GOP Pulls Back Senate Healthcare Proposal....What's Next?

NYAPRS Note: The following is pieced together from a number of national news reports. In New York yesterday, Gov Andrew Cuomo and NYC Mayor Bill De Blasio appeared to drop their longtime animosity to join forces to denounce the Senate GOP proposal and NYS Attorney General Eric Schneiderman vowed to sue if the bill was approved.

McConnell Abandons Obamacare Repeal and Replace Effort
July 18, 2017

Senate Majority LeaderMitch McConnell pulled the plug late Monday on the Republican effort to overhaul the U.S. health insurance system and pledged the chamber will now focus on only dismantling the 2010 health care law.

“Regretfully, it is now apparent that the effort to repeal and immediately replace the failure of Obamacare will not be successful,” the Kentucky Republican said.

O’Connell said he planned to hold a vote in the coming days to take up the House-passed bill to replace the 2010 health law and then call up an amendment to eliminate major parts of Obamacare, such as the Medicaid expansion, insurance subsidies and fines for the employer and individual mandates.

Republicans passed a similar bill to effectively repeal Obamacare in 2015 under reconciliation — the fast-track budget procedure the GOP is using to thwart a Democratic filibuster — but it was vetoed by President Barack Obama.

McConnell added that the repeal-only bill is "what a majority of the Senate has already supported in 2015," but GOP lawmakers have voiced severe doubts that such a plan can win the 50 votes necessary this year given the uncertainty it would throw onto insurance markets. The 2015 vote was viewed as mostly symbolic at the time given Obama’s certain veto.

But after his own caucus tanked McConnell's attempts to repeal and replace Obamacare simultaneously and at the prodding of the president, the GOP leader is going to force his caucus to go on the record on health care. If the Senate does vote to open debate on the House bill, which is not guaranteed, the repeal-only bill would be the first amendment. But senators would still be able to offer unlimited amendments to the bill, leading the GOP down an uncertain road once the process began.

….GOP leaders had hoped he would return in a week and they could start work on the bill….

Among the paths forward for Republicans:

CURRENT PLAN: BRING UP HOUSE BILL, THEN ATTEMPT STRAIGHT REPEAL — That's what Senate Majority Leader Mitch McConnell quickly announced, saying that a vote on starting debate on the House bill and then the Senate's 2015 reconciliation bill would be scheduled in the coming days. President Donald Trump also called for the Senate to repeal Obamacare and deal with a replacement later. 
— How it would work: If leadership can get a simple majority for a Motion to Proceed, McConnell said he will bring up the House repeal bill — the shell they were always going to use. The 2015 reconciliation bill, which repealed major parts of the ACA, would be offered as the first amendment and replace the House-passed text. 
It's going to be hard to even start debate, POLITICO's Jen Haberkorn points out — most senators are on the record opposed to the House bill. But it will force them to be on the record on Obamacare, too.
— Probability of success: Unlikely. Republicans need 50 votes to start debate on the House bill, but they only have 52 to begin with — or 51, if the vote is held before ailing Sen. John McCain returns to Washington — and the party would likely suffer additional defections….

FALLBACK PLAN: ATTEMPT TO REVISE BILL AGAIN — If the repeal vote fails or is pushed off, McConnell may try to find new compromises with the existing framework.
— Probability of success: Highly unlikely. The gaps within the caucus have been exposed after months of haggling, with conservatives and moderates in direct opposition over measures like insurance market protections and Medicaid expansion. Some remain upset with the closed-door process that McConnell pursued and are calling for hearings and "regular order."

FALLBACK PLAN: PURSUE COMPROMISE LIKE CASSIDY-COLLINS — South Carolina Sen. Lindsey Graham is the latest Republican to sign onto the idea of more state flexibility, a key tenet of the bill pushed by the Louisiana and Maine moderates.
— Probability of success: Doubtful. Only a handful of senators have explicitly said they back the bill, which essentially allows states that like the ACA markets to keep the law's protections and states that don't like the ACA to pursue their own less regulated alternatives.

There's also a fourth option — that Republicans simply walk away from their health care fight. But it doesn't appear that's in the cards, with McConnell seeking to get the GOP on the record and force defectors to explain why they're keeping Obamacare.

Liberal activists fighting to save Obamacare are seeking to capitalize on an unexpected gift — at least another week, if not more, before the Senate GOP will bring its repeal plan to the floor.

Activists are preparing protests well into next month aimed at keeping the pressure on Senate Majority Leader Mitch McConnell's (R-Ky.) conference, particularly the half-dozen most closely watched moderate swing votes.

“Every day the Senate doesn’t repeal ACA and gut Medicaid is a day that makes it less likely they’ll be able to,” Washington director Ben Wikler told reporters.

"Every day this bill is dangling out there in public, it becomes more unpopular."

…The right mounted no similar flurry of public activity in defense of the bill, underscoring the mismatch in grassroots energy between liberals and conservatives who had pressed McConnell to embrace a more straightforward repeal strategy.

…Rather than organize the sort of massive marches that anti-Trump groups favored earlier in the year, health care organizers are focusing on personal stories from constituents appealing directly to their senators. Capitol Police reported arresting 33 demonstrators in the Senate as of midday Monday during liberal groups' protest actions.

"The message we’ve been telling our groups, especially the ones in D.C., is to go to an office," said Indivisible policy director Angel Padilla. "You want to go rally and march? Great! But if you want to be effective at congressional advocacy, go to your member's offices and make sure they see you inside."

Medicaid's newfound popularity and its moderate champions
The Senate's overhaul of Medicaid went far beyond what Obamacare itself had done to expand the health care program for the poor; it made the biggest changes since the program's creation in the 1960s. Several Republican moderates found it increasingly difficult to support the move to cap federal spending and take $800 billion out of the program. Collins and Lisa Murkowski (R-Alaska), for instance, argued that the repeal bill shouldn't include such sweeping entitlement reform.

Medicaid now covers 74 million people, roughly one in five Americans. About half of those covered are children; in some states, Medicaid covers more than half of all births. It is also the largest source of funding for long-term care in the U.S. And the millions of people added to the rolls through Obamacare expansion only added to its popularity.

Governors from both parties — including key Republicans like Ohio's John Kasich, Nevada's Brian Sandoval, Arizona's Doug Ducey and Arkansas' Asa Hutchinson — had also criticized the GOP's efforts on Medicaid, which would have blown big holes in state budgets. The Senate bill would have led to 22 million more uninsured people, roughly 15 million of them from Medicaid.