Obamacare Replacement Amendment Fails in Senate

Obamacare Replacement Amendment Fails in Senate
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Senate Republicans failed to pass their repeal and replacement plan for the Affordable Care Act Tuesday night, likely ending the possibility of passing repeal and replace simultaneously this week and putting the future of any comprehensive replacement plan in jeopardy. 

The plan, which would have gutted major portions of Obamacare and overhauled the Medicaid program, failed in a 43-57 vote late Tuesday night, with nine Republicans voting against it. The vote was the first in a series of amendment votes expected on the ACA this week, though it likely represented Republicans' best opportunity to move forward on a total ACA remake. A vote to repeal Obamacare with a two-year delay -- the same measure the Senate passed in 2015 -- will be considered Wednesday, though it is expected to fail.  

The final tally showed there wasn’t enough support for the measure, which was released in June and went through several iterations in recent weeks, even if it had only required a simple Republican majority of 51 votes, meaning the GOP still has significant work to do to reach consensus on a replacement plan. 

Tuesday's measure required 60 votes because last-minute provisions in the plan were not scored by the Congressional Budget Office, and thus did not meet guidelines under the budget reconciliation process. The two provisions, proposed by Sens. Ted Cruz of Texas and Rob Portman of Ohio, were added to increase GOP support for the measure.

The vote came after Republicans agreed in dramatic fashion earlier Tuesday to open debate on the process of repealing Obamacare -- a vote that required a tiebreak from Vice President Mike Pence and Sen. John McCain’s unexpected return to Washington from Arizona just a week after receiving a diagnosis of brain cancer.

As of last week, a number of moderate Republicans were concerned about the Medicaid provisions in the legislation. But Portman and others secured an amendment in the measure adding $100 billion to help Americans in the Medicaid expansion pool pay their medical expenses under private insurance. On Tuesday night, senators who shared Portman's Medicaid concerns were divided, with some, like Shelley Moore Capito, voting for the measure, and others, like Dean Heller, Susan Collins and Lisa Murkowski, voting against it.

“Is this replacement perfect? No, I don’t think any replacement is,” Portman said. “But it’s a big improvement over the status quo.”  

Cruz, whose amendment would have allowed insurers to offer plans that aren’t compliant with Obamacare regulations, said he wasn’t discouraged by Republicans voting against the proposal Tuesday night, calling it “the first step in the process” and saying he thinks the proposal needs to be in the final legislation.

Democrats, as they have throughout the entirety of this debate, remained entirely opposed to the amendment. Sen. Ron Wyden of Oregon called the amendment a “prescription for trouble.” 

“Senators are flying in the dark,” he said before the vote. “It is not too late for Republican senators to put a stop to this shadowy, unacceptable process. Nobody in this chamber, not one senator, has to choose between Trumpcare or straight repeal or any partisan plan.”

After Tuesday’s failed vote on the replacement and Wednesday’s likely vote on the repeal-only measure, senators will debate an unlimited number of amendments in what’s known as a vote-a-rama -- a procedure required by the rules of budget reconciliation, the process Republicans are using to pass their health care bill without Democratic support. 

That process is expected to take several days, as Republicans and Democrats offer dozens of amendments meant both to alter the legislation and to force members of the other party to take politically difficult votes. It remains unclear what Republicans’ final measure will look like, though South Dakota Sen. John Thune, a member of leadership, said it’s likely to be a scaled-down repeal of certain Obamacare provisions -- essentially whatever Republicans can negotiate that will win 50 votes to pass. 

Getting that support, however, will prove difficult. Two Republicans, Collins of Maine and Murkowski of Alaska, voted against beginning debate on Obamacare repeal at all and are unlikely to support the final package. McCain, in a major address on the Senate floor earlier Tuesday, signaled that he was unlikely to support the final bill. Many other senators remain undecided, unclear on what exactly they would be voting on. 

“It’s going to be based on our discussions over the next couple days and what it looks like 50 of our members are willing to vote out as part of some kind of compromise at the end of the process,” Thune said.  

James Arkin is a congressional reporter for RealClearPolitics. He can be reached at jarkin@realclearpolitics.com. Follow him on Twitter @JamesArkin.

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