July 26, 2017
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On Tuesday, the Senate very narrowly voted to open debate on a bill to at least repeal much of the Affordable Care Act, and Tuesday night, nine Republicans and 48 Democrats and independents shot down Senate Majority Leader Mitch McConnell's plan to repeal and replace ObamaCare. (McConnell's modified Better Care Reconciliation Act "is not necessarily dead," Axios notes. "Another, simpler version — like the most recent one scored by the Congressional Budget Office — could still come up later in the process.")

Late Wednesday morning or early afternoon, the Senate is expected to vote on a measure to repeal ObamaCare without a replacement plan, similar to a bill Republicans passed in 2015, thwarted by former President Barack Obama's veto. It is widely expected to fail, too. If so, the last plausible option for Senate Republicans is to pass what's being called "skinny repeal," scrapping ObamaCare's personal and employee mandates and a medical device tax, but leaving Medicaid, ObamaCare subsidies, benefit regulations, and everything else in place. "Basically no senators will like it," Politico explains, "but they may vote for it just to keep the repeal drive going."

Assuming the House wouldn't hold an up-or-down vote on the "skinny repeal" bill, it would go to a House-Senate conference committee, where Republicans would try to come up with a bill that could pass in both chambers. "The endgame is to be able to move something at the end of this process across the Senate floor that can get 50 votes and then to get into conference with the House," said Sen. John Thune (R-S.D.).

Before a final vote, the Senate will consider dozens of amendments, in what's being called "vote-a-rama" sessions, likely starting Thursday night. The Senate parliamentarian will also likely be asked to approve or throw out measures that don't meet the restrictions of the budget reconciliation process Republicans are using. Nobody knows where this unusual legislative effort to modify a huge chunk of the economy and a health-care system used by tens of millions of Americans will end, but it is expected to conclude early Friday. "All we have to do today is to have the courage to begin the debate with an open amendment process," McConnell told his caucus on Tuesday. "And let the voting take us where it will." Peter Weber

July 24, 2017

Senate Majority Leader Mitch McConnell (R-Ky.) will ask the Senate as early as Tuesday to begin debate on a bill to gut the Affordable Care Act, but not even Senate Republicans know what bill they will be asked to vote on. It isn't entirely clear they will know before voting to open debate, either. Some senators said that McConnell has assured them they would be told before voting on the "motion to proceed" whether they would be proceeding to a vote on one of the versions of a bill to repeal and replace ObamaCare or just to repeal much of the law. The No. 2 Senate Republican, Sen. John Cornyn (R-Texas), said late last week that letting senators know what bill they would be voting on is "a luxury we don't have."

McConnell's current strategy "is to lean heavily on lawmakers to at least vote to allow debate on the bill, in the hopes that amendments and other tweaks could yield an agreement," The Wall Street Journal reported Sunday. That strategy carries some risk, as do all the others. McConnell put together his version of the bill with no public hearings or deliberation in committee. On Friday, the Senate parliamentarian issued a preliminary ruling that some two dozen provisions in the GOP bill would require 60, not 50, votes, throwing a new wrinkle in McConnell's plans to pass the bill using the budget reconciliation process.

On Saturday, President Trump urged Senate Republicans to "step up to the plate" and "vote to repeal and replace" ObamaCare.

When CBS News political director John Dickerson asked Sen. Susan Collins (R-Maine) what's going on with the legislation on Sunday's Face the Nation, she said that was a good question. "It appears that we will have a vote on Tuesday," she said. "But we don't know whether we're going to be voting on the House bill, the first version of the Senate bill, the second version of the Senate bill, a new version of the Senate bill, or a 2015 bill that would have repealed the Affordable Care Act now and then said that somehow we'll figure out a replacement over the next two years. I don't think that's a good approach to facing legislation that affects millions of people and one sixth of our economy." The part on health care begins at the 4-minute mark. Peter Weber

July 20, 2017
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Two new polls on Thursday show a sizable bipartisan majority of Americans wanting Republicans and Democrats to work together on health-care legislation, rather than the GOP trying to repeal and replace ObamaCare on its own. In a CNN/SSRS poll, 77 percent of respondents said they would like to see Republicans work with Democrats to pass a health bill with bipartisan support, including 69 percent of Republicans, while only 12 percent of all respondents (and 25 percent of Republicans) wanted the GOP to continue going it alone.

When asked how they would like Congress to handle ObamaCare, 35 percent said they wanted President Trump and the GOP to just abandon trying to change the law and keep it as is, 34 percent said they wanted to see parts of ObamaCare repealed only when a replacement was ready, and 18 percent (and 30 percent of Republicans) said they wanted ObamaCare scrapped, replacement or no.

In an Associated Press/NORC poll also released Thursday, 8 in 10 respondents — including 66 percent of Republicans — said they wanted Republicans to approach Democrats to negotiate, and almost 90 percent wanted Democrats to take the GOP up on that prospective offer, including 81 percent of Democrats. In the AP poll, solid majorities of voters opposed all the major parts of the GOP replacement plan, though they also did not seem enthusiastic about ObamaCare's individual mandate. And a growing majority, 62 percent, said the federal government has a responsibility to make sure all Americans have health coverage, while 37 percent disagreed.

