The Senate Health Bill is Dead

While you were sleeping, the Republican-led Senate bill to repeal and replace many aspects of the Affordable Care Act has died. Two more Republican senators, Senator Mike Lee of Utah and Senator Jerry Moran of Kansas, said they would be a “no” for a procedural vote on the bill, bringing the number of Republican senators in opposition to the Better Care Reconciliation Act to four. No Democrats were expected to vote for the bill, so Republicans could only have afforded three defections from their ranks in the Senate.

The bill would have undone or greatly neutered key provisions of the ACA, also known as Obamacare. A recent draft circulating of the bill, for example, would have allowed insurers to sell so-called “skimpy” insurance plans, which lacked the minimum standards for coverage that insurers must provide under the ACA. This could have included coverage issues important to people with diabetes, like providing coverage for certain medical conditions and prescription drug coverage. Critics feared this provision would have caused healthy people to flock to such plans, leaving people with preexisting conditions in de facto high risk pools, which are much more expensive. The legislation also would have greatly curtailed the expansion of Medicaid that was undertaken under the ACA.

This likely also marks the end of the line for similar legislation that passed the House of Representatives, known as the American Health Care Act. However, this does not represent the end of efforts to repeal and replace the ACA, a law which for the first time barred insurers from denying coverage or charging more for preexisting conditions. In a late-night tweet, President Donald Trump indicated that he wanted the Republican-majority Congress to repeal the ACA without having a replacement plan in place.

Senate Majority Leader Mitch McConnell (R-KY) echoed this sentiment in a statement last night:

“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.”

In other words, the senator would like to pass legislation to repeal the ACA, giving the law a two year sunset, without having a replacement plan in place. It’s unclear if Senator McConnell has the votes to do this. Earlier in the year, this repeal-now-replace-later idea was floated in Congress, but it never gained enough traction. Also, it may be difficult for Republican lawmakers up for reelection in 2018 to explain to voters that they were working on a replacement bill after voting to start the clock on repealing what has been now shown to be a semi-popular piece of legislation.

However, it should be noted that on-the-record Republican opposition to the current Senate bill is evenly divided between those who worry about the effects of repealing the ACA and those who felt the current legislation didn’t go far enough in repealing the law. If Senator McConnell can flip two “no” votes to the “yes” column, he would be able to pass the legislation he has proposed. Time will tell if Republicans will coalesce around Senator McConnell’s call for a repeal-only bill.

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Craig Idlebrook is a past editor for Insulin Nation, Type 2 Nation, and Información Sobre Diabetes. He is now the community engagement and content manager for T1D Exchange.

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