• Senate Republicans unveiled a “skinny repeal,” a narrow measure to roll back parts of the Affordable Care Act. It would leave 15 million more Americans without insurance next year, the Congressional Budget Office said.
• Speaker Ryan tried to reassure senators balking at the narrow bill, but he left the door open for “skinny” passage.
How Senators Voted On “Skinny” Repeal »
YES
NO
Republicans
49
3
Democrats
0
48
Total
49
51
Senate rejects scaled-down Obamacare repeal.
The Senate on Friday rejected a new, scaled-down Republican plan to repeal parts of the Affordable Care Act, seemingly derailing the Republicans’ seven-year campaign to dismantle the health care law.Senator John McCain, Republican of Arizona, cast a decisive vote to defeat the proposal, joining two other Republicans, Susan Collins of Maine and Lisa Murkowski of Alaska, in opposing it.
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The 49-51 vote was a huge setback for the majority leader, Mitch McConnell of Kentucky, who has spent the last three months trying to devise a repeal bill that could win support from members of his conference. It was also a blow to President Trump, who lashed out.
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Donald J. Trump
✔@realDonaldTrump
3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let ObamaCare implode, then deal. Watch!
11:25 PM - Jul 27, 2017
The truncated Republican plan was far less than what Republicans once envisioned. Republican leaders, unable to overcome complaints from both moderate and conservative members of their caucus, said the skeletal plan was just a vehicle to permit negotiations with the House, which passed a much more ambitious repeal bill in early May.
The so-called “skinny” repeal bill, as it became known at the Capitol this week, would still have broad effects on health care. The bill would increase the number of people who are uninsured by 15 million next year compared with current law, according to the nonpartisan Congressional Budget Office. Premiums for people buying insurance on their own would increase by roughly 20 percent, the budget office said.
But President Trump backed it to the hilt, pressuring, cajoling and threatening wavering Republicans.
Shortly before the vote, he took to Twitter.
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✔@realDonaldTrump
Go Republican Senators, Go! Get there after waiting for 7 years. Give America great healthcare!
7:43 PM - Jul 27, 2017
McConnell unveils narrow Obamacare repeal bill.
Senator Mitch McConnell, the majority leader, pulled in his sails on repealing the Affordable Care Act, and unveiled a more narrow measure that would:REPEAL THE INDIVIDUAL MANDATE, which says that most Americans must have health insurance or pay a tax penalty.
REPEAL THE EMPLOYER MANDATE, which requires large employers to offer health insurance to their workers.
GIVE FLEXIBILITY TO STATES, making it much easier for them to waive federal requirements that health plans provide consumers with a minimum set of benefits like maternity care and prescription drugs.
EXPAND HEALTH SAVINGS ACCOUNTS, increasing the limit on contributions to such tax-favored accounts
DELAY A TAX ON MEDICAL DEVICES.
INCREASE FUNDS FOR COMMUNITY HEALTH CENTERS.
DOCUMENT
Read the Senate
‘Skinny Repeal’ Bill
Republicans on Thursday released a narrow measure to roll back parts of the
Affordable Care Act.
OPEN DOCUMENT
C.B.O.: ‘Skinny’ bill would leave 15 million more uninsured.
The Congressional Budget Office said the latest, more narrow bill to dismantle the Affordable Care Act would leave 15 million more Americans without insurance next year and would raise insurance premiums by about 20 percent over the next decade.The measure would decrease federal budget deficits by about $179 billion over a decade, according to the budget office.
HEALTH CARE IN AMERICA By A.J. CHAVAR and DREW JORDAN 1:12What Is the Health Care ‘Vote-a-Rama?’
Video
What Is the Health Care ‘Vote-a-Rama?’
Jonathan Weisman, deputy Washington editor for The Times, explains the voting and amendment process that the bill to repeal and replace the Affordable Care Act must go through next.By A.J. CHAVAR and DREW JORDAN on Publish DateJuly 27, 2017.Photo by Brendan Smialowski/Agence France-Presse — Getty Images.Watch in Times Video »
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Ryan tried to calm Senate nerves.
With senators pleading for reassurance, Speaker Paul D. Ryan did his best.“If moving forward requires a conference committee, that’s something the House is willing to do. The reality, however, is that repealing and replacing Obamacare still ultimately requires the Senate to produce 51 votes for an actual plan.”He then said whatever compromise comes out of the House-Senate conference would have to pass the Senate first before the House picks it up.
View image on Twitter
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Seung Min Kim
✔@seungminkim
BREAKING: @SpeakerRyan says "If moving forward requires a conference committee, that is something the House is willing to do."
