Graham-Cassidy Failed. Now What?

By Jill Zorn

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This week marked another failure of Congress to pass a bill to repeal and replace the Affordable Care Act (ACA).   This time it was the Graham-Cassidy bill that couldn’t find the votes to be passed in the Senate and then sent to the House.

As Politico reports,

At one point, the bill seemed to have a real chance of success. And then it ran into the same hurdles that killed every other GOP health plan. Ultimately, a number of Senate Republicans remain wary of transforming the U.S. health system in such a haphazard process — especially with plans to make deep cuts to Medicaid and roll back protections for people with pre-existing conditions.

Why did the bill fail?

A terrible process

The beginning of the end of Graham-Cassidy began on Friday, September 22, when Senator John McCain announced that he could not “in good conscience” vote for the bill.  Just as he had on a previous repeal effort he objected to the rushed and unusual process that broke well-established norms in the Senate for law-making.  Read his statement here.

Another Senator, quoted in Politico, expressed similar concerns about the messy process:

“I can’t be on CNN defending something if it’s in its 27th iteration when I think it’s the third iteration. That’s not the way I do business,” said Sen. John Kennedy (R-La.). “I don’t even know what the last version looked like.”

Too much division within the Republican party

There seems to be no way to satisfy both the extreme right and the more moderate wings of the party.  As Sarah Kliff wrote in Vox:

There is no clear ground between the Senate moderates and conservativesAny future Republican repeal efforts will confront the same obstacle as those we’ve seen fail in recent months. There appears to be no policy middle ground between someone like Sen. Rand Paul (who wanted to see the insurance markets completely deregulated) and Sen. Susan Collins (who wanted to ensure nobody in her state lost coverage).

Supporters of repeal and replace don’t agree on their goals

It turns out that “repeal and replace” is a slogan, not a plan.  Reporter Dylan Scott interviewed policy experts in conservative think tanks for his Vox article, Obamacare Repeal Died Again.  Republicans Have No Plan B:

“There really wasn’t a robust and serious conversation about what is the conservative or Republican solution to health care policy,” Dan Holler, who oversaw the repeal debate for Heritage Action for America, told me. “There was really no consensus within the Republican Party on where to go forward.”

The public is against repeal

The one hearing held on the Cassidy-Graham bill was targeted by a large group of protesters, many of them from the disabled advocacy group ADAPT.  These demonstrators illustrated the reality that Americans were against this bill.  A poll taken just a few days before the hearing showed only 20 percent of those asked approved of the legislation.

The visible opposition of talk show host Jimmy Kimmel may have also helped stop the bill.  Another poll shows voters trusting him more on health care issues than they trust Republicans in Congress.  His message about needing to make sure people with pre-existing conditions retained coverage was one that resonated with the public.

Ironically, the result of the past tumultuous months of repeal attempts is that the ACA is now more popular than ever.

Maybe ACA repeal failed for this simple reason, articulated by Ezra Klein in his Vox article Why Obamacare Survived:

The secret to Obamacare’s persistence is that the American people want the health care system made better — by which they mean they want more people to have affordable health insurance — and Obamacare achieves that goal. By contrast, the GOP, at every single turn, has offered plans to make the system worse.

What’s Next?

The next federal fiscal year begins on Monday.  Does that mean we have to be ready immediately for another attempt at repeal?

The good news is, it seems we will get a brief reprieve, while congress turns its attentions to a tax reform package.  But the bad news is possible repeal of the ACA is not likely to go away completely until there is political change in Washington D.C.

The danger of repeal using the reconciliation process is certainly far from over and this article games out some of the possible routes.  In fact, Senators Graham and Cassidy emerged from a meeting with the president yesterday vowing to hold hearings and keep trying to pass their bill.

At the same time, repealing the ACA next year will not be easy and faces clear obstacles.  And talk of a bipartisan compromise to stabilize the marketplaces is again in the air.

It’s impossible to predict the future in this extremely volatile political environment.  But there is no question that advocates will have to remain vigilant.

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