'Skinny Repeal' Bill Dies in Senate Vote

By Robert Lowes
WebMD Health News

July 28, 2017 -- The Senate early Friday morning narrowly defeated a "skinny" repeal of the Affordable Care Act (ACA).

Republican Sen. John McCain of Arizona cast the deciding vote against the proposal. He joined Sen. Susan Collins (R-Maine) and Sen. Lisa Murkowski (R-Alaska) in opposing the measure. No Democrat voted for it.

It was the third time this week that Senate Republicans failed to undo the signature legislation of the Obama administration, also known as Obamacare.

The latest version, called the Health Care Freedom Act (HCFA), called for just a few changes to the embattled law. But one of those was big — the elimination of the individual mandate to obtain health insurance coverage.

The Senate bill's collapse breaks one of President Donald Trump's signature campaign promises. Following the vote, Trump tweeted: "3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let ObamaCare implode, then deal. Watch!"

Without no legislative fix in sight, the Obamacare marketplaces remain mired in uncertainty at a time when health insurers are considering their participation for 2018.

The American Medical Association (AMA), like many health organizations and patient advocacy groups, maintained that the Senate bill would have harmed patients. Some estimates said approximately 16 million Americans would lose insurance coverage.

Expressing relief over the bill's collapse, AMA President David Barbe, MD, called for Congress to begin a bipartisan effort to improve the health law.

"The first priority should be to stabilize the individual marketplace to achieve the goal of providing access to quality affordable health coverage for more Americans," he said in a statement.

Before the vote, House Speaker Paul Ryan (R-WI) said House Republicans were willing to turn the bill over to a House-Senate conference committee to forge a compromise measure instead of voting on it as-is. A handful of Senate Republicans had vowed that they would not support the bill unless they received assurances that a conference committee would take it up.

Earlier in the week the Senate had voted down a more comprehensive version of a bill to repeal and replace Obamacare, along with a different measure that would have repealed ACA without a replacement.

The newest version would have eliminated the penalty for not obtaining health coverage, effectively killing the individual mandate. The bill also would have:

  • Through 2024, eliminated the penalty for employers with 50 or more workers that do not offer them insurance.
  • Allowed individuals with tax-exempt health savings accounts to contribute more money to them for 3 years.
  • Repealed the tax on medical device makers for 3 years.
  • Cut off Medicaid reimbursement of Planned Parenthood services for 1 year.
  • Eliminated the Prevention and Public Health Fund in 2019.
  • Given states more flexibility in obtaining waivers under the ACA to implement their own healthcare reforms.

The Congressional Budget Office (CBO) said that under the bill, the number of uninsured Americans would increase by 15 million in 2018 compared with the current law's trajectory. By 2026, there would be an additional 16 million uninsured.

The CBO has said that eliminating the individual mandate would destabilize the individual insurance market by reducing the number of young healthy people who buy coverage, forcing insurers to raise premiums for a sicklier, costlier risk pool and making insurance increasingly more unaffordable.

HealthDay News contributed to this report.

©2017 WebMD, LLC. All Rights Reserved.

Health Solutions From Our Sponsors