A legislative free-for-all will ensue in the Senate following Tuesday’s vote to begin 20 hours of debate on repealing the Affordable Care Act, as Republicans and Democrats try to re-shape legislation passed by the House.
Senate Majority Leader Mitch McConnell began the process Tuesday afternoon, offering the first amendment immediately after the 51-50 tally was sealed by Vice President Mike Pence’s tiebreaking vote.
McConnell’s proposal would repeal the ACA after a two-year delay — putting lawmakers safely on the other side of the 2018 congressional elections. During that period, replacement legislation would presumably be passed.
McConnell plans to offer a second amendment that would include the Senate’s updated repeal legislation, the Better Care Reconciliation Act, which features a measure by Sen. Ted Cruz, R-TX, to allow insurers to sell cheaper, less-comprehensive coverage. That amendment includes a proposal that would help Medicaid expansion enrollees move into private insurance plans.
Senators Bill Cassidy, R-LA, and Lindsey Graham, R-SC, also plan to offer a proposal that would convert nearly $110 billion in federal spending for Obamacare health insurance into state innovation grants.
And that’s just the start. After debate time equally divided between Democrats and Republicans, what comes to a floor vote could look far different in structure and cost from anything the senators have yet considered.
“The problem you have with that particular process is when you get through with the final product, you have no idea how much (the legislation) costs or what the budget assessment is or anything like that,” said Julius Hobson, senior policy advisor at Polsinelli law firm in DC.
President Donald Trump, who has pushed congressional Republicans to move more quickly on his top legislative priority, applauded the Senate for clearing the legislative hurdle and “taking a giant step to end the Obamacare nightmare.”
“The Senate must now pass a bill and get it to my desk so we can finally end the Obamacare disaster once and for all,” Trump said in a statement.
That could prove challenging, however, said Hobson, who served over 13 years as lobbyist and director of congressional affairs for the American Medical Association.
He said every Republican repeal bill has called for big cuts to Medicaid and that has been a major sticking point with GOP senators such as Rob Portman of Ohio and Shelley Moore Capito of West Virginia, even though both of them voted to begin debate.
After dramatically returning to the Senate to cast a critical vote on Tuesday, Sen. John McCain called for Republicans to work with Democrats in a bipartisan fashion as they go forward.
But speaking to reporters before the vote, Dr. David O. Barbe, president of the American Medical Association, said that can only happen if the GOP Senate and House repeal proposals are stopped.
“Once we get these stopped, then we can start talking in a bipartisan way,” Barbe told reporters in a conference call. “There is a lot of good policy out there on how to do a better job of delivering care in this country….There is no lack of good policy. It has been hijacked by politics. And that’s what we’ve got to turn.”
The politics were on full display Tuesday.
Senator Rand Paul, R-KY, was initially opposed to the motion, but ended up supporting the measure when he found he could get a vote on an amendment for a straight repeal vote.
“Some of us want clean repeal, some of us want the Senate leadership bill,” Paul said after the vote. “They're both going to get a vote early on. I think that's the way to do it. If not, if one of them fails, maybe we can find something in between that actually succeeds.”
Wisconsin Sen. Ron Johnson and McConnell were engaged in an intense conversation on the Senate floor as the vote was occurring. Senators Susan Collins, R-ME, and Sen. Lisa Murkowski, R-AK, had voted against McConnell's proposal, meaning any additional Republican defections and the measure wouldn’t pass. So Johnson's vote was critical.
Afterwards, Johnson explained why he supported the measure “The state of our healthcare system because of Obamacare, particularly in the individual market, is a very sorry state. It's a huge mess,” Johnson said explaining his vote.
As the debate moves forward, Hobson said the legislation would likely become more conservative if it goes to conference. He wouldn’t say how that would affect the bill’s chances for passage.
“In the 45 years I’ve been in this business, this is the most bizarre reconciliation process I have ever seen,” Hobson said.
Anita Kumar and Jessica Campisi contributed to this report.