The CNN/SSRS poll was conducted July 14-18 among 1,019 adults, and has a margin of sampling error of plus or minus 3.7 percentage points. The AP/NORC poll was conducted July 13-17, also among 1,019 adults, and has a margin of sampling error of plus or minus 4.1 points. Peter Weber

July 20, 2017
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A group of at least 20 Republican senators met for nearly three hours in Sen. John Barrasso's (R-Wyo.) office on Wednesday night, hoping to hash out their differences on health-care legislation and revive a push to repeal and maybe replace the Affordable Care Act that had been declared dead earlier this week. At various points, Senate aides and members of President Trump's Cabinet were part of the meeting, but the get-together ended with just the GOP senators talking among themselves. "We're at our best when we're among ourselves," Sen. John Kennedy (R-La.) said afterward.

Several senators said after the meeting that it was productive and made them more optimistic that they could pass some form of ObamaCare repeal next week, though none of them was sure what legislation Senate Majority Leader Mitch McConnell (R-Ky.) will have them vote on. The senators said there were no breakthroughs, however, and they still appear to be short the votes to pass either McConnell's repeal-and-replace bill or the repeal-and-delay backup plan, especially with Sen. John McCain (R-Ariz.) sidelined by brain cancer treatment. "We do have work to do to get to a vote of 50," Barrasso said.

Unidentified people familiar with the meeting told The Washington Post it had been set up by the White House to help persuade reluctant senators to support McConnell's repeal-and-replace bill, though at least two of the four GOP senators on record opposing that bill — Sens. Rand Paul (Ky.) and Susan Collins (Maine) — did not attend; Barrasso told Politico the meeting had been planned before Wednesday's lunch at the White House, where Trump had told GOP senators to give up their August recess to work on health-care legislation and needled senators wary of the bill. Between the lunch meeting and late-night conference, the Congressional Budget Office estimated that the repeal-and-delay bill would leave 17 million more people uninsured next year and 32 million more uninsured in a decade. Peter Weber

July 19, 2017

Senate Majority Leader Mitch McConnell (R-Ky.) insists he will hold (and probably lose) a vote on repealing without replacing the Affordable Care Act, the idea presumably being that after seven years of promising to scrap ObamaCare, Republican senators will be pressured to follow through.

President Trump has moved on to blaming Democrats and vowing to let ObamaCare fail, but "there is no way to spin to those who were promised that the Affordable Care Act would be repealed and replaced once Republicans held full power in Washington that what has happened is the fault of forces outside the party," says Dan Balz at The Washington Post. "It is as though Republicans unknowingly set a trap and then walked into it without having prepared escape routes." He argues that Republican voters will punish the party in 2018:

The failed promise to repeal and replace ObamaCare surely will affect the mood and enthusiasm of the Republican base heading toward 2018. When the Gallup organization asked Americans about the future of the Affordable Care Act recently, 30 percent overall said they favored "repeal and replace," but 70 percent of Republicans supported that option. GOP lawmakers will have left them empty-handed, perhaps disillusioned. [Washington Post]

That's certainly the "unexamined conventional wisdom," says the Kaiser Family Foundation's Drew Altman at Axios, but "when you look at the polling, the idea that the base will rise up and punish Republicans if they don't repeal the ACA appears to be exaggerated, and possibly even a political fiction." Altman points to KFF polls showing that only 7 percent of Trump voters and 5 percent of Republican voters listed health care as their top concern.

Republicans don't like ObamaCare, but November 2018 is a long way away and they have bigger fish to fry, Altman says. "The one thing most likely to keep the ACA on the agenda now would be an effort by the administration to undermine it, and it's far from clear who benefits and loses politically from that." In fact, former Rep. Tom Davis (R-Va.) tells The Washington Post, "Republicans might have gotten a break by not seeing an unpopular law go into effect. Sometimes, having no law is better than having one that people perceive as bad law." Peter Weber

July 17, 2017
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Republicans decided last fall that they would use their unexpected control of the White House and Congress to quickly repeal the Affordable Care Act and move on, but as their replacement legislation faces yet another delay and continued uncertainty in the Senate, it is clearer than ever that President Trump and "many in Congress dramatically underestimated the challenge of rolling back former President Barack Obama's signature achievement," Politico reports.

Congressional GOP aides now point to the lack of experience, vision, and expertise in the slow-starting Trump White House, while White House aides note that congressional Republicans have been promising to repeal and replace ObamaCare since 2010, long before Trump ran for office. But the fissures in the Republican caucus were clear as early as late January, at a closed-door GOP policy retreat in Philadelphia, Politico says:

House Speaker Paul Ryan laid out a three-pronged approach to scrapping ObamaCare. He wanted to repeal as much of the legislation as possible, eliminate more through deregulation, and then work with Democrats on a replacement, said one former Republican aide. Many Republican lawmakers doubted Democrats would work with them on redoing the health-care law.

