BRANDON COLLIGAN, PUSHING FORWARD
In the early morning hours of Friday, July 29 the Senate took up a vote to repeal parts of The Affordable Care Act. This “skinny” repeal consisted of eliminating penalties that uphold the individual mandate and would seek to eliminate the Prevention and Public Health Fund. Senate Republicans had already put themselves on a narrow path to successfully pass the repeal following a series of failed efforts in weeks before. Friday night, Senate Majority Leader Mitch McConnell unveiled a comparatively barebones bill to a vote in hopes of getting it passed by using obscure Senate rules. The goal being to bring a bill to the floor that could pass, regardless of its substance, and create a broader proposal that could keep the repeal process alive. The vote outcome was expected to be predictable and thought to tout party lines with a handful of exceptions. All Senate Democrats would oppose the bill while a handful of Republicans, most notably Maine’s Susan Collins and Alaska’s Lisa Murkowski were expected to oppose. That would then leave 50 Republicans as ‘yes’ votes, making Vice President Vice Pence the tiebreaker.
There was a curveball however. Arizona senator John McCain, making a dramatic return to the Senate following a recent brain cancer diagnosis, cast his vote against the repeal bill. Audible gasps were heard in the Senate chamber, as McCain made a symbolic thumbs down gesture and audibly said ‘no’ as he cast his vote. The repeal bill failed by a single vote. McCain’s vote was an upset to many who did not foresee him abandoning the party line, particularly after a (maybe not so surprising) yes vote on opening debate to the repeal process. McCain’s vote was decisive in this single repeal vote. However, there are many substantial and overlooked reasons as to why repeal efforts have failed thus far.
The Republicans have been ultimately fighting an uphill battle from the beginning of this Congress’s session. While having a majority in both houses, the Affordable Care Act is now more popular than it is unpopular. Certain elements of the ACA, particularly those in regards to preexisting conditions and cuts to Medicaid are popular across party lines. Public pressure has a dramatic influence on the decision making of legislators and has shown to be a factor in the debate, regardless of political affiliation. Lobbying on behalf of governors has been critical, as state executives have called for a bipartisan solution to protect state’s Medicaid expansion.
Full out repeal of the ACA is also deeply unpopular with private interests. Many of which have benefitted from the Medicaid expansion and the various subsidies to insurers and hospitals. Many of these entities have lobbying heavily against recent repeal efforts and are calling for an overhaul to the current system. Major stakeholders in the healthcare debate such as the American Association of Retired Persons (AARP), the American Medical Association, along with hundreds others have stated their opposition to repeal without a replacement. This is not surprising considering the magnitude of a measure that would impact nearly a fifth of the total U.S economy. This does not even consider the human cost of such a bill, and the severe, long term implications of repealing such a massive piece of healthcare legislation.
All of these factors show why it is increasingly difficult for Republicans to pass a repeal effort. It is also increasingly difficult to see any tactical advantage for Congressional Republicans to pursue such efforts. As pressure mounts and the right loses its window to pass any major overhaul, one should wonder what the rationale is for conservatives to push such an unpopular agenda. Yet the right is seemingly split on the implications of repeal. Many claim, including those in the Trump wing of the party, that the right would lose face if they didn’t follow through on their promise to repeal. However, there have been a variety of outspoken critics who see the implications of attaching the party to such an unpopular measure.
They are correct in doing so. If Mitch McConnell and President Trump continue to push for repeal, the party and the conservative movement will be indefensibly tied to a failed effort to take medical coverage away from millions of Americans. While there has been bipartisan consensus on the shortcomings of the ACA, particularly those in regards to insurance markets, these problems will not be addressed by full repeal. The failure to acknowledge these complexities is in part the reason for their inability to execute their repeal. So while Senators Colins, McCain, and Murkowski may not have voted against this legislation to appease supporters of the Affordable Care Act, they may in fact have saved the face of their own divided party.