Senate GOP's 'skinny repeal' fails after John McCain defects

Republicans’ last-ditch attempt to unravel the Affordable Care Act failed early Friday morning when three GOP senators voted against a “skinny repeal” bill known as the Health Care Freedom Act.

The measure failed, 51-49, with Republican senators John McCain of Arizona, Lisa Murkowski of Alaska and Susan Collins of Maine casting the deciding votes. The party could lose only two votes, with all Democrats opposed.

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“This is clearly a disappointing moment,” Senate Majority Leader Mitch McConnell said following the defeat of the measure, adding that it will be “interesting to see” what Democrats suggest as a way forward.

One effort he doesn’t want to be part of, McConnell noted, is “bailing out insurance companies without any thought of reform.”

For his part, Senate Minority Leader Chuck Schumer, D-N.Y., suggested lawmakers “turn the page” and work together on improving the ACA.

This was the third bill that the Senate voted on to repeal the ACA this week that failed. The other two measures, the Better Care Reconciliation Act and the Obamacare Repeal Reconciliation Act, would have repealed more of the current law.

What the bill contained

The bill, which was released around 10 p.m. Thursday, would have permanently repealed the ACA’s individual mandate, temporarily removed the employer mandate and extended the moratorium on the medical device tax through 2020. It would also have increased health savings account contributions, increased community health center funding and banned federal payments for one year to Planned Parenthood.

Further, the bill included changes to section 1332 waivers that said the Health and Human Services secretary “shall” approve states’ applications to waive certain ACA rules, as long as those proposals cover as many people as comprehensively as the ACA without increasing federal spending. Those “guardrails” had been struck from the Better Care Reconciliation Act’s version of the provision, but added back in after the Senate parliamentarian ruled Thursday that the BCRA version of the provision wouldn’t pass muster.

The Congressional Budget Office said in an analysis released late Thursday that the bill would increase the number of uninsured individuals by 16 million as of 2026, compared to under the ACA. It said individual market premiums would increase by 20% in all years between 2018 and 2026, relative to current law. 

The CBO also estimated that bill would reduce the federal deficit by $135.6 billion. It had to save at least $133 billion to be eligible under budget reconciliation rules.

Into the wee hours

Not long after the bill was released Thursday night, Democrats took to the floor to denounce it and the process in general. Sen. Chris Murphy, D-Conn., for example, called the healthcare overhaul saga “nuclear-grade bonkers.” 

The American Medical Association also issued a statement calling the bill a “toxic prescription that would make matters worse.”

RELATED: Healthcare groups warn against 'skinny repeal' that targets ACA coverage mandates

Around 12:20 a.m. Friday, the Senate began voting on a motion from Sen. Patty Murray, D-Wash., to send the bill back to committee. The motion failed, but the Senate held the vote open for roughly an hour while Vice President Mike Pence helped GOP leadership whip up votes for the skinny repeal measure. 

Pence spent a significant amount of that time talking to Sen. McCain, who along with fellow GOP senators Lindsey Graham, R-S.C., Bill Cassidy, R-La., and Ron Johnson, R-Wisc., held a press conference earlier in the day to threaten to withhold their votes for the skinny bill unless House leaders offer assurances that they will conference on the bill rather than pass it as is.

“The skinny bill as policy is a disaster,” Graham said during that conference. “The skinny bill as a replacement for Obamacare is a fraud. The skinny bill is a vehicle for getting conference to find a replacement—it is not a replacement itself.”

House Speaker Paul Ryan responded with a statement on Thursday night that seemed aimed at reassuring them. “If moving forward requires a conference committee, that is something the House is willing to do,” he said. Yet that statement also left the door open to pass the skinny repeal bill.

Ultimately, out of the four senators who held the press conference, only McCain voted against the measure.

In case you missed it

Earlier Thursday, the Senate voted 57-0 to defeat a single-payer amendment brought by Sen. Steve Daines, R-Mont., with the purpose of exposing which Democrats would support the left-leaning proposal.

Indeed, Daines himself admitted before holding the vote that “socialized medicine would be a disaster for the American people.”

Thus, Sen. Bernie Sanders, I-Vt.—himself a strong supporter of a single-payer system—said earlier in the day that he wouldn’t support the measure, calling it a “sham.”