Senate Majority Leader Mitch McConnell’s (R-KY) effort to bring
an Affordable Care Act (ACA) repeal and replacement bill to the
floor collapsed this week in the face of opposition from several
members of his own party. The development marked a stunning
setback – and a potentially fatal blow – for Republicans in their
seven-year quest to overturn President Obama’s signature domestic
achievement. The continued legislative uncertainty also
raises serious questions regarding the long-term future of the
American healthcare system.
Shortly after McConnell’s admission that he lacked the votes to
proceed to the legislation, President Trump took to Twitter to
say that Republicans should simply repeal the ACA and work on a
long-term plan – with Democrats – to replace Obamacare.
Incidentally, the majority leader endorsed the president’s
recommendation in announcing his intention to bring up a bill to
repeal the ACA in two years, with a subsequent measure drafted to
address health coverage and access. That effort, however,
also appears doomed as three Republican senators – Shelley Moore
Capito, (WV), Susan Collins (ME), and Lisa Murkowski (AK) – have
all declared that they will oppose a procedural motion to begin
debate on a repeal-only bill.
Looking ahead, it remains uncertain whether Republicans will be
able to jumpstart a renewed healthcare reform discussion.
In the continued absence of achieving critical mass within
their own party ranks, Republicans would need to rely on
Democrats to come to the table, perhaps to discuss improvements
to the existing system, as was recently suggested by Senate
Minority Leader Chuck Schumer (D-NY).
Another potential dynamic is President Trump’s ability to dictate
significant changes in the operation of the current healthcare
system. For starters, the president has continually
threatened to withhold billions of dollars in cost-sharing
reduction payments, which are provided to insurance companies in
exchange for reducing deductibles for low-income customers.
In response to the prospect of such a move, insurers have
raised healthcare premiums for 2018 and may pull out of
additional markets if the federal payments are ultimately
eliminated.
