In the end, the survival of the Affordable Care Act came down to the man who made a dramatic return to the Senate this week after undergoing brain surgery.
Sen. John McCain, an Arizona Republican, joined GOP Sens. Susan Collins of Maine and Lisa Murkowski of Alaska early Friday morning in voting against the so-called “skinny repeal’’ of the ACA.
The measure was defeated by a vote of 49 to 51, with all Senate Democrats voting against it. Both Georgia Republican senators, Johnny Isakson and David Perdue, voted in favor of the proposal.
With the historic vote, the ACA, which has survived two U.S. Supreme Court decisions, may have made its narrowest escape yet.
But in the aftermath of the Republican measure’s defeat, the problems with Obamacare’s insurance markets remain. What happens now to those insurance exchanges is a crucial issue going forward. And it’s unclear whether Republicans will make another legislative attempt to repeal the 2010 law.
The ‘’skinny’’ bill was far short of the overhaul that Republicans envisioned when they campaigned for years against Obamacare.
Still, the bill would have caused a substantial disruption in the health insurance markets by eliminating the ACA requirement for most Americans to have coverage, known as the individual mandate. The Congressional Budget Office projected that 16 million fewer Americans would have coverage over the next decade if the proposal had become law. It would also have raised premiums 20 percent next year, the CBO said.
It would have also suspended the mandate for large employers to offer coverage to their workers.
The stripped-down measure would delay a tax on medical devices. It would also cut off federal funds for Planned Parenthood for one year and increase federal grants to community health centers. And it would increase the limit on contributions to tax-favored health savings accounts.
And the “skinny’’ bill would make it much easier for states to waive federal requirements that health plans provide consumers with a minimum set of benefits such as maternity care and mental health coverage. It would also eliminate funds provided by the ACA for a wide range of prevention and public health programs.
After the vote, Democratic senators called for a bipartisan effort on shoring up the health insurance exchanges, which aim to provide coverage to those who don’t have job-based or government coverage.
Sen. Jeff Merkley, an Oregon Democrat, said after the measure’s defeat that the Trump administration should continue the ACA subsidies to insurers that bring down out-of-pocket costs for consumers in the exchanges.
Merkley also called for extra funding for insurance companies that have a disproportionately high share of medical costs from services provided to their exchange patients.
In Georgia, nearly 500,000 people enrolled for coverage this year in the state’s exchange.
Senate Majority Leader Mitch McConnell (R-Ky.) unveiled the “skinny repeal” draft only a couple of hours before Friday morning’s vote. “Our only regret is that we didn’t achieve what we hoped to accomplish,” McConnell said after the failed vote.
“It is time to move on,” McConnell said.
President Trump in an early morning tweet reacted to the Senate vote, writing “3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let ObamaCare implode, then deal. Watch!”
The American Medical Association’s president, Dr. David Barbe, issued a statement after the vote saying, “While we are relieved that the Senate did not adopt legislation that would have harmed patients and critical safety net programs, the status quo is not acceptable. We urge Congress to initiate a bipartisan effort to address shortcomings in the Affordable Care Act.
“The first priority should be to stabilize the individual marketplace to achieve the goal of providing access to quality, affordable health coverage for more Americans.”
On Thursday, McCain and Sen. Lindsey Graham (R-S.C.) had been seeking a guarantee from House leaders that if the Senate approved this “skinny repeal,’’ the House would not simply approve that exact bill and send it to President Trump’s desk.
Graham, in fact, called the pared-down bill a “disaster’’ and a “fraud.”
McCain returned to the Senate on Tuesday and called for the health care bill to go through “regular order” in the chamber.
“Let the Health, Education, Labor, and Pensions Committee under Chairman [Lamar] Alexander and Ranking Member [Patty] Murray hold hearings, try to report a bill out of committee with contributions from both sides,’’ McCain said Tuesday. “Then bring it to the floor for amendment and debate, and see if we can pass something that will be imperfect, full of compromises, and not very pleasing to implacable partisans on either side, but that might provide workable solutions to problems Americans are struggling with today.”