Without Votes for BCRA, McConnell Calls for Repeal and Delay of ACA

Note: By midday on Tuesday, 3 Republicans announced they opposed a straight repeal of the Affordable Care Act. Update at the end of the article.

With plans to repeal and simultaneously replace the Affordable Care Act (ACA) derailed now that 4 Republican senators have announced they would oppose the Better Care Reconciliation Act (BCRA) of 2017, Senate Majority Leader Mitch McConnell (R-Kentucky) is returning to older plan: repeal and delay.

After Senators Mike Lee of Utah and Jerry Moran of Kansas both released statements Monday night that they would vote “no” on the Senate’s healthcare bill because it did not go far enough to repeal the ACA, McConnell said in a statement that the approach of repealing and immediately replacing “the failure of Obamacare will not be successful.”

Instead, he announced his decision to have the Senate vote on the House bill with a 2-year delay to the repeal “to provide for a stable transition period to a patient-centered healthcare system that gives Americans access to quality, affordable care.” McConnell is advocating bringing back what the Senate passed in 2016 that was immediately vetoed by President Barack Obama.

President Donald Trump has recently been tweeting his support of the strategy to repeal and delay, first on June 30 and again on Monday after Moran and Lee announced their opposition to the BCRA:

Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!

— Donald J. Trump (@realDonaldTrump) July 18, 2017

Senator Rand Paul (R-Kentucky), who was also going to vote “no” on BCRA, immediately tweeted support for the president and a “clean repeal.” Another Republican who endorsed repealing the bill without a replacement was Representative Mark Meadows (R-North Carolina), who is the chairman of the Freedom Caucus.

Time for full repeal of #Obamacare--let's put the same thing on President Trump's desk that we put on President Obama's desk https://t.co/2ik567ayKR

— Mark Meadows (@RepMarkMeadows) July 18, 2017

In January, the Congressional Budget Office (CBO) had weighed in on the impact that the old bill, which eliminated the ACA’s penalties, taxes, premium credits, and cost-sharing subsidies, but left in place the regulations on the market. The CBO had estimated that such legislation would increase the number of uninsured by 18 million in the first year, increasing to 32 million in 2026, while premiums in the individual market increased by 20% to 25% in the first year and would double by 2026. However, this estimate only considers the scenario of a partial repeal without a replacement, not what would happen if the bill was partially repealed with a 2-year delay.

A January 2017 Health Affairs blog post, written by Joseph Antos, PhD, and James Capretta, MA, of the conservative think tank American Enterprise Institute, explained that such a partial repeal without any legislation to replace the law would “result in an untenable situation in the marketplace: insurance rules that presume large subsidies for insurance and strong enforcement of the individual mandate, both of which would be eliminated by the repeal bill.”

There could be additional opposition from within the Republican Party, as Senator John McCain (R-Arizona), who is recovering from surgery, released a statement supporting the idea of reforming the ACA with help from Democrats.

“One of the major problems with Obamacare was that it was written on a strict party-line basis and driven through Congress without a single Republican vote,” he said. “As this law continues to crumble in Arizona and states across the country, we must not repeat the original mistakes that led to Obamacare’s failure. The Congress must now return to regular order, hold hearings, receive input from members of both parties, and heed the recommendations of our nation's governors so that we can produce a bill that finally provides Americans with access to quality and affordable healthcare.”

By noon on Tuesday, 3 Republican senators announced they would vote no on any bill that repealed the ACA without a replacement. Collins, who was already committed to voting against BCRA, was joined by Senators Shelley Moore Capito (R-West Virginia) and Rob Portman (R-Ohio) in opposition against a straight repeal. Capitor cited concerns about her constituents who rely on Medicaid expansion.

"My position on this issue is driven by its impact on West Virginians," she said in a statement. "With that in mind, I cannot vote to repeal Obamacare without a replacement plan that addresses my concerns and the needs of West Virginians."

Collins took to Twitter:

I will vote no on the motion to proceed to repeal the Affordable Care Act without a replacement. I voted against this same proposal in 2015. pic.twitter.com/Szuke5zYNL

— Sen. Susan Collins (@SenatorCollins) July 18, 2017