The president and one of his former campaign rivals also unexpectedly helped undermine the GOP's repeal plans. Sen. Rand Paul (R-Ky.) said on television the GOP needed a replacement plan if it was going to repeal the law. Then Trump endorsed that requirement. Their comments caused GOP leaders to start from scratch. Now that the Senate's attempt to revamp the health-care law has run into roadblocks — with moderates insisting on protecting coverage for their constituents, while conservatives focus on undoing as much of ObamaCare as possible — both Paul and Trump have suggested going back to a repeal-only bill. [Politico]

One White House aide told Politico that if Trump signs a health-care law by August, all this drama will be forgotten. You can read more about the Republican health-care missteps and inflated expectations at Politico. Peter Weber

July 17, 2017
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Sen. John McCain (R-Ariz.) announced Saturday that he is recovering at home from surgery to remove a blood clot above his left eye, prompting Senate Majority Leader Mitch McConnell (R-Ky.) on Sunday to postpone a vote on the newest version of his health-care overhaul. Two of the 52 Republican senators — Susan Collins (Maine) and Rand Paul (Ky.) — have said they will vote no on the bill as currently written, meaning McConnell can't lose another Republican and pass the bill. Collins said Sunday on ABC's This Week that eight to 10 other GOP senators have "deep concerns" about the bill.

A key question for the bill's future, then, is when McCain will return to the Senate. The statement from McCain's office suggested he would be out only this week, but its explanation for the procedure — removal of a blood clot from "above his left eye" during a "minimally invasive craniotomy with an eyebrow incision" — prompted some medical experts contacted by The New York Times to suggest he could be out of longer than expected, depending on the specifics. A craniotomy is when surgeons open the skull, and the recovery time from such an operation "is usually a few weeks," said Dr. Nrupen Baxi, a neurosurgeon at New York's Albert Einstein College of Medicine.

The GOP push to replace the Affordable Care Act is getting increasingly unpopular and attracting more opposition from medical and insurance groups, a few key Republican governors, and liberal groups. "The McCain absence gives Mr. McConnell and the White House a chance to continue working on holdout senators without having to back down from a vote this week," The Wall Street Journal explains. "But it also creates a window for the 2010 health law's supporters to continue a fight they believe is more likely to be successful the longer they wage it." The bill's GOP proponents and outside analysts say they think the bill will be harder to pass the longer it is delayed, too.

"The longer the bill languishes, the less likely it will pass," Greg Valliere, chief global strategist at Horizon Investments, tells The Wall Street Journal. "While McCain's absence complicates the health debate, it already was in deep trouble, even when he was healthy." The White House, which unsuccessfully lobbied skeptical GOP governors over the weekend, did not comment directly on the delay. "We wish Sen. McCain a speedy recovery," said spokeswoman Helen Aguirre Ferré. Peter Weber

July 6, 2017
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The White House and a pair of influential conservative advocacy groups have endorsed a proposal by Sen. Ted Cruz (R-Texas) that would allow health insurers to offer cheaper, less-comprehensive plans as long as they also offered at least one plan that includes the essential consumer protections required by the Affordable Care Act. Senate Majority Leader Mitch McConnell (R-Ky.) has sent Cruz's proposal to the Congressional Budget Office for cost-benefit analysis.

Wednesday's endorsement of the Cruz amendment by the leaders of FreedomWorks and the Club for Growth "is significant: Without at least a neutral stance from conservative groups, it could be impossible for McConnell to find the 50 votes needed to pass a repeal this month," Politico reports. "But what the right is asking for may not be able to pass the Senate." The proposal may well violate budget rules that McConnell is using to push through his bill with 51 votes, and more centrist senators and outside insurance experts are concerned that it would essentially price people with pre-existing conditions and other high medical needs out of the insurance market.

"People who have higher health-care needs and need more comprehensive coverage would choose ACA-compliant plans," said Cori Uccello at the American Academy of Actuaries. "People who are healthy now would tend to choose noncompliant plans with really basic benefits. People who want or need more comprehensive coverage could find it out of their reach, because it might become unaffordable." Sen. Susan Collins (R-Maine), who was frequently thanked during July 4 festivities for helping at least slow down the bill, agreed that the Cruz language "would lead to adverse selection in the marketplace," adding: "It would also vitiate the important consumer protection of having a prohibition against annual and lifetime caps" on benefits.

Cruz and his allies argue that the amendment would lower premiums and allow individual consumers to essentially opt out of ObamaCare, but touching the pre-existing condition language may be a deal-breaker for other Republicans. "Sen. Lamar Alexander of Tennessee is speaking against it in caucus lunches and Sen. Deb Fischer of Nebraska, a staunch conservative, also vocally opposes Lee and Cruz's idea," Politico says. "Many senators believe that the House made a critical error by allowing states to opt out of pre-existing condition protections and are determined not to touch that part of ObamaCare." A Senate vote could come as early as next week. Peter Weber

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