The Senate barreled towards a vote to repeal major pillars of Obamacare late Thursday night after months of painful negotiations and soul-searching that laid bare a hard-to-swallow political reality for Republicans: There is little will left in the GOP to gut a health care law that the party has been railing against for seven years.
Shortly before 10 p.m. ET, Senate Republican leaders finally unveiled legislation that had been closely guarded from the public — as well as their own colleagues — for days.
Vice President Mike Pence arrived at the Capitol at 11:30 p.m ET to cast a potential tie-breaking vote.
The legislation, referred to as a “skinny repeal” bill, would repeal the Affordable Care Act’s individual and employer mandates and temporarily repeal the medical device tax. The bill would also give states more flexibility to allow insurance that doesn’t comply with Obamacare regulations.
The bill would mean 16 million more people would be uninsured by 2026 than under Obamacare, the Congressional Budget Office said in a report released late Thursday night.
But just hours away from a vote, it was still unclear whether Senate Majority Leader Mitch McConnell had garnered the 50 “yes” votes needed to pass it. The most notable holdout was Arizona Sen. John McCain, who had made a dramatic return to Washington after brain cancer surgery this week in part to cast this vote.
McCain and several of his colleagues had thrown the Republican negotiations into turmoil earlier in the day, when they threatened to scuttle the bill unless they were offered guarantees that the House would enter negotiations after the Senate passed the bill.
The drama — Republican senators imploring their own colleagues across the Capitol to vow that they would not pass the bill they are about to pass — crystalized the remarkable dissatisfaction and deep reservations that Republican members feel about weakening Obamacare and threatened the prospect of providing a long-awaited legislative victory to the party and President Donald Trump.
“Go Republican Senators, Go! Get there after waiting for 7 years. Give America great healthcare!” Trump tweeted late Thursday.
After a phone call with House Speaker Paul Ryan, GOP Sens. Lindsey Graham and Ron Johnson said they had received the reassurances they needed and would vote yes.
But McCain was uncharacteristically silent as he left the Senate chamber.
“I think John is rightfully upset with the process and whatever he does, he’s earned the right to do it,” Graham told reporters.
Earlier in the evening, Graham and his colleagues had savaged the “skinny repeal” bill.
“I’m not going to vote for a bill that is terrible policy and politics just to get something done,” Graham said at a press conference. Joined by McCain, Johnson and Bill Cassidy, Graham said he has grown increasingly concerned that contrary to GOP leaders’ assurances, the bill that the Senate passes would be immediately taken up by the House — rather than going to a House-Senate conference for further negotiations — and end up on Trump’s desk.
“We have to have an assurance that it will go to a normal conference — right now that is not the case.”
Shortly after that press conference, Ryan responded that the House would be willing to go to a conference committee but his carefully crafted statement did not include a specific guarantee that the House would not vote on the Senate’s proposal. It appeared aimed at moving the process forward while protecting House Republicans from being blamed if should the entire process collapses.
“The burden remains on the Senate to demonstrate that it is capable of passing something that keeps our promise, as the House has already done,” Ryan said. “Until the Senate can do that, we will never be able to develop a conference report that becomes law.”
As he received a barrage of questions from reporters about the Senate’s strategy of passing something that it doesn’t ultimately want the House to pass, Cornyn pushed back with this quip: “I guess we ought to go back to Schoolhouse Rock.”
Rep. Mark Meadows, leader of the House Freedom Caucus, the group of conservatives who can help pass or sink a health care bill in the House, says he doesn’t like a skinny-only plan.
“Am I gonna send a skinny health care plan to the President for him to sign? The answer is absolutely not,” Meadows told reporters.
Senate Minority Leader Chuck Schumer said Ryan’s statement is insufficient.
“That is not worth anything,” Schumer, D-New York, said on the Senate floor. “They want to pass this bill, skinny repeal, and send it to the President.”
The bill calls for jettisoning the individual mandate, one of Obamacare’s least popular provisions. And it would eliminate the mandate that employers provide affordable coverage for eight years.
It would defund Planned Parenthood and some similar providers for one year, while giving additional funding to Community Health Centers.
The legislation would allow states to waive Obamacare’s insurance regulations.
It would allow people to sock away more money in Health Savings Accounts, a favored vehicle of Republicans, and the bill would eliminate the tax on medical device manufacturers for three years.
Vote-a-rama
The Republican Party’s ongoing efforts to pass legislation to weaken the Affordable Care Act is expected to culminate in the famous Senate process known as vote-a-rama, in which senators can introduce an unlimited number of amendments — often for the purpose of driving home a political point and forcing colleagues in the other party to cast uncomfortable votes.
Throughout the week, Democratic aides said they were fully prepared to flood the zone. The ultimate goal will be “to make this process so painful that voting ‘no’ on the final proposal will be the only thing that provides relief for them,” was one aide’s blunt outlook.
Sen. Patty Murray, D-Washington, blasted the possibility of an early-morning vote.
“It appears that the Republican leader has a last-ditch plan waiting in the wings,” Murray said on the floor. “As soon as they have an official score from the CBO, which could be hours from now, in the dead of night, Sen. McConnell will bring forward legislation that Democrats, patients and families, and even many Senate Republicans, have not seen and try to pass it before anyone can so much as blink.”
No matter what, senators are ready for an all-nighter.
“I brought my pillow,” said Sen. John Kennedy, R-Louisiana. I don’t think they let you sleep on the Senate floor — but you can sleep in the hall if you need to.”
Threat to Murkowski?
Leadership’s careful maneuvering — a “high-wire act,” Sen. John Cornyn, the second-ranked Republican chamber called it Wednesday — came as the Trump administration was pursuing a different tact, according to a report in the Alaska Dispatch News.
According to that report, Interior Secretary Ryan Zinke called Alaska Sens. Lisa Murkowski and Dan Sullivan and informed them that Murkowski’s opposition to the vote Tuesday to start debate “put Alaska’s future with the administration in jeopardy.”
Murkowski chairs the panel that’s jurisdiction includes oversight of the Interior Department — and Zinke.
The other Republican who voted against Tuesday’s motion, Maine’s Susan Collins, said she has not heard from the White House since that vote.
Asked directly if she’s received any threats from the White House, Collins said, “No.”