4:29 PM - Jul 27, 2017
That was not all that reassuring. If the Senate failed to pass that conference agreement, the House could have still passed the Senate’s “skinny repeal” and sent it to President Trump for the signing ceremony he desperately wants.
That was decisive for Mr. McCain.
now
Frank Thorp V
✔@frankthorp
McCain leaving the Capitol asked why he voted NO: "I thought it was the right thing to do."
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✔@frankthorp
Here is McCain's FULL STATEMENT on his NO vote: pic.twitter.com/ADRblPPzaf
11:31 PM - Jul 27, 2017
“Creepy Billionaires.”
That’s who Senator Sheldon Whitehouse, Democrat of Rhode Island, said were dictating the terms of the latest Republican health care bill. It does have a ring to it — could be a rock band.Three Republicans: No ‘yes’ votes without assurances of a conference.
HEALTH CARE IN AMERICA By ROBIN STEIN, NATALIE RENEAU and ROBIN LINDSAY 2:16The G.O.P.’s Health Care Hail Mary: ‘Skinny Repeal’Video
The G.O.P.’s Health Care Hail Mary: ‘Skinny Repeal’
Margot Sanger-Katz, a New York Times correspondent, explains the implications of a new, more narrow health care bill Republicans are working on.By ROBIN STEIN, NATALIE RENEAU and ROBIN LINDSAY on Publish DateJuly 26, 2017. Photo by Gabriella Demczuk for The New York Times. Watch in Times Video »
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The senators were unsparing in their criticism of the so-called skinny repeal, which would repeal the mandates that most individuals have health insurance and large employers cover their employees but leave most of the health law in place. Such a bill would crater the health insurance market and send premiums skyward, they said.
“The skinny bill as policy is a disaster,” Mr. Graham said. “The skinny bill as a replacement for Obamacare is a fraud.”
GRAPHIC
How Many People
Across America
Are at Risk of
Losing
Their
Health Insurance?
A state-by-state look at who could lose insurance under the proposed
Republican health care plans.
OPEN GRAPHIC
Senator Johnson said: “The skinny bill in the Senate doesn’t come close to meeting our promises.”
But they feared that House Republican leaders could just take the stripped-down bill, pass it and send it to President Trump.
“Right now, I am voting no,” Mr. McCain said.
Mr. Graham was emphatic.
“I need assurances from the speaker of the House and his team that if I vote for the skinny bill, then it will not be the final product,” Mr. Graham said. “I’m not going to vote for a pig in a poke.”
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Photo
From left, Senators Lindsay Graham of South Carolina, John McCain of Arizona and Ron Johnson of Wisconsin, all Republicans, spoke about the “skinny repeal” bill on Thursday.CreditJustin Gilliland/The New York Times
Mr. Ryan’s assurances may just win the night. For all his bluster, Mr. Graham said he would trust the speaker.
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Lauren Gambino
✔@laurenegambino
Graham is a yes on the skinny repeal. He says he's been assured there is no appetite to take up the skinny bill in the house.
6:37 PM - Jul 27, 2017 · Washington, DC
Sen. Johnson also looked like a yes.
But Mr. McCain was holding out.
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✔@laurenegambino
Graham says that McCain is upset by the process. "Whatever he does, he's earned the right to do it."
6:41 PM - Jul 27, 2017 · Washington, DC
Senate Republicans trim sails on ‘Repeal and Replace.’
The turmoil came as Senate Republicans, unable to reach consensus on broad legislation to repeal and replace the Affordable Care Act, looked instead at chipping away at it.Besides the mandates, Senator David Perdue, Republican of Georgia, said the other item under discussion for the so-called Skinny Repeal is rolling back a tax on medical devices imposed by the health law.
But to avoid a 60-vote threshold for passage, the bill must meet specific deficit reduction targets. It’s still not clear how those targets will be reached.
Then there’s the question of what would come next. Republican leaders are assuring senators that the narrow repeal would be merely a vehicle to begin negotiations with House Republicans on a broader compromise to repeal and replace the Affordable Care Act. But some senators worry that they are being asked to vote for legislation they don’t like on a promise that it won’t become law — but they have no guarantee that the House won’t take it up and pass it.
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Cameron Joseph
✔@cam_joseph
.@SenJohnMcCain on House just passing the skinny repeal bill: "I'm very worried about it and I would be worried about the product."
10:42 AM - Jul 27, 2017
This might not have helped.
