Health Care

Middle-of-the-night vote clears way for Obamacare repeal

Obamacare
C-SPAN shows Thursday’s early morning Senate vote to go forward with repeal of the Affordable Care Act.

WASHINGTON — Senate Republicans took the first major step in repealing the Affordable Care Act in the wee hours of Thursday morning, invoking an arcane budget reconciliation process that eliminated the threat of a Democratic filibuster.

With a simple majority, Republicans passed Senate Concurrent Resolution 3, which lays the groundwork to repeal ACA by mandating that the House and Senate committees that oversee health care draft major cost-cutting measures — essentially a repeal bill — to be submitted to the House and Senate budget committees by Jan. 27.

The vote on the legislation split essentially down party lines, 51 to 48.

Fifty-one Senate Republicans voted for the resolution, with only Rand Paul, R-Kentucky, breaking from his caucus to vote no. Paul objected to the resolution because the underlying budget projections would add nearly $10 trillion to the deficit over the next 10 years. He also said he was concerned that Republicans were repealing the ACA without offering a replacement plan.

Those voting against the resolution included every Democrat save Dianne Feinstein of California, who did not vote. The two independent members of the chamber — Bernie Sanders of Vermont and Angus King of Maine — joined Democrats in opposing the legislation.

The lights stayed on in the Senate chamber early into Thursday morning as Democrats expressed grave concerns over the legislation, even as the Republican chair interrupted them, saying that “debate is not allowed during a vote.”

At 1:12 a.m. Thursday, Sanders expressed his disgust with the resolution, saying, “On behalf of elderly people who cannot afford prescription drugs I vote no.”

Patrick Leahy
Sen. Patrick Leahy, D-Vt. File photo by Randolph T. Holhut/The Commons

Sen. Patrick Leahy spoke right after Sanders, saying, “I join my colleague from Vermont and I vote no.”

Democrats offered 11 amendments aimed at stopping the resolution as part of a “vote-a-rama” process. The amendments intended to force Republicans to take politically toxic votes that could potentially be used against them during campaign season.

The amendments — none of which passed — were sharply written in order to inflict as much political damage as possible.

One introduced by Sen. Sherrod Brown, D-Ohio, aimed to halt the legislation as it “would undermine the historic coverage gains the United States has made in children’s health, which have resulted in the lowest uninsured rate for children in the nation’s history.”

Another amendment, offered by Sens. Sanders and Amy Klobuchar, D-Minn., would have allowed for American pharmaceutical distributors to import and sell lower-cost prescription medicines from Canada and other countries.

Sanders has long railed against the ban on prescription drug importation, even traveling to Canada two decades ago with Vermonters to purchase cheaper cancer medicines.

Sanders seemed hopeful that his amendment might pass, since Republican President-elect Donald Trump endorsed medication price regulations in a Wednesday news conference.

“There’s very little bidding on drugs,” Trump said Wednesday. “We’re the largest buyer of drugs in the world. And yet we don’t bid properly. We’re going to start bidding.”

“You know what?” Sanders said in a floor speech Wednesday afternoon. “Mr. Trump is exactly right. Pharma is getting away with murder. Pharma has gotten away with murder for many, many decades.”

The Sanders-Klobuchar amendment failed, 52 to 46, but 12 Republicans voted for it. Leahy supported Sanders’ amendment, though 13 Democrats voted against it.

With the repeal resolution passed in the Senate, it is expected to pass in a House vote on Friday.

While Republicans have rallied around repeal of the ACA, the party has yet to introduce a comprehensive replacement plan.

“Maybe they will develop a plan, but right now, what they are talking about is repealing legislation which has brought millions of people health care and they have no substitute,” Sanders warned Wednesday.

Although Republicans can steer repeal through a budget resolution, any replacement plan would require 60 votes to pass, meaning that a handful of Democrats would have to come on board.

A repeal of the Affordable Care Act is expected to have a significant impact on insurance coverage across the nation, including in the Green Mountain State.

According to data from the Agency of Health and Human Services, the uninsured rate in Vermont has fallen 53 percent since the enactment of the Affordable Care Act.

The Kaiser Family Foundation recently reported that Vermont receives more than $70 million in federal health care tax credits annually through the ACA, with the average monthly middle-income tax credit totaling $300 per person.

In addition, the ACA expanded Medicaid eligibility in Vermont. A combination of state and federal dollars pays for the increased coverage.

