Yet again, it was an amazing week.
The Trumpcare zombie ambled on. On Tuesday, with an appearance by Sen. John McCain (R-AZ) after cancer surgery and a tie-breaking vote case by Vice President Pence, Senate Republicans pushed through a motion to proceed to debate on repealing the Affordable Care Act (aka Obamacare).
McCain criticized the procedures the Republican-controlled Senate was using but voted in favor of debate anyway. Some Democrats criticized him for voting for a process that could result in the end of health insurance for millions even as McCain has his own major health issues.
Tuesday evening, the latest version of Trumpcare repeal-and-supposedly-replace legislation (Trumpcare 3.0 by some counts) failed by a vote of 43 yes votes to 57 no votes, a stunning defeat for the Republican-controlled Senate.
On Wednesday, the Senate then defeated a bill repealing Obamacare with no replacement by 45 yes votes and 55 no votes, yet another major loss. The legislative process kept proceeding but it seemed that the zombie had run into a brick wall, even though its legs kept moving.
With great effort, the zombie almost succeeded in scaling that wall, though. Senate (Republican) Majority Leader Mitch McConnell proposed a “skinny repeal” bill that would just repeal the parts of Obamacare that Republicans hate the most, with the primary target being the requirement that nearly every American have insurance or pay a penalty.
The problem is that you can’t run a health insurance program where healthy people can skip health insurance and not get it unless they get sick. (Insurers cannot currently bar those with preexisting conditions.) You tend to get all the sick people in the program and many of the healthy people outside of it. That means that the insurance premiums for those in the program skyrocket in the so-called “death spiral” where fewer and fewer people can afford the premiums. The system then collapses.
Still, McConnell tried to sell “skinny repeal” as a bill that would then go into a Senate/House conference committee. There, in theory, a bill acceptable to both houses would be hammered out. The House, though, could simply vote to accept the Senates’ “skinny repeal” bill as is. Many Republicans demanded that Speaker of the House Paul Ryan guarantee that the House would not do that, but his statement was ambiguous.
You know a bill is screwed up when its supporters will only vote in favor of it with the promise that it will NOT become law. But the Senate Republicans desperately wanted to pass an Obamacare repeal bill of some sort so they could claim they had fulfilled their many promises over the last seven years to repeal Obamacare.
(By the by, moving to a single-payor health-care system – eliminating the insurers – would save the United States about 17 trillion dollars over 10 years.)
That brought us to Wednesday night, when McConnell had scheduled a vote on “skinny repeal” for midnight. Presumably that was so fewer people would be watching.
It seemed the Republicans had the votes to let Pence break a tie again. Then John McCain entered the Senate and began conferencing with Senator Lisa Murkowski of Alaska and Senator Susan Collins of Maine, the two Republicans on record to vote against “skinny repeal”. When it was his time to vote, McCain dramatically stood in front of the Senate Clerk and literally gave a thumbs-down. The bill failed by that single vote.
(There is a fascinating account of what transpired in the Senate Chamber for those who are interested.)
Kudos to Republican Senators McCain, Murkowski and Collins for defeating this awful bill – and to the 48 Democratic Senators that Senate Minority Leader Chuck Schumer kept together to vote as a block against it.
Sadly, that is not the end of the saga. McConnell just needs to get one of those three Republican Senators to vote differently and “skinny repeal” passes. One must imagine he will be putting tremendous pressure on them and offering them huge favors for a changed vote. While it seems those three will not easily be persuaded, it is still possible.
Further, Senator McCain has particularly aggressive brain cancer and is not expected to last a year. If he retires or passes on, at that point Arizona’s Republican governor Doug Ducy appoints an interim senator and that senator could well vote with McConnell.
2018 brings further challenges. Many more Senate seats that are up for re-election in 2018 are held by Democrats than by Republicans. If the Republicans gain an additional seat, again “skinny repeal” could pass.
Finally, Trump again is saying that he may veto the money needed to be given to the insurance companies to help pay for the health-insurance premiums that people with limited income receive. White House aide Kelley Conway says that Trump will decide this week. If those subsidies are blocked, it would mean that millions of poorer Americans would not be able to buy health insurance. That means that they will use emergency rooms for healthcare (emergency rooms cannot turn away patients) and everyone else’s health insurance prices increase.
On the other hand, health insurers hate this approach and perhaps they and the hospitals will be able to exert enough pressure to save the subsidies.
And with all that, we’re not even going to address Anthony (the “Mooch”) Scaramucci’s foul public comments, Reince Priebus being tossed from the White House, the latest North Korean missile test or Russia.