The Health 202: Today is a huge turning point in the GOP’s long struggle to repeal Obamacare


Nearly eight years ago, the press shop for Senate Republicans circulated a letter demanding transparency on what would eventually become the Affordable Care Act.

The letter was from eight Democrats who were concerned about too much secrecy as the bill was being written. Their chief, then-Senate Majority Leader Harry M. Reid (D-Nev.), should ensure its full text and score from the Congressional Budget Office was posted online at least 72 hours before the first vote to start floor debate, the senators wrote on Oct. 6, 2009.

“Every step of the process needs to be transparent, and information regarding the bill needs to be readily available to our constituents before the Senate starts to vote on legislation that will affect the lives of every American,” they wrote.

Fast-forward to today. Senate Republican leaders are charging toward a vote, likely this afternoon, opening up debate on a health-care bill, but it’s unclear exactly what health-care bill Majority Leader Mitch McConnell (R-Ky.) will bring to the floor (if he even gets that option). It could be previously passed legislation repealing but not replacing big parts of the ACA (which President Obama vetoed). Or it could be some iteration of the Better Care Reconciliation Act, the measure McConnell wrote behind closed doors and has amended several times in hopes of gaining the 50 votes needed to pass it. The CBO has scored several versions, but McConnell would need to significantly revise his legislation should it have any chance at final passage.

Lofty ideals like transparency and cooperation fell by the wayside a long time ago in this process. Basically, Senate Republicans are scrambling to unite around a bill — any bill — that would undercut Obamacare enough to contend they fulfilled their long-standing promise to repeal and replace President Obama’s law. But today may be the end of the road, at least for now, if those same Republicans can’t muster enough votes to even start floor debate.

Watch for all sorts of moving pieces today, on both the political and policy fronts — chief among them Sen. John McCain’s (R-Ariz.) return to the arena after being diagnosed with brain cancer (he was recovering from an initial surgery in Arizona this week). McConnell needs McCain’s vote to have any chance of proceeding to floor debate, but it’s not entirely clear whether he’ll get it — along we can’t imagine why the senator would return to vote “no” on opening debate.

If 50 Republicans don’t support a motion to proceed — essentially opening up floor debate — the whole thing effort is dead, for the time being. Sen.Susan Collins (R-Maine) has said she’ll oppose the motion to proceed, meaning only one more Republican can defect for debate to begin. If enough members do support a motion to proceed, that kicks off a so-called vote-a-rama where McConnell could offer one of several different health-care bills and senators could propose all sorts of amendments to it. 

And don’t forget Democrats. They could challenge specific parts of health-care legislation that may not fit within the narrow confines of a budget reconciliation bill, essentially forcing Republicans to strike those elements if the parliamentarian agrees. Parliamentarian Elizabeth MacDonough indicated last week that key elements like a six-month waiting period to buy insurance for those not continuously covered might have to go.

It’s a dramatic day in the health-care world, there’s no doubt about that. As the day unfolds, Obamacare repeal could very easily fold. Republicans are just too divided over how to structure Medicaid and the individual insurance market.

Not even retired GOP House speaker John Boehner (R-Ohio) thinks his party will be able to repeal Obamacare, my colleague Robert Costa reports this morning. Bob obtained a video of Boehner telling a business gathering last week that Republicans are “not going to repeal and replace Obamacare” because “the American people have gotten accustomed to it.”

“Here we are, seven months into this year, and yet they’ve not passed this bill. Now, they’re never — they’re not going to repeal and replace Obamacare,” Boehner told a private crowd in Las Vegas. “It’s been around too long. And the American people have gotten accustomed to it. Governors have gotten accustomed to this Medicaid expansion, and so trying to pull it back is really not going to work.”

Republicans’ best hope is to peel away aspects of the law, such as some tax provisions and regulations, and to end health insurance mandates, Boehner added.

“When it’s all said and done, you’re not going to have an employer mandate anymore, you’re not going to have the individual mandate,” he said. “The Medicaid expansion will be there. The governors will have more control over their Medicaid populations and how to get them care, and a lot of Obamacare taxes will probably go.”

Boehner has made similar comments previously, predicting in February that Republicans will instead fix the ACA’s flaws and “put a more conservative box around it.”


AHH: All Republicans should be present and accounted for at today’s planned health-care vote, with McCain’s announcement late last night that he’ll return to Washington, D.C. His vote will be critical to starting debate on the bill.

“Senator McCain looks forward to returning to the United States Senate tomorrow to continue working on important legislation, including health care reform, the National Defense Authorization Act, and new sanctions on Russia, Iran and North Korea,” McCain’s office said in a statement.

“McCain’s dramatic return could inject some suspense into the procedural vote to open debate, which so far has failed to pick up strength — no matter which version is considered,” my colleagues Sean Sullivan, Kelsey Snell, Ed O’Keefe and John Wagner report. “Revered on both sides of the aisle, the news that McCain has brain cancer cast a pall over the Capitol last week and his return is sure to provide a morale boost for colleagues in both parties. But most immediately, McCain may provide a critical vote in support of beginning formal debate on the health-care bill.”