More than $2 billion of the state’s $5.8 billion budget in fiscal year 2017 came from federal funds. The largest share of that $2 billion — roughly $1.1 billion — went to the state’s Medicaid program, according to a tally from the Department of Finance and Management.

A comprehensive breakdown of Medicaid spending in Vermont is available here.

Top health care officials in Vermont have predicted dire consequences if the Affordable Care Act is repealed entirely, predicting that many residents would drop insurance, while others would have to pay much higher premiums.

A recent study by the Commonwealth Fund found that ACA repeal could also harm the overall economy in Vermont. The study predicted that Vermont could lose as many as 6,000 private and public sector jobs. A majority of the jobs losses would be in the health care and insurance sectors.

On Wednesday — before the Senate vote — Gov. Phil Scott said he was opposed to a repeal of the Affordable Care Act. He said his budget team was “in a holding pattern” regarding the impact on federal health care subsidies.

Scott said his team was looking to find savings in state Medicaid spending, which is the largest portion of Vermont’s budget.

Asked if he would welcome more federal help to ease state Medicaid spending, Scott said: “I’m not advocating for more federal Medicaid money, but I wouldn’t imagine we would turn it down.”

He didn’t say how his administration would respond to the more likely scenario, wherein the spigot of federal health care money is tightened, or even eliminated. Scott instead reiterated his pledge to “build a budget within our means without raising taxes or fees.”

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Jasper Craven

About Jasper

Jasper Craven is VTDigger’s political reporter. A Vermont native, he first discovered his love for journalism at the Caledonian Record. He double-majored in print journalism and political science at Boston University, and worked in the Boston Globe’s Metro and Investigative units. While at the Globe he collaborated on Shadow Campus, a three-part investigative series focused on greed and mismanagement in Boston’s off-campus student housing market. The series was a finalist for the 2015 Pulitzer Prize.
He also spent two years at MuckRock, a news sited dedicated to investigation and analysis of government documents. 

Craven covered Vermont’s U.S. Congressional delegation for the Times Argus in the summer of 2014, and worked as a Metro reporter for the Chicago Tribune before joining the staff of VTDigger.

Email: [email protected]

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  • Pete Novick

    Here’s a paper explaining ACA repeal process via budget reconciliation and published by a center-right organization, the American Action Forum:

    How to Repeal the Affordable Care Act through Reconciliation

    https://www.americanactionforum.org/wp-content/uploads/sites/default/files/JohnMaskoPaper.pdf

    It’s worth a read, first because, while detailed, it is not at all complicated, and nor is it arcane. I can see this process being normalized for the next two years at least across much of the federal budget. It starts with a budget resolution which is what the House and Senate are crafting now.

    Plus, it helps to know the legislative intent and the history of its use in Congress, which is not a doomsday story as the press is making it out to be. Like Joe Biden says, you’re entitled to your own opinions, but not your own facts.

    So take thirty minutes and read it. You may win valuable prizes and impress your friends.

    Cheers

    • Tom Grout

      Thank you Pete.

    • Bruce S. Post

      During the debate over the Omnibus Budget Reconciliation Act of 1981, I was on the professional staff of the U.S. Senate Subcommittee on Education, Arts and the Humanities, then chaired by Vermont’s own Robert T. Stafford. Prior to 1981, reconciliation had been a little used part of the congressional budget process. With the election of Ronald Reagan, OMB Director David Stockman used what was then the arcane reconciliation process to propose significant changes in many major federal laws by by-passing the normal deliberations of the respective congressional committees. Senator Stafford, along with some other moderate Republicans, slowed down this freight train in order to prevent some damaging and unwise changes to federal law.

      Here is something I posted on this topic: http://talkingpointsmemo.com/edblog/great-grand-daddy-of-reconciliation.

      Then, Congress moved so fast, the name of a CBO budget analyst was actually printed in the budget bill presented to the U.S. House.

  • Dennis Works

    Ah yes… middle-of-the-night tricks by Repubs to repeal the ACA. While not perfect, it DID do a lot of good, such as forbidding insurance companies from denying coverage for pre-existing conditions and allowing children to remain on their parents’ health insurance until they are 26. Millions of people who did not have health insurance in the past now have it… and Republicans want to take that away. A vast majority of the experts have warned that repeal of the ACA without a replacement plan will cause MAJOR upheaval – in the health care industry and the entire economy. But Republicans don’t care. And I’m willing to bet that Trump won’t go against this repeal – even though he promised during the campaign that repeal of the ACA would be a gradual process that would not occur until Republicans came up with their own plan. It’s also telling that Republicans, who CLAIM fiscal responsibility as one of their enduring mantles, won’t allow price negotiating or importation for cheaper drugs.

