In the wee small hours of this morning, Senate Republicans failed to advance a bill to repeal and replace the Affordable Care Act, after Senator John McCain (R-AZ) joined Senators Susan Collins (R-ME) and Lisa Murkowski (R-AK) and all 48 Democrats in opposing this last (?) effort. No one suggested that the so-called “skinny” repeal, which would have rescinded the individual and employer mandates, eliminated the medical device excise tax, and made a few other changes, was itself serious health reform legislation, but some saw it as a way of getting to a House-Senate conference where a compromise bill could be hammered out. Senator Lindsay Graham’s (R-SC) statement reflected this sentiment: “I’m not going to tell people back in South Carolina that this product actually replaces Obamacare, because it does not, it is a fraud.” In the end, Graham was persuaded to vote in favor by Speaker Paul Ryan’s pledge that the House would not vote on the skinny bill, and instead would move to conference, but that was not enough for McCain, who expressed the view that it was time to stop attempting a one-party solution to health care reform and return to regular order: “We must now return to the correct way of legislating and send the bill back to committee, hold hearings, receive input from both sides of the aisle, heed the recommendations of the nation’s governors, and produce a bill that finally delivers affordable health care for the American people.”
It is unclear whether that is the path Senate Republican leadership will take. Senator McConnell (R-KY) indicated an intention to “move on” and scheduled votes on appointments for next week, while President Trump tweeted his familiar message that he intended to let Obamacare “implode” and that would bring Democrats to the negotiating table. However, two weeks ago, both McConnell and Minority Leader Chuck Schumer (D-NY) indicated a willingness to work together on a bipartisan measure that would stabilize insurance markets. My speculations of July 21 on what such a measure might look like – including funding the CSRs and putting more funds into state stabilization/reinsurance funds – may therefore be worth revisiting in preparation for a possible next round of work on health care reform.