First, a Republican-led effort to reform health care, unveiled last week, derailed Monday night when two more GOP senators said they would vote against the bill.
By lunchtime the next day, Senate leadership’s backup plan — to repeal the Affordable Care Act and figure out a replacement later — also appeared to lack sufficient votes in the Republican caucus.
The series of events cast further doubt over the future of a central campaign promise of many congressional Republicans and President Donald Trump.
As Senate Republican leaders vowed to stay the course, other senators, including Vermont’s, as well as Vermont officials and health care professionals urged lawmakers to find a compromise.
Republicans hold 52 seats in the U.S. Senate. With Democrats and independents firmly opposed to GOP health care proposals so far, the leadership can afford to lose the votes of only two party members.
Sens. Jerry Moran, R-Kan., and Mike Lee, R-Utah, announced Monday that they would not vote for the latest proposal to replace Obamacare. Their defections fatally brought the total number of dissenting majority party members to four.
After losing support for the latest repeal-and-replace proposal, Senate Majority Leader Mitch McConnell, R-Ky., vowed instead to push ahead with a separate measure that closely resembles a bill Congress passed in 2015, but was vetoed.
The proposal would repeal the Affordable Care Act with a two-year window, during which time lawmakers could work out a replacement plan, according to McConnell.
The original act was 2,300 pages and overhauled more than 33,000 pages of state and federal health care laws. For Vermont, repealing those laws could force a loss of federal funding to cover tens of thousands of new enrollees in the Medicaid program and eliminate a federal agency that entered into a major health reform contract with the state in 2016.
By midday Tuesday, however, three Republican senators had said publicly they would not support a bill to repeal the current policy now without a plan for a replacement.
Despite the apparent lack of support for the repeal proposal, McConnell promised a vote “sometime in the near future” as he talked to reporters after a weekly caucus lunch.
“We will have demonstrated that Republicans by themselves are not prepared at this particular point to do a replacement,” he said. However, he believes there is appetite for a repeal bill at this time.While Senate Republicans sought out a new approach to the issue, others celebrated that the Republican-led health care bill appeared dead.
On his way to the Senate floor Tuesday shortly after noon, Sen. Bernie Sanders, I-Vt., said he was “delighted” that the Republican-led legislation had lost sufficient support.
“Well, this legislation is not what the people of Vermont wanted, not what the people of America wanted, not what doctors wanted, not what hospitals wanted, not what nurses wanted,” he said.
Asked about the latest proposal to repeal the Affordable Care Act and replace it later, he replied, “I don’t think that that will succeed.”
Sanders, long a proponent of single-payer health care, said the focus going forward should be seeking out a way to provide health care coverage to everyone. He said he plans to unveil his own health care proposal “in the very near future.”
Sen. Patrick Leahy, D-Vt., said the developments concerning health care show the challenges of realizing Republicans’ “repeal and replace” promise.
“It makes for a great sound bite if you don’t actually have to do anything,” he said Tuesday afternoon.
Leahy, like many other Democrats and some Republicans, urged a collaborative approach to changing health care.“I’m hoping it’s a wake-up call that there are a lot of people up here, Republicans and Democrats, who want to work things out,” he said.
Gov. Phil Scott joined with a bipartisan group of 10 other governors to issue a call for the Senate to reject the proposal to repeal the Affordable Care Act and replace it later.
“The best next step is for both parties to come together and do what we can all agree on: Fix our unstable insurance markets,” the group wrote in a statement.
One day after standing with Vermont’s top state officials across the political spectrum in opposition to the Republican health care proposal, Scott said Tuesday he was pleased lawmakers responded to states’ concerns.
Vermont health care leaders seek bipartisanship
In Vermont, health care leaders are calling for Congress to slow down and take a bipartisan approach to improve the Affordable Care Act, not scrap it altogether.
Al Gobeille, the secretary of the Agency of Human Services, said it would take three to four years to repeal the Affordable Care Act, just as it took from 2010 to 2014 to set up the individual health insurance exchanges that are central to the law.“If they want to change the way we regulate insurance and change the way Medicaid law is, they need to do that carefully, understanding the magnitude of this,” he said. “Everyone needs to slow down and say carefully, ‘What does this really mean, on many levels, if you change this law?’”
Paul Harrington, from the Vermont Medical Society, which represents doctors, said lawmakers need to reach across the aisle. “Hyper-partisanship has been the hallmark of this Congress, and it’s resulted in some proposals that would really threaten health insurance, particularly for those most vulnerable — the very young, the very old, and the disabled,” Harrington said.
“The medical society strongly opposes the Republicans trying to go it alone and repeal the Affordable Care Act without having an adequate replacement put forward,” he said. “The medical society believes the only way they can do that is in a bipartisan basis, allow physicians and those representing patients to have a voice in the process.”
Both Jeff Tieman, the CEO of the Vermont Association of Hospitals and Health Systems, and Tom Huebner, the CEO of Rutland Regional Medical Center, said Congress should be working to improve competition on health insurance exchanges like Vermont Health Connect and make the insurance cheaper.
“In many states there’s insufficient numbers of insurers in those markets — people don’t have great choice,” Tieman said. “It’s true that those need to be fortified and improved.”
“I would improve the subsidies and cost-sharing assistance that these bills would provide to low-income and middle-income people so they’re somewhat shielded from high premiums and out-of-pocket costs,” he said. “So rather than scaling those back, I would ramp them up.”
Huebner said: “There are some pieces of the exchanges that need to be shored up. We need to ensure proper funding for the subsidies. I actually think we need to do more about ensuring people participate in the exchanges because that will ultimately keep the cost increases down.”