    • Walter Carpenter

      “But Republicans don’t care.”

      No, they do not care, just as long as the uber wealthy do not have to pay taxes and the campaign contributions keep pouring in. 100 million Americans could be uninsured and they would not care about it all.

      • Sandy Conrad

        “Paul objected to the resolution because it’s underlying budget projections would add nearly $10 trillion to the deficit over the next 10 years.”

        I guess Republicans know how to increase our federal deficit too. Let’s face it, no American is going to win with this middle of the night move.

        • Walter Carpenter

          Let’s face it, no American is going to win with this middle of the night move.”

          There will be some Americans who will win because of it. But most of us will only lose and that is just the way they want it.

      • Sandy Conrad

        “Paul objected to the resolution because it’s underlying budget projections would add nearly $10 trillion to the deficit over the next 10 years.”

        I guess Republicans know how to add to the federal deficit too. Let’s face it, no Americans win in this middle-of-the-night move.

      • david schwartz, md

        Up until this post, I have always agreed with your perspective. I disagree now but time will tell. For those who voted Trump in, you might be experiencing “buyer’s remorse” when you lose your health insurance. And, let’s also hope that our next “shot at the ring” is in 4 years and not 8.

      • Walter Carpenter

        “Republicans are only doing what they learned from the Democrats.”

        Bull feathers. The GOP and their benefactors, like Koch Brothers, had pioneered it long before Obamacare. They used it during Obamacare to give Obamacare over to the profiteers.

        “I guess now the Democrats can’t steal from places like the rust belt and give it to their corporate executives who support their ideological objects like wind towers and solar panels.”

        Actually, it is the other way around.

        http://www.businessinsider.com/red-states-more-dependent-on-federal-government-2015-7

        “Get over it, you lost, American won.”

        We did not lose as we did not lose the popular vote, but America did not win either. Bigotry and Racism won through our screwy voter system. Maybe that still is America.

    • David White

      Same way dems passed it. Except it was on Christiana’s eve

    • Jim Manahan

      Passage of the ACA without proper vetting has already caused MAJOR upheaval in the healthcare industry and the entire economy, so you’re a little late with that concern. It gave Shumlin an open door to throwing away over $200M!

      • Patricia Goodrich

        The democrats did the best they could under the circumstances. Like the Constitution, they knew that there would have to be amendments made as time and circumstances changed, as they always do. We are behind most of the world with our healthcare costs. Private insurance is more expensive than a Single-Payer plan like Medicare, which is successful, Social Security, and also Medicaid, covering those who cannot afford insurance without financial aid.

        Why is it okay to cut taxes for the rich and begrudge health care for the poor? Why do the rich never have “enough” to satisfy them? Why do they begrudge a living wage or help to the poor? You can’t “buy” happiness or satisfaction.

  • Darcy Canu

    I don’t know about anyone else – I for one am insured by ACA through VHC, and I’m making haste to get important things done NOW.
    For the first time in my life, at age 63, when I really NEED insurance and have no other option for purchasing it, I may be without it! Employer doesn’t offer it. The Repugs need a fair, well researched plan to put in place BEFORE ACA is repealed, or thousands of people like me will be twisting in the wind. What’s fair about any of this? Nothing.

    • Patricia Goodrich

      Darcy, the republicans had a plan, it was called RomneyCare and has been in place, in Massachusetts. It was developed by a republican think tank., The Heritage Foundation. It was one of many plans researched by democrats in drafting the ACA, or Obama Care.

      • Darcy Canu

        I am a MA. native and was there when Romney Care made its’ debut.
        There does NOT seem to be anything of substance in place NOW, when we’ll collectively need it. If there is, direct me to it. I’d like to be informed of this plan.
        This is a case of putting the cart before the horse. Since ACA now appears to be water over the dam, it still doesn’t mean that the users who need health care should be put in jeopardy b/c campaign promises need to be kept.
        Apologize for the platitudes, they just seem to work in this situation…I’m not convinced that the new administration knows what end is up.