This post has been updated as of July 17 to reflect recent events.
We’ve been hearing for months that Republican elected officials wanted to “repeal and replace Obamacare” — officially known as the Affordable Care Act — as soon as they got into office. But efforts to do so have met with resistance both inside and outside of Congress. The saga has seen many twists and turns — but where does it stand now?
That’s the million-dollar question on every Congress-watcher’s mind in D.C. these days.
How did we get here?
Getting the House to pass its version of the bill was rocky enough. At first, its very existence was a mystery that even members of Congress couldn’t solve. Then, a few weeks later, a vote on the measure was abruptly cancelled minutes before it was scheduled to happen when it became clear that the votes weren’t there.
The Senate’s version has had less high comedy and fewer cartoon-style chase scenes, but has been every inch as thorny a process for its supporters.
Its process, too, was largely conducted in secret, leaving everyone else to piece it together from leaks and educated guesses. Eventually, a version became public. Here’s a timeline of what’s happened since then:
June 22: Senate finally released draft bill of its plan to repeal and replace the Affordable Care Act.
June 23: After getting a look at the text, hospital, doctor, and public health groups nationwide oppose the bill, saying it makes “unsustainable” cuts to coverage.
June 26: The Congressional Budget Office (CBO) comes up with a preliminary score, finding that the bill would likely cause 22 million more Americans to become uninsured than currently are.
June 27: Unable to come to consensus before the July 4 recess, the Senate postpones the vote on the bill until July.
July 13: The Senate introduces a new draft of the bill, including language that will functionally restore pre-existing condition exclusions to millions of Americans as well as cut Medicaid.
July 14: The health insurance industry writes a letter to the Senate saying that they cannot support the Cruz amendment. “This provision will lead to far fewer, if any, coverage options for consumers who purchase their plan in the individual market,” the groups wrote. “As a result, millions of more individuals will become uninsured.”
July 15: Sen. John McCain (AZ) announces that he will be absent from the Senate for at least one week due to a health issue; in response McConnell delays a procedural vote planned for July 18.
Where the Senate stands
The Senate was supposed to come back after the July 4 recess and sit down and agree to something they could vote on. D.C. insiders and Congressional reporters say that process, so far, is a mixed bag.
McConnell announced July 11 that the Senate will stay in session through the first two weeks of August. Usually, Congress leaves town for the entire month, and that time has been scheduled off this year as well.
Shifting the break strongly implied that McConnell feels he needs more time to wrangle his party’s members into shape and make a bill happen. McConnell then released an updated draft on July 13.
The CBO was expected to issue a score for that bill — not including the implications of the Cruz amendment, which was added too late to be scored — on July 17.
However, McConnell announced late on July 15 that vote has now been “deferred” indefinitely due to McCain’s absence — because without McCain, as it currently stands, the bill cannot pass.
In order to pass it, McConnell needs to line up 50 Republican Senators who will vote for it. (A tie-breaking 51st vote can be cast by Vice President Mike Pence.)
There are currently 52 Republicans in the Senate, so for it to pass, no more than two can oppose it.
Senator Susan Collins (ME) has repeatedly voiced disapproval with the bill, particularly over its Medicaid cuts, and is is a no.
Senators Shelley Moore Capito (WV), Dean Heller (NV), John Hoeven (ND), Lisa Murkowski (AK), and Rob Portman (OH) have also all expressed concern with the Medicaid cuts in the bill. However, none have said explicitly yet whether they intend to vote for or against it, and the most recent draft includes some carve-outs that could sway some of them toward favoring it.
On the other end of things, none of the conservative bloc that opposed the first draft — Sens. Ted Cruz (TX), Ron Johnson (WI), Mike Lee (UT), and Rand Paul (KY) — has outright endorsed the new version yet either.
While Cruz called it “a very positive development,” Paul has reiterated his opposition.
With Collins and Paul both standing against bill, that means McConnell can only afford to lose one additional vote if he wants it to pass — so he can’t proceed without McCain.
So now what?
At this point it is honestly anyone’s guess what happens with American health care in the coming weeks.
The math in the Senate is simple: no bill can succeed without at least 51 votes. So McConnell cannot call for a vote on the bill until McCain is back, unless he wants to lose. But in the meantime, Republican support for the bill — already tepid and tenuous at best — may continue to wilt even further as the delay stretches out through July and into August.
Meanwhile, Sens. Lindsey Graham (SC) and Bill Cassidy (LA) introduced a completely different healthcare bill on July 13.
“We’re going to support Mitch’s effort with his new plan, but we want an alternative and we’re going to see which one can get 50 votes,” Graham said to CNN at the time. “We’re not undercutting Mitch, he’s not undercutting us.”
However, Graham also does not appear actively or loudly to be courting support for his bill as yet.
In short: Everyone in D.C. is guessing, but nobody quite knows what the future of this bill — or the ACA — is going to look like.