ACA Repeal Failure: Skinny Repeal Defeated, 23 Million Would Have Lost Coverage
The Republican-led repeal effort over seven months produced several bills that the CBO estimated would cause tens of millions of Americans to lose health insurance. The final attempt — 'skinny repeal' — was a bill so limited in scope that even its Republican proponents did not want it to become law; its stated purpose was to pass something into conference. John McCain, who had returned from brain cancer treatment to cast the deciding vote, gave a thumbs-down at 1:30 AM to defeat the bill 51-49. Trump's response was to blame Republicans and to threaten to withhold the cost-sharing reduction payments that stabilized the ACA market, causing premiums to rise.
Overview
For seven years, Republicans had run on repealing the Affordable Care Act. When they controlled the White House, the Senate, and the House simultaneously for the first time, they could not do it.
The reason was numerical: the bills they wrote would have taken health insurance away from tens of millions of Americans. Every Republican who had to vote on those bills knew this. Three of them voted no.
The Process
The skinny repeal was drafted without committee hearings, without expert testimony, without a CBO score of its final form, and with the text delivered to senators the night before the vote. Republican senators were being asked to vote on a bill whose consequences they could not assess.
This was not an accident — it was a feature. Moving quickly meant avoiding scrutiny. Avoiding scrutiny meant avoiding the CBO scores that had sunk the earlier versions by documenting how many people would lose coverage.
The Promise That Wasn't Kept
Trump had promised in the campaign that "everybody's going to be covered" and "no one will be losing coverage." The bills his administration supported would have caused tens of millions of people to lose coverage. The gap between the promise and the policy was total.
The Sabotage
When the legislative repeal failed, Trump authorized the termination of cost-sharing reduction payments in October 2017. These payments stabilized the ACA market and kept premiums manageable for millions. Their termination increased premiums, increased the federal deficit, and destabilized insurance markets — achieving through executive action what the legislative repeal had failed to accomplish.
Courts found the termination illegal. The costs had already been incurred.
Timeline
Sequence of events
January 20, 2017
Trump signs executive order directing agencies to undermine ACA
On his first day, Trump signs an executive order directing agencies to waive, defer, and delay ACA provisions 'to the maximum extent permitted by law.' The order is a signal of intent to undermine the law while legislative repeal is pursued.
June 26, 2017
Senate ACA repeal bill — CBO: 22 million would lose coverage
The CBO scores the Better Care Reconciliation Act, finding it would cause 22 million people to lose insurance by 2026. The bill fails to attract enough Republican support to proceed to a vote.
July 25, 2017
McCain returns from cancer treatment to vote
McCain, who had been diagnosed with glioblastoma brain cancer days earlier, returns to the Senate to vote on the procedural motion to proceed with ACA debate. He votes to proceed while delivering a speech calling for regular order and bipartisan process.
July 28, 2017
Skinny repeal fails 49-51 — McCain's thumbs down
At approximately 1:30 AM, McCain walks to the front of the chamber and gives a thumbs-down, casting the 51st vote against the skinny repeal. The vote is 49-51. The repeal effort ends.
October 12, 2017
Trump terminates cost-sharing reduction payments
Trump signs an executive order terminating the CSR payments that helped lower-income ACA enrollees afford their plans. Premiums rise; insurers exit markets. Federal courts find the termination illegal but the damage to market stability is already underway.
Sources
- ↑ John McCain Casts Decisive Vote Against 'Skinny Repeal' — The New York Times
- ↑ The Senate failed to pass the 'skinny' Obamacare repeal bill — The Washington Post
- ↑ CBO Cost Estimate — Better Care Reconciliation Act — Congressional Budget Office
- ↑ Senate GOP fails to pass 'skinny repeal' of Obamacare — The Associated Press
Verification