“I’m pretty confident we’ll get on the bill even without John, “ Sen. John Cornyn (R-Tex.), the chamber’s lead GOP vote-counter, told reporters.

President Trump hailed McCain’s return:

McCain’s cross-country trip might indicate hope for a health-care bill, Politico’s Jennifer Haberkorn tweeted:

Or maybe McCain’s just coming back for the National Defense Authorization Act (NDAA) the Senate is hoping to move on. CNN’s Jeremy Herb:

From The Atlantic’s McKay Coppins:

HuffPost’s Jennifer Bendery: 

Either way, McCain always votes for a motion to proceed, per Talking Points Memo’s Tierney Sneed:

OOF: A former GOP senator from a more bipartisan time is pleading with his successors to resist “bullying” to support the health-care bill. Former Minnesota senator David Durenberge (Minn.), a centrist who worked on health-care policies during his nearly two decades in the Senate and ever since, wrote in an op-ed yesterday that “voting on this hodgepodge of mysterious bills is not the way” for Republicans to fulfill their promise to repeal the ACA.

When senators are asked by their president to vote for a bill that could radically change health-care, they should ask questions, hold hearings, understand what it would mean for constituents and listen to those who understand the system, Durenberger writes for USA Today. And when it doesn’t add up, senators should vote against it, he says.

“This week, the Senate once again is set to vote on a health care bill that will radically change how people get coverage and who can afford their care. But unlike normal times, senators, you are being asked to approve a motion to proceed to a vote…without knowing what will be in the bill you would vote on,” he writes. “A vote in these circumstances will rightly provoke anger and distrust unlikely to abate. Take it from me: A no vote on the Motion to Proceed this week is the only one that will be defensible in the years to come.”

OUCH: Quite literally, but in a good way. House Majority Whip Steve Scalise (R-La.) has started the physical recovery process from his gunshot wound at the Alexandria baseball practice shooting, he told colleagues yesterday.

“A group of House Republicans got a surprise pep talk Monday from their missing man: Majority Whip Steve Scalise,” my colleague Mike DeBonis reports. “Scalise called in to the weekly Republican whip team meeting Monday evening and, according to several attendees, shared encouraging news: He has started the physical recovery process and could be transferred soon from Medstar Washington Hospital Center, where he has been hospitalized since the June 14 shooting, to a specialized rehabilitation facility.”

“There was no word on when Scalise might return to work. A spokesman, Chris Bond, said Scalise told the whips that ‘he is looking forward to working through the rehab process and returning to the Capitol once he is ready,'” Mike writes. “Scalise has undergone a series of operations to address the wound to his hip, most recently a July 13 surgery to combat a ‘deep tissue infection.'”


You can almost read President Trump’s fear of failure in his tweets this morning. Trump, who had promised to repeal Obamacare on Day One of his term, is preparing to blame congressional Republicans if and when the whole thing goes down in flames.

Trump even joked about firing Health and Human Services Secretary Tom Price if the effort fails, during a speech at the 2017 National Scout Jamboree yesterday in West Virginia.

“By the way, you’re going to get the votes?” Trump asked Price in front of the crowd. “He better get ’em. He better get ’em. Ah, he better — otherwise, I’ll say, ‘Tom, you’re fired!’” 

Later on yesterday, at the White House, Trump made a late-hour appeal to members of his own party to move forward with debate on an Obamacare repeal bill, The Post’s John Wagner and Jenna Johnson report.

“Any senator who votes against starting debate is telling America that you are fine with the Obamacare nightmare, which is what it is,” Trump said in an afternoon speech.

Trump implored fellow Republicans to make good on their promise to repeal the ACA that has been a staple of their rhetoric for seven years. “For Senate Republicans, this is their chance to keep their promise,” Trump said. “Over and over again, they said repeal and replace, repeal and replace. But they can now keep their promise to the American people.”

“Besides decrying the shortcomings of Obamacare, Trump touted what he described as the improvements that would come under the GOP legislation,” John and Jenna write. “Trump said that the legislation eliminates the ‘painful individual mandate’ that required Americans to have health insurance or pay a penalty fee, along with removing mandates for employers. He claimed premiums would be ‘significantly’ lowered and health insurance markets would be stabilized — notions that multiple analyses have disputed — and that access to health savings accounts would be expanded.”


–Senators should probably just duel it out today instead of voting on the health-care bill dividing them. The Health 202 isn’t taking credit for that idea; it comes from Texas GOP Rep. Blake Farenthold, who said yesterday that if the three female Republican senators opposing the measure were men from South Texas, he might challenge them to a duel.

“The fact that the Senate does not have the courage to do some of the things that every Republican in the Senate promised to do is just absolutely repugnant to me,” Farenthold told his local radio host Bob Jones on Friday. “Some of the people that are opposed to this, there are female senators from the Northeast… If it was a guy from South Texas, I might ask him to step outside and settle this Aaron Burr-style.”  (Burr famously shot and killed his political adversary, Alexander Hamilton, in a duel in 1804.)

