After rejecting a full-scale repeal of the Affordable Care Act (ACA), the U.S. Senate voted against so-called skinny repeal legislation, which would have repealed only Obamacare’s individual mandate, employer mandate, and tax on medical devices.
The Senate rejected the skinny repeal by a 49-to-51 vote on July 28 and only narrowly approved allowing floor debate on the American Health Care Act (AHCA), an Obamacare replacement bill approved by the House, on July 25. Vice President Mike Pence, whose constitutional duties include presiding over the U.S. Senate, cast the tie-breaking vote after the Senate voted 50–50 on whether to debate AHCA.
Once debate commenced, Sen. Majority Leader Mitch McConnell (R-KY) called a vote on amendments to AHCA that would have repealed Obamacare and replaced it with the Senate’s Better Care Reconciliation Act (BCRA). The repeal legislation resembled a bill Congress approved and President Barack Obama vetoed in 2015.
The Senate voted 43–57 to reject full repeal and replacement with the BCRA on July 25. Nine Republican senators voted with the Senate’s 48 Democrats. The Senate voted 45–55 against full repeal of Obamacare without a replacement on July 26.
The Senate moved on to consider a skinny repeal of a handful of Obamacare provisions. If approved, people would no longer have been fined the greater of 2.5 percent of their income or $700 per adult for declining to buy health insurance. Employers of at least 50 employees working at least 30 hours weekly would no longer have had to provide health insurance.
Repeal or Revise?
Ed Hudgins, director of research at The Heartland Institute, which publishes Health Care News, says in the wake of the Senate’s failures, states should take the lead in health care reform.
“Repeal of Obamacare, the promise of all elected Republican members of Congress when running for office, has seemingly been killed in their negligent hands,” Hudgins said. “But alternatives live. State governments can act to give their own citizens greater access to health care choices and better health care services.”
Dr. Gerard Gianoli, president of the Ear and Balance Institute in Covington, Louisiana, says ACA made an already-flawed health insurance system more dysfunctional.
“I am no fan of Obamacare, and I am no fan of what preceded Obamacare,” Gianoli said. “But given the choice of the two, I’d pick our pre-Obamacare health care system, hands down. Repeal of Obamacare with no replacement is a step up from our current situation.”
Under ACA, insurers profit as customers are forced to buy expensive insurance and state budgets are overwhelmed by Medicaid expansion, Gianoli says.
Obamacare has benefited only one group: insurance companies,” Gianoli said. “Due to Obamacare, patients have seen premiums skyrocket as their access to health care has diminished. Medicaid expansion has caused state budgets to explode while not producing any measurable improvement in the quality of health care.”
Congress should remove the federal government from the sphere of health care regulation, Gianoli says.
“Our health care system is in desperate need of a ‘federal government-ectomy,'” Gianoli said. “The more the federal government is involved in health care, the worse it becomes.”
Not Soon Enough
The repeal bill rejected on July 25 would have taken effect in 2019 or 2020.
Dr. Alieta Eck, cofounder of the charity clinic Zarephath Health Center in Somerset, New Jersey, says leaving Obamacare intact for two more years would be a mistake.
“Why two years?” Eck said. “Why prolong the suffering? Six months should be enough time for people to make a change. End all the mandates and taxes that have driven up medical costs. End the Medicaid expansion to able-bodied working adults. Medicaid expansion and insurance subsidies have only enriched the executives of insurance companies and hospitals while doing little to increase access to care.”
The sooner Obamacare is gone, the sooner Democrats will work with Republicans to craft better legislation, Eck says.
“The Affordable Care Act is an atrocity that must end as soon as possible,” Eck said. “Once it is gone, Democrats will have a chance to work with the Republican Congress to craft something that will be best for the people. Expanded health savings accounts, affordable high deductible insurance without the networks, direct primary care, and return of Medicaid dollars back to the states are all ideas that need to be carefully considered.”
Like the AHCA, BCRA would retain Obamacare’s regulatory structure.
Dr. Chad Savage, founder of the direct primary care practice YourChoice Direct Care in Brighton, Michigan, says Republicans’ temporary shift in focus toward full Obamacare repeal may have been Congress’ last-best chance to enact free-market reform.
“Perhaps in the long run [repeal] is the best option,” Savage said. “It appeared the GOP was missing a once-in-a-lifetime opportunity to change the incentives away from an insurance-based and controlled system back to a free-market, consumer-driven system. A clean repeal [would] give them just that opportunity.”
Michael T. Hamilton ([email protected], @MikeFreeMarket) is managing editor of Health Care News, author of the weekly Consumer Power Report, and host of the Health Care News Podcast.
Dr. Jane Orient, “Let’s Change to ‘Repeal-and-Restore’ Obamacare,” Association of American Physicians and Surgeons, July 25, 2017: https://heartland.org/news-opinion/news/lets-change-to-repeal-and-restore-obamacare
Michael T. Hamilton, “Senate Delay of Health Care Bill Shows Political Worries Over Subsidy Appeal,” Health Care News, The Heartland Institute, August 2017: https://heartland.org/news-opinion/news/lets-change-to-repeal-and-restore-obamacare
Emma Vinton, “Study: Large Employers Want Health Insurance Flexibility, Transparency,” Health Care News, The Heartland Institute, July 14, 2017: https://heartland.org/news-opinion/news/study-large-employers-want-health-insurance-flexibility-transparency
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