As Republican senators seek assurances that the bill they are being asked to vote on won’t become law, the House majority leader, Kevin McCarthy of California, may have sent shivers down a spine or two in the upper chamber with this announcement.“While last votes are currently scheduled to take place tomorrow, Members are advised that — pending Senate action on health care — the House schedule is subject to change. All Members should remain flexible in their travel plans over the next few days. Further information regarding potential additional items will be relayed as soon as possible.”That doesn’t sound like a man preparing for lengthy House-Senate negotiations on a comprehensive health care bill. So maybe the “skinny repeal” could become law after all?
Parliamentarian takes another scalp.
Senate Republicans also would have liked the “skinny repeal” to include a measure that would make it much easier for states to waive federal requirements that health insurance plans provide consumers with a minimum set of benefits like maternity care and prescription drugs.Then the Senate parliamentarian stepped in. The parliamentarian, Elizabeth MacDonough, objected on Thursday to the waiver provision, saying it appeared to violate Senate rules being used to speed passage of the bill to repeal much of the Affordable Care Act.
Republicans want to make it easier for states to get waivers for two reasons: State officials can regulate insurance better than federal officials, they say, and the federal standards established by the Affordable Care Act have driven up insurance costs.
But Republicans are learning the limits of the fast-track rules they are using. The Senate is considering the repeal bill under special procedures that preclude a Democratic filibuster, but the procedures also limit what can be included in the bill.
“The function of reconciliation is to adjust federal spending and revenue, not to enact major changes in social policy,” said Senator Bernie Sanders, independent of Vermont. “The parliamentarian’s latest decision reveals once again that Republicans have abused the reconciliation process in an attempt to radically change one-sixth of the American economy by repealing the Affordable Care Act.”
The Senate bill would give states sweeping new authority to opt out of federal insurance standards established by the Affordable Care Act. It builds on a section of the law that allows states to obtain waivers for innovative health programs. But it would relax many of the requirements for such waivers that Democrats put into the law, signed by President Barack Obama in 2010.
Insurers come off sidelines with warning.
The health insurance lobby, America’s Health Insurance Plans, came off the sidelines on Thursday to warn Senate leaders against repealing the Affordable Care Act’s mandate that most Americans have insurance without approving some mechanism to pressure people to maintain their coverage.“We would oppose an approach that eliminates the individual coverage requirement, does not offer continuous coverage solutions, and does not include measures to immediately stabilize the individual market,” the group wrote.
AHIP played a major role in getting the Affordable Care Act passed in 2010 but has been reluctant to intervene in the fight over its repeal. On Wednesday, the Blue Cross Blue Shield Association, a narrower insurance lobby, weighed in with a similar warning.
Both groups were pulled into the fray by expectations that the Senate could end up voting in the early morning hours of Friday on a narrow bill that repeals a few important parts of the Affordable Care Act but leaves much of the law in place. Two of the pieces that would be repealed are the mandates that individuals have health insurance and that large employers cover their employees. The Senate had intended to repeal those mandates but create a new rule that anyone who allows coverage to lapse would have to wait six months before getting a new policy.
That lock out period was supposed to be enough to convince people not to simply wait until they were sick to buy insurance, a prospect that could send insurance markets into a tailspin, since only sick people would have insurance.
GRAPHIC
The “Skinny”
Repeal Republicans
Hope to Pass Would
Leave
Huge
Numbers Uninsured
This chart shows what a narrower repeal would do.
OPEN GRAPHIC
But it looks certain that any bill that can emerge from the Senate would not have the lock out provision, a deep concern to insurers who say that without it, insurance premiums would soar.
The American Medical Association piles on.
The American Medical Association, by far the largest physicians’ advocacy group, has stood firmly against each of the bills to repeal the Affordable Care Act. Now the A.M.A. has come out against the “skinny repeal.”“There has been considerable speculation regarding a so-called ‘skinny package’ that would primarily eliminate penalties related to the individual and employer mandates and provide tax cuts to device manufactures and the health insurance industry. Eliminating the mandate to obtain coverage only exacerbates the affordability problem that critics say they want to address. Instead, it leads to adverse selection that would increase premiums and destabilize the individual market.Oh, and so does AARP.
“We again urge the Senate to engage in a bipartisan process – through regular order – to address the shortcomings of the Affordable Care Act and achieve the goal of providing access to quality, affordable health care coverage to more Americans.”
Protesters make their voices known.
Photo
Capitol Police officers stopped a group of protesters on Thursday. CreditTom Brenner/The New York Times
Across the Capitol on Thursday, supporters of the Affordable Care Act tried to reach out to senators, sometimes through mass protests, sometimes through their stories.
