Last night the Senate failed to advance the last version of healthcare reform currently under consideration, with a dramatic 49-51 vote at 1:30 am. The bill became known as “skinny reform” because it contained only a few regulatory changes rather than a full repeal of the Affordable Care Act, and was designed to be a procedural step, a package that could simply get a majority to vote for it so, having passed “something”, the Senate and House could form a conference committee and work out a compromise between their two versions. In fact, some Senators indicated that they would only vote for the skinny reform if there were assurances that it would not be accepted as-is by the House and passed into law, rather than go to conference. Ultimately the bill was opposed by all 48 Democrats and Republican Senators Collins, Murkowski, and McCain.
The Senate is moving on to other issues after the August recess, with tax reform the next big bill that will take up much of the calendar in the fall along with the annual spending bills. This does not mean that repealing the Affordable Care Act will not be revived at some point. Republicans may conclude that in writing their bills they overreached when they decided to include entitlement reform in an ACA repeal bill. It wasn’t necessary to cut $800 billion out of Medicare over ten years in this process, with the resulting headlines about 20 million people losing their Medicare benefits. They may come back with a repeal and replace bill that just takes aim at the Affordable Care Act. But for procedural reasons, this was probably their only opportunity to pass a repeal bill with only Republican votes this year.
Now the question becomes what happens to the ACA, which is still the law of the land. It is doing well in some areas but not in others. It relies on insurance companies which still have no certainty about the program’s future on which to make business decisions. The President has said he will let it fail, at which point he believes Democrats will be willing to negotiate a solution.
The Administration has already taken small steps to destabilize the ACA, and there is the ongoing question of monthly payments to the insurers that make their participation worthwhile. The Administration can stop making them. Congress could step in, but how far would it go to at least temporarily help stabilize a program it has been trying to eliminate? The spending bill that funds the Department of Health and Human Services, and therefore important parts of the ACA, for fiscal year 2018 will likely become the next battleground. Republicans will write the bill but Democrats have the votes to block it. Compromise is a possibility.