Farenthold was referring to Sens. Susan Collins of Maine, Lisa Murkowski of Alaska and Shelley Moore Capito of West Virginia, who have said they wouldn’t vote for a repeal-only bill. The Twitterverse had some fun with it:

New York Magazine contributing writer Yashar Ali:

From CNN’s Juana Summers:

–Some reporters helpfully listed the key Republican senators — both conservatives and moderates — to watch during today’s vote(s):

Vox’s Dylan Scott: 

From Bloomberg’s Sahil Kapur:

–Democrats and supporters of the ACA are keeping up their outcy, even though there’s little more they can do than stand in the sidelines and watch everything unfold:

From Sen. Jeff Merkley (D-Ore.): 

Andy Slavitt, head of the Centers for Medicare and Medicaid Services under Obama:

The AARP, which has been advocating strongly against the GOP health-care measures, issued a warning:


–The venerable Congressional Budget Office is under fire from Republicans for its estimates of the effects of their proposals to repeal and replace parts of the ACA, even though it was established in 1975 by Congress to provide independent analyses of legislation. It’s not the first time the CBO has issued unpopular estimates; its refusal to credit much budget savings to Hillary Clinton’s 1993 health-care plan is one of the factors that killed her effort during the Bill Clinton administration.

But the rhetoric attacking the nonpartisan agency this time around certainly seems sharper — and it’s led by the White House. On July 12, the White House tweeted a video criticizing the CBO and its methods. Titled “Reality Check,” it claims the “Congressional Budget Office’s math does not add up.” In particular, it makes two key claims — that the CBO “inaccurately measures health coverage” and that it uses “faulty assumptions and bad numbers.”

How valid is the White House case? According to Post Fact Checker Glenn Kessler, not valid at all. He looks at each claim:

“Inaccurately estimates health coverage”

This claim is based on the fact that the CBO originally estimated 25 million people would be enrolled in the Obamacare marketplaces this year, but only 10.3 million are signed up. But the agency was almost spot-on about the overall number of uninsured: It said 30 million people would lack coverage in 2016; the actual figure is 28.6 million.

“This top-line estimate is what is important, because it helps determines how various health-care policies affect the federal budget,” Glenn writes. “CBO got the mix of types of insurance incorrect, underestimating the number of people joining Medicaid and overestimating how many employers would require employees to join the exchanges. The agency also did not predict (understandably) the website problems and slow rollout that affected enrollment from the start (and probably made employers reluctant to stop providing their own insurance).”

“So, although the video claims that the CBO inaccurately measures health coverage, the CBO just about nailed the most important figure from a budget perspective,” Glenn continues. “That’s relevant because, in the video, the White House is trying to undermine an equivalent figure in the CBO’s estimate of Senate GOP plans — that 22 million fewer people than under the current law would have health insurance a decade from now.”

“Faulty assumptions and bad numbers”

It’s correct that the CBO used an out-of-date baseline in estimating the Senate GOP health-care bill. By drawing from a March 2016 baseline instead of the January 2017 baseline, it assumes 18 million people are in the marketplaces instead of 10 million. That results in a less-favorable estimate of health coverage under the Senate bill.

However, Republicans ordered the CBO to use the old baseline, so the White House is trying to fault the agency for a decision made by its congressional allies. The GOP-led Congress in January was in such a rush to repeal Obamacare that it moved forward before the CBO could complete an updated baseline.

Now the problem for Republicans is that switching to a more recent baseline might actually not change the bottom-line effect on the number of uninsured — while it could reduce the projected budget savings that lawmakers are counting on to use a parliamentary procedure that thwarts a Senate filibuster requiring 60 votes. The whole reason for using this procedure, known as reconciliation, is to avoid having to negotiate with Democrats on the legislation. So switching to a more accurate baseline might make passage in the Senate even more difficult.

“It’s rather hypocritical for the White House to blame the CBO for using a baseline mandated by Republicans as part of an effort to cut Democrats out of the process,” Glenn concludes. “If given a choice, the CBO presumably would prefer to offer calculations based on the most recent baseline, as then estimates of the potential effect on the budget would be more accurate.”





  • The DC Society of Health Policy Young Professionals and the Government Affairs Industry Network host an event on the future of health-care reform.
  • The Bipartisan Policy Center hosts an event on The Future of Comparative Effectiveness Research.

Coming Up

  • The House Energy and Commerce Subcommittee on Health will hold a hearing on examining the extension of special needs plans on Wednesday.
  • The Hill is hosting an event on health care affordability and access on Wednesday.
  • Bloomberg Government hosts an event on the cost of health care on Wednesday
  • A health-care rally is planned for Saturday in Washington, D.C. 


Why health care is so hard for the GOP:

Trump says Senate Republicans ‘have not done their job’ on Obamacare repeal:


Trump says “Obamacare is death”:

‘Phelps vs. Shark’ was simulated. Here are 4 times humans actually raced animals:


From The Late Show with Stephen Colbert: “McConnell Vs. Shark: A Race To Pass Healthcare:”


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