“I had epilepsy as a kid. I would not have been able to be covered under what you’re proposing,” one man told Senator Richard Shelby, Republican of Alabama.
The senator replied: “I think we need to have — not just for you but for any group that is underserved medically — we ought to protect them.”
Vigils broke out throughout the Capitol and around lawmakers’ offices.
Protesters in the Senate gallery chanting “kill the bill” disrupted proceedings on Tuesday just before the Senate voted, 51-50, to begin the health care debate. Democrats, including Senator Cory Booker of New Jersey, spoke to crowds on the steps of the building. Hundreds of protesters flooded the lawns outside the Capitol.
“The message was: we are not backing down,” Nora Franco, campaign organizer at Planned Parenthood, said in the Capitol. She added, “Now is not the time to throw in the towel. Now is the time to literally be harassing your senators.”
Seven years ago, similar scenes unfolded before the votes on the Affordable Care Act, but then, the passion came from the opponents. Those voices now are little in evidence.
Has Alaska’s delegation crossed Trump?
President Trump went after Senator Lisa Murkowski of Alaska, who was one of only two Republicans to vote against starting debate on health care this week, with a Twitter post on Wednesday.But that might not be the end of it.
Ryan Zinke, the Interior secretary, called both Ms. Murkowski and Alaska’s other senator, Dan Sullivan, “letting them know the vote had put Alaska’s future with the administration in jeopardy,” The Alaska Dispatch News reported. Mr. Sullivan, also a Republican, voted in favor of beginning debate.
“I’m not going to go into the details, but I fear that the strong economic growth, pro-energy, pro-mining, pro-jobs and personnel from Alaska who are part of those policies are going to stop,” Mr. Sullivan said, according to the newspaper.
But the leverage goes both ways.
Ms. Murkowski is the chairwoman of the Senate Energy and Natural Resources Committee, which has oversight of the Interior Department. She is also the chairwoman of the Senate Appropriations subcommittee with jurisdiction over the department.
She likely can do more to Mr. Zinke than he can do to her.
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Kasie Hunt
✔@kasie
DELAYED: Hearing to confirm a series of nominees to Zinke's Interior. Murkowski also controls Interior $$ via approps subcom chair
9:15 AM - Jul 27, 2017
Tracked down by reporters on Capitol Hill, Mr. Sullivan called for the administration and Alaska’s small but powerful congressional delegation to “get back to cooperation.”
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Vaughn Hillyard
✔@VaughnHillyard
Alaska Sen. Sullivan responds, today, to call with Zinke --> "Sooner we can get back to cooperation...better it's going to be for Alaska."
9:52 AM - Jul 27, 2017
No word yet from Ms. Murkowski.
Where did the Senate leave off on Wednesday?
Wednesday’s big vote was on a measure to repeal major parts of the existing health law — but without swapping in something new.Republicans have struggled to agree on the contents of a replacement for the law, so a “clean repeal” bill seemed like a good alternative to some of them.
But the measure was soundly rejected. Seven Republicans — including Senator Lamar Alexander of Tennessee, the chairman of the Senate health committee — joined Democrats in voting against it.
The repeal-only measure was expected to fail. But the episode demonstrated the problem facing Republican leaders: They don’t have enough votes to pass a broad replacement of the health law. They also don’t have the votes to simply repeal major parts of it.
GRAPHIC
The Outcomes of
the Many Republican
Health Plans Are
Not So
Different
Comparing how the plans would affect key measures like the number of
uninsured and the deficit.
OPEN GRAPHIC
What happens on Thursday?
Senate Republicans have been trying to push through a repeal by using special budget rules that limit debate to 20 hours. That time is expected to be exhausted on Thursday.After it expires, the Senate will move into what is known as a “vote-a-rama” — a marathon series of votes on amendments.
Photo
Senator Chuck Schumer, the minority leader, leaving the Senate chamber after lawmakers on Wednesday rejected a proposal to repeal the health care law. CreditStephen Crowley/The New York Times
Typically, Democrats would be expected to offer a barrage of amendments. But on Wednesday night, the minority leader, Chuck Schumer of New York, said Democrats would not offer any amendments until Mr. McConnell revealed the final bill he wants the Senate to consider.
“We ought to see it soon, in broad daylight, not at the 11th hour,” Mr. Schumer said.
The vote-a-rama could begin late in the day on Thursday. If Democrats do offer a blizzard of amendments, it could stretch overnight. But it remains unclear when, exactly, Mr. McConnell plans to reveal his legislation.
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