In a new interview with NPR, Senate Majority Leader Mitch McConnell said what Republicans have been whispering since last week: The effort to repeal the Affordable Care Act probably died when Alabama elected Democrat Doug Jones to the Senate.
“We obviously were unable to completely repeal and replace with a 52-to-48 Senate,” said McConnell (R-Ky.). “We’ll have to take a look at what that looks like with a 51-to-49 Senate. But I think we’ll probably move on to other issues.”
Jones, whose victory will become official later this month, is expected to join the Senate when it returns in January. On the trail, Jones firmly opposed efforts to end the ACA and said that even in deep-red Alabama, voters had moved on.
“Repeal and replace is a political slogan,” Jones said this month. “It’s not something that’s workable.”
Jones’s arrival will allow just two Republicans in the Senate to block any repeal bill. Throughout 2017, Republicans lost at least three votes from their side on every version of repeal. By their last attempt, in September, key Republicans such as Sens. John McCain (Ariz.) and Susan Collins (Maine) warned that the repeal bills were not workable and needed to go through regular order.
After NPR’s interview with McConnell aired, Sen. Lindsey O. Graham (R-S.C.) — who met with allies this week to strategize passage of his own repeal bill — issued a statement saying that the campaign was not over.
“I’m fully committed to Repealing and Replacing Obamacare in 2018 by block-granting the money back to the states and away from Washington bureaucrats who are completely unaccountable to the patients of America,” Graham said. “To be successful we will need presidential leadership with the same passion to replace Obamacare as President Obama demonstrated in passing Obamacare.”
But Republicans, moving on from the issue, have already given up some of the tools that might have been used in the 2019 budget reconciliation process. They zeroed out the ACA’s taxpayer mandate, the least popular element of the law, in their tax overhaul. Doing so, according to the Congressional Budget Office, will reduce the deficit by $338 billion over 10 years. That’s money that can’t be used again — and without it, the Cassidy-Graham repeal bill of September and the “skinny repeal” of July would have been scored as increasing the deficit.
After securing the repeal of the mandate, Republican leaders suggested that the ACA would become so hobbled that Democrats would be compelled to replace it. The first serious attempt to repeal the law had been a lawsuit to kill the mandate; without it, both opponents and supporters of the law predicted a “death spiral” as consumers opted simply not to buy insurance.
“Arguably, doing away with the individual mandate makes the Affordable Care Act unworkable — not that it was particularly great beforehand,” Senate Majority Whip John Cornyn (R-Tex.) told Bloomberg News this week. “Hopefully this will precipitate the bipartisan negotiation on what we need to do as an alternative.”
But since losing at the Supreme Court in 2012, ACA opponents have watched more than 14 million people enter health insurance exchanges created by the law. In the truncated enrollment period this year, 8.8 million people enrolled or changed plans on the exchange and 2.4 million people got coverage for the first time. The theory behind the GOP’s mandate-repeal push, and the theory that killed cost-sharing subsidies, was that voters would blame Democrats, not the governing party, when their premiums spike — a theory not shared by Democrats.
Even before McConnell’s comments, conservative activists were talking about a need to move on from the repeal wars. Tim Phillips, the president of Americans for Prosperity, said in an interview this week that the conservative organizing giant would focus on overhauling welfare in 2018, not health care.
“There’s a time to come back to health care, but it’s probably not January 2018,” Phillips said.
President Trump, who has veered between promising to blame Democrats for health-care costs and taking credit for repeal bills, has also begun to discuss the ACA as an issue of the past.
“When the individual mandate is being repealed, that means Obamacare is being repealed, because they get their money from the individual mandate,” Trump said at Wednesday’s Cabinet meeting. “The individual mandate is being repealed. So in this bill, not only do we have massive tax cuts and tax reform, we have essentially repealed Obamacare.”
The president misstated the policy somewhat. The ACA’s expanded coverage is paid for through more than $500 billion of tax changes, and the mandate made up just $65 million of them. Democrats, however, have said they would prefer the president to think he has already won.
“The president is under some other illusion that he has repealed the Affordable Care Act,” House Minority Leader Nancy Pelosi (R-Calif.) said Thursday. “He’s damaged it, but he hasn’t repealed it. I don’t know if he knows that.”