Obamacare repeal fails again in the Senate in 49-51 vote

Local lawmakers want healthcare debate to move to individual states

The Senate's effort to pass a stripped-down version of an Obamacare repeal measure -- the so-called "skinny repeal" of the Affordable Care Act -- failed during a vote, 49-51, held shortly around 1:30 a.m. Friday.

Sen. John McCain, R-Ariz., was among those who voted 'no.' There were gasps and applause from the Senate floor when he voted.

It came in the middle of the Senate's days-long debate in which it struggled to pass any option for repealing or replacing the Affordable Care Act. Two earlier attempts - one to pass a repeal-and-replace option, and another on a repeal-only measure - both failed Wednesday.

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The bill that did not pass during the early hours of Friday morning is dubbed "skinny" repeal because of its limited scope. The text of the pared down bill, released just hours before the vote, revealed that it would scrap the individual mandate for insurance coverage, repeal the employer mandate for at least eight years and allow individuals to put more money in tax-exempt health savings accounts.

The bill also suspends a tax on medical devices and allows states to seek waivers from consumer protections in the Affordable Care Act.

An estimate from the nonpartisan Congressional Budget Office showed that skinny repeal alone would leave 16 million more people uninsured than the current law over the next decade, and would raise premiums for some consumers by 20 percent.

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At least four Republican senators had threatened to block the so-called skinny repeal proposal unless they have assurances from House Speaker Paul Ryan that it is only a placeholder and would not be passed in the House and sent to the president’s desk. They, and others, want this to serve a vehicle for the next step of negotiations between the House and the Senate.

"The skinny bill as policy is a disaster. The skinny bill as a replacement for Obamacare is a fraud," Sen. Lindsey Graham, R-S.C., said. He said he could support the bill, but warned of the dire consequences if it was allowed to become law.

Graham said he has had conversations with Freedom Caucus chair Rep. Mark Meadows, R-N.C., in which Meadows has warned him that House Majority Whip Steve Scalise has apparently been telling "some" people that the House will just take up the skinny repeal and pass it and put it on the president's desk.

"I need assurances that it will not be the final product," Sen. Graham went on during a press conference Thursday. Graham said he worried about rumors that House Majority Whip Steve Scalise, who has been recovering from a gunshot wound but was released from the hospital this week, was considering bringing the narrow repeal bill up for a vote as is.

Amid the negotiations Thursday evening, House Speaker Paul Ryan opened the door for the Senate proposal to be considered in a conference committee with House lawmakers, giving the Senate efforts a much-needed boost.

"It is now obvious that the only path ahead is for the Senate to pass the narrow legislation that it is currently considering,” Ryan’s statement read. “Senators have made clear that this is an effort to keep the process alive, not to make law. If moving forward requires a conference committee, that is something the House is willing to do."

As the possibility of the Senate passing a partial repeal bill loomed Thursday, several patient, hospital and insurance groups put out statements arguing that scrapping even just the mandate that individuals buy insurance could have real consequences for health care marketplaces.

Blue Cross wrote in statement: “A system that allows people to purchase coverage only when they need it drives up costs for everyone.”

America's Health Insurance Plans CEO Marilyn B. Tavenner echoed their concern, writing in a statement: “We would oppose an approach that eliminates the individual coverage requirement, does not offer alternative continuous coverage solutions, and does not include measures to immediately stabilize the individual market.”

The AARP called it a “wolf in sheep’s clothing.” Citing a recent report from the Congressional Budget Office that predicted repealing even just the individual mandate could lead to 15 million more Americans uninsured in the next decade a 20 percent premium increase for folks buying their own insurance.

This increase in premium costs could lead to some people's being priced out of plans, or the federal government may aid those people through subsidies and tax credits.

The individual mandate provides social cost savers as well. If people don't have insurance and get sick, hospitals, taxpayers and local governments end up covering the costs. "In the absence of a mandate, those social costs would probably increase relative to the case under current law," the CBO said in a report last December.

Sen. Ron Johnson, R-Wis., indicated he would vote for a bare-bones package as long as it kept the process moving forward. "We'll keep the process going. If we've got to do something less than obviously I'd want to keep the process going, we'll do it," he said.