his Kentucky seatmate, Republican Rand Paul. President Trump had also suggested that strategy, and did it again Monday night, soon after the joint announcement of opposition by Sens. Jerry Moran of Kansas and Mike Lee of Utah.

At about 10:45 p.m., McConnell issued this statement: “Regretfully, it is now apparent that the effort to repeal and immediately replace the failure of Obamacare will not be successful. In the coming days, the Senate will vote to take up the House bill with the first amendment in order being what a majority of the Senate has already supported in 2015 and that was vetoed by then-President Obama: a repeal of Obamacare with a two-year delay to provide for a stable transition period to a patient-centered health care system that gives Americans access to quality, affordable care.” He declined to be more specific about “the coming days.”

Around 9 p.m., Lee and Moran had joined Paul and moderate Republican Susan Collins of Maine in publicly opposing McConnell’s revised bill. That left the majority leader two votes short of the 50 he needed from Republicans to advance the bill.

“The two conservatives timed the release of their statements and made clear that modest tinkering around the edges of the legislation drafted by McConnell would be insufficient to meet their demands,” The Washington Post reported.

Asked June 30 about the idea of repealing now and replacing later, McConnell said he would “stick to” his strategy of passing a comprehensive repeal bill only with Republican votes.

McConnell said in early June that he wasn’t working with any of the 48 Democrats because “They’re not interested in doing anything we’re interested in doing” on health care, but in late June he warned Republicans that if they couldn’t pass a comprehensive overhaul on their own, they would have to join with Democrats to stabilize the market for private health insurance, including taxpayer-subsidized plans.

“My suspicion is in any negotiation with Democrats will include none of the reforms that we would like to make on the market side and the Medicaid side,” McConnell said then.

Before McConnell’s late-night announcement, Senate Democratic Leader Chuck Schumer of New York called for a bipartisan effort. “This second failure of Trumpcare is proof positive that the core of this bill is unworkable,” Schumer said.

“Rather than repeating the same failed, partisan process yet again, Republicans should start from scratch and work with Democrats on a bill that lowers premiums, provides long-term stability to the markets and improves our health-care system.”

McConnell had promised a vote on his bill this week, but had to back off when Sen. John McCain of Arizona was sidelined by surgery. Paul said Sunday that the delay would give conservatives time to realize that the bill wasn’t what they want.

McConnell had hoped to get Lee’s vote by allowing insurance companies to sell the sort of low-cost, low-coverage plans that the 2010 law prohibited. (Insurance companies said the language would split the insurance market between the health and not so healthy, driving up costs for the latter.)

Sweeteners that McConnell added to the bill to get moderates, such as more money to treat opioid addiction and a one-year delay in the phase-out of Medicaid expansion, forced him to keep Obamacare’s taxes in the bill, and Lee objected to that.

Also, The Associated Press reports, Lee said the bill didn’t “go far enough in lowering premiums for middle class families” or “create enough free space from the most costly Obamacare regulations.” Moran said the bill “fails to repeal the Affordable Care Act or address health care’s rising costs.”

“Moran faced pressure at home about how the bill would affect Kansas, including its rural hospitals,” The New York Times noted, “The Kansas Hospital Association said last week that the latest version “comes up short, particularly for our most vulnerable patients.”

The Kentucky Hospital Association likewise opposed McConnell’s plan to phase out federal funding for expansion of Medicaid, which has boosted many Kentucky hospitals. It said that if the expansion was phased out, Congress should restore the 2010 law’s cuts in special reimbursements to rural hospitals for care of Medicare patients.

The defeat was “one of the most embarrassing blows Mitch McConnell has endured in his two and a half years as Senate majority leader,” Sean Sullivan writes for The Washington Post. With his next move, “McConnell appeared to be issuing a dare. . . . He was giving the conservatives the chance to vote on a straight-up repeal. But first they would have to record their vote for a House bill they loathe. There would be no guarantee that the amendment to repeal would pass — and no guarantee that other, less welcoming amendments would fail.

“If hard-right conservative senators vote no to starting debate and the effort quickly collapses, McConnell can come back at them and blame them. He is likely to try shifting the blame onto others, and he has given himself a new talking point to counter the ‘clean repeal’ crowd — including President Trump. If they vote yes, then suddenly they’re back on track, at the table debating legislation that has at least some chance of passing in some form.

“But don’t count on the latter scenario ever happening. Even if the Senate got to a clean repeal vote, it wouldn’t be likely to pass. Moderates are petrified of voting for repeal-only legislation. Even some conservatives suggested Monday that the better idea is to completely start over again with a new effort led by the committees. So why would the conservatives go out on a limb for something that isn’t expected to actually become law?”
Laura Litvan and Steven T. Dennis of Bloomberg write, “A repeal without a replacement is almost certain to get blocked in the Senate as well.”

Leigh Anne Caldwell of NBC News notes, “Just last week, Sen. Roy Blunt, R-Mo., told reporters that straight repeal wouldn’t get the support of 50 Republicans.” Blunt, chair of the Rules Committee, is a close McConnell ally.

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