“Reforming Medicaid, one of the most broken forms of health care, by block granting it to the states, letting the states actually be innovative and coming up with better ways to run health care for lower income people. … That saved $800 billion. It failed by one vote in the Senate.”

— Rep. Steve Scalise (R-La.), House majority whip, in an interview with Maria Bartiromo, Fox Business News, Nov. 13, 2018

“We actually got rid of Obamacare, except for one vote.”

— President Trump, remarks during a Cabinet meeting, Aug. 16

“We had it done, but unfortunately, somebody decided to vote against that at the last moment, even though they campaigned for years saying they were going to do it.”

Sen. John McCain (R-Ariz.) may have passed away in August, but his late-night thumbs-down vote that in 2017 blocked passage of a slimmed-down repeal of the Affordable Care Act continues to be an all-purpose excuse for Republicans.

We’ve documented in our database of President Trump’s false and misleading claims that the president repeatedly claims he was just one vote away from triumphally killing Barack Obama’s signature achievement. He’s made the claim at least 30 times.

Similarly, in a Wall Street Journal opinion article, Rep. Jason Lewis (R-Minn.), who was defeated for reelection, made a similar “one-vote” claim to argue that McCain’s vote cost the Republicans the House.

But we were especially struck by Scalise’s recent statement that block-granting Medicaid — part of the repeal bill — failed by one vote in the Senate. He certainly impressed Bartiromo, who responded, “Wow.”

But this “one-vote” rhetoric is very misleading. Let’s explain what’s going on here.

The Facts

As anyone who has taken basic civics knows, the House of Representatives and the Senate must pass the same law before it is presented to the president for his signature. If the two bodies pass different versions of a similar law — as is often the case — negotiators must meet to hammer out an agreement, known as a conference report.

Then, both houses must vote on the final deal. There are many occasions when a lawmaker might vote for a bill initially, if only to advance it for further tinkering, but then vote against the final conference report.

In other words, there are no guarantees.

So where was Obamacare repeal in this process? Barely out of the starting gate.

The House narrowly passed the American Health Care Act (AHCA), 217 to 213. An earlier version had failed, but amendments were added that brought along conservatives who had previously balked. The Senate, however, was not happy with the AHCA and crafted its own version of the law, the Better Care Reconciliation Act (BCRA).

There were significant differences between the two versions, though both sought to reduce projected Medicaid spending by instituting a per capita cap on spending. (Scalise called it a block grant in the interview, but that was only an option for states.)

Currently, states and the federal government share in the cost of Medicaid, but the proposed laws would have capped federal funding per enrollee. There were differences in how each body would have calculated the caps, but the net result is that federal spending on Medicaid would have dropped significantly — $772 billion over 10 years in the BCRA and $834 billion in the AHCA.

That was too much for many senators, and Sen. Rob Portman (R-Ohio) introduced an amendment that would have restored $100 billion of Medicaid funding. But even after that was added, the BCRA was rejected by the Senate by a vote of 43 to 57, including “no” votes from nine Republicans.

McCain actually voted for this version of the bill, which needed 60 votes for passage because the Senate parliamentarian determined that certain provisions violated rules that otherwise would have allowed passage with 51 votes (50 votes plus the vice president casting the tiebreaker).

So that’s not one vote short. It’s 17 votes short.

Sen. Rand Paul (R-Ky.) offered a plan to repeal Obamacare and then delay implementation for two years while lawmakers worked out the details. That would have only needed 51 votes for passage, but it was rejected, 45 to 55, with seven Republicans (including McCain) voting against it.

Finally, there was a vote on “skinny repeal.” This would have repealed the individual and employer mandates but it would have left much of the rest of the law intact, including Medicaid expansion. In other words, this would not have put any cap on Medicaid spending. This is the bill that McCain, Sen. Susan Collins (R-Maine) and Sen. Lisa Murkowski (R-Alaska) voted against, along with all Democrats, so it only had 49 votes.

Even if it had passed, the differences between the AHCA and the skinny repeal would have been stark and perhaps insurmountable. Given the votes on the floor, Senate negotiators would not have been empowered to accept a major cap on Medicaid spending — and if the bill included that, it probably would have gone down in defeat in the Senate. (Similarly, a bill without a cap on Medicaid spending might have lost conservative votes in the House.) McCain had said he voted against the skinny repeal because he wanted the legislation to go through a regular committee process, so a jammed-together conference process might not have won him over.

“One reality about conference committees is that, technical restrictions aside, they can accept or reject almost any provision. So it is at least possible that if the bill had gone to conference, they might’ve been able to add that provision,” said Norman Ornstein, congressional expert at the American Enterprise Institute. “I would be dubious that the Senate conferees, knowing the unpopularity of the provision, would have gone along.”

Lauren Fine, a spokeswoman for Scalise, insisted that it was possible that the Medicaid provision could have survived if the bill had gone to conference. “The Medicaid provision was in the House-passed AHCA bill,” she said. “The McCain ‘no’ vote ended the possibility of going to conference, where that provision would have been part of the negotiations on melding the House and Senate versions.”

When we expressed doubt on that outcome, she responded: “You have no idea how a conference committee would have absolutely turned out, and that Whip Scalise is certainly as informed as anyone else to speculate what would or would not be decided in conference committee.”

The Pinocchio Test

Even if McCain had supported the skinny repeal, lawmakers still would have had to negotiate a compromise agreement. Then passage would have been needed in both chambers, which was not assured, given the narrow margin for passage of the House bill.

So at a minimum, it is misleading to say that the Obamacare repeal was just one vote short, as Trump often does. But in the case of the specific Medicaid provision touted by Scalise, it was 17 votes short even with a $100 billion sweetener. There’s a slim possibility some sort of Medicaid funding reduction would have emerged if there had been a conference agreement, but nothing of the size — $800 billion — claimed by Scalise.

Bartiromo was certainly fooled by Scalise’s language, which is why it is important for politicians to be precise about what took place.

Three Pinocchios

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“Reforming Medicaid, one of the most broken forms of health care, by block granting it to the states, letting the states actually be innovative and coming up with better ways to run health care for lower income people. … That saved $800 billion. It failed by one vote in the Senate.”
in an interview with Maria Bartiromo, Fox Business News
Tuesday, November 13, 2018
Share the Facts
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1
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Washington Post rating logoWashington Post Rating:
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“We actually got rid of Obamacare, except for one vote.”
remarks during a Cabinet meeting
Thursday, August 16, 2018