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Wednesday, July 25, 2018

Remember: The Real Senate "Repeal and Replace" Bill Only Got 43 Votes in 2017

Most everybody remembers the dramatic middle of the night vote to repeal the Affordable Care Act on July 28 of last year, punctuated by Senator John McCain’s thumbs-down on the Senate floor. And for anyone who did forget the events of that night, President Trump loves to mention that thumbs-down at every rally, in an effort to portray the defeat of the bill repealing the ACA as narrow, driven by McCain’s idiosyncratic politics, and perhaps easily reversed in the future.

A focus only on that much-televised vote overlooks the significance of what actually happened in last summer’s failed effort by President Trump and his Republican allies to repeal the health law. The vote on July 28 was actually the third and least substantive of three bills repealing the ACA to lose in the Senate last year.

The first and more telling vote took place one year ago today, on July 25. The key vote involved the final version of the detailed bill to repeal and replace the Affordable Care Act, known as the “Better Care Reconciliation Act” or BCRA. That bill began in the House—it was formally introduced there in March 2017—and passed the House narrowly on May 4. Senate Republican leadership then worked on the bill for almost three months, producing multiple versions, and bringing a final version to the Senate floor one year ago. Every version would have gutted core consumer protections, massively cut the Medicaid program, and caused tens of millions of people to become uninsured.

After months of work and numerous different versions of the bill, the actual detailed Republican repeal and replace bill finally came to a climactic Senate floor vote on July 25. There it lost NINE Republican Senate votes. These included not only Senators Susan Collins and Lisa Murkowski, but also Senators Tom Cotton, Bob Corker, Lindsey Graham, Dean Heller, Mike Lee, Jerry Moran and Rand Paul. Most of these no votes were objecting to core aspects of the bill. The bill was NOT close to passing.

Following this firm Senate rejection, Senate Republican leadership tried to salvage a “placeholder” repeal bill in the hopes of first repealing the ACA and then revisiting a replacement in a separate bill. This first took the form of a “repeal with no replacement” bill, which lost 55-45, and then a final “skinny repeal” bill. As we described last year, the “skinny repeal” bill was a tactical ploy to enable a new variant of the “repeal and replace” bill to be hashed out in secret in conference committee and then voted on with no amendments. It was this last-ditch, essentially procedural vote that was stopped narrowly by John McCain’s thumbs-down. Then, a few weeks later, a new version of “Repeal and Replace bill” called the Graham-Cassidy bill was put forward: it too was withdrawn in late September for lack of support in the Senate.

As we look back on the events of last summer, we should remember that the only detailed Republican bill that actually got a Senate vote didn’t come close to passing, and with good reason. This is important to keep in mind as we look ahead to 2019 where we face the possible threat of a renewed legislative fight to defend Medicaid and the Affordable Care Act.