Stuck at a 50 no-vote impasse since last Thursday, and delayed by Friday's blood clot surgery of 80-year-old Sen. John McCain (R-Ariz.), the Senate's optimistically monikered Better Health Care Act (BHCA) died a sudden death Monday night, as two Republicans joined forces to be the decisive 51st and 52nd votes to prevent the 115th Congress's most important piece of legislation from even being considered on the Senate floor.
Sen. Mike Lee (R-Utah), the libertarian-leaning fiscal conservative with no love lost for President Donald Trump (even while insisting that the unorthodox president is arguably an avatar for "constitutional conservatism"), was always a leading choice to join ideological fellow traveler Rand Paul (R-Kentucky) in rejecting a bill that, contra seven years of electorally successful promises to repeal Obamacare, left its basic framework in place. When he had been one of four GOP senators to oppose a previous version of BHCA last month, Lee had erected a high bar for changing his vote: "it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their health care costs." And in an interview with me one week ago, Lee stressed that it the Senate's rewrite included the Consumer Freedom Amendment he had co-authored with Ted Cruz (R-Texas), "then I can get to a yes. If they can't then I won't; it's that simple."
That is indeed what happened, as Lee explained in a piece for The Resurgent tonight. The updated bill included some of the Consumer Freedom Amendment, but not all, and the difference was both a policy and political dealbreaker. "The new version still forces insurance companies to follow Obamacare's 'single pool' regulation," Lee complained. "A new analysis by a government agency claims it would raise insurance premiums for people on freedom plans by $600 a year. I do not want to gamble $600 in relief for middle-class families in exchange for an amendment that might be undermined because of Obamacare regulations."
Had Lee been the lonely 51st vote (joining the previously opposed moderate Susan Collins of Maine), you could have expected to see the Tea Party/libertarian minority of the Senate come under similar blame and scrutiny as the House Freedom Caucus did from President Trump after Obamacare reform's first failure in the people's chamber. But the Utahn was lashed at the hip with Sen. Jerry Moran (R-Kansas), whose objections were more procedural. "This closed-door process has yielded the BCRA, which fails to repeal the Affordable Care Act or address healthcare's rising costs," Moran said in a statement. "We must now start fresh with an open legislative process to develop innovative solutions that provide greater personal choice, protections for pre-existing conditions, increased access and lower overall costs."
Senate Majority Leader Mitch McConnell (R-Kentucky) reacted to the news by formally abandoning repeal-and-replace. "Regretfully, it is now apparent that the effort to repeal and immediately replace the failure of Obamacare will not be successful," McConnell said in a statement. "So, in the coming days, the Senate will vote to take up the House bill with the first amendment in order being what a majority of the Senate has already supported in 2015 and that was vetoed by then-President Obama: a repeal of Obamacare with a two-year delay to provide for a stable transition period to a patient-centered health care system that gives Americans access to quality, affordable care." That, The New York Times concluded this evening, "has almost no chance to pass, either."
There will be a likely mini-cascade in the coming hours and days of Republican senators expressing their belated disgust with the now-dead legislation. Wisconsin's Ron Johnson, for example, who had been one of prior bill's opponents, expressed outrage earlier today that McConnell had reportedly promised moderates that purported future Medicaid cuts wouldn't actually take place. "I was strongly in favor of the motion to proceed before I read the comments by Senator McConnell," Johnson told reporters. "It really does put in jeopardy the motion to proceed." Vulnerable western Sens. Jeff Flake (R-Ariz.) and Dean Healler (R-Nev.), both of whom face dicey re-election bids in 2018 and rumored primary challenges from Trump-backed candidates, never had to say definitively how they'd vote, though their lack of enthusiasm has been palpable. And according to Washington Post political reporter Robert Costa, "Privately, several House [members] and [senators] told me for weeks they didn't really want to pass it." The bill has always been profoundly unpopular among the public, and unloved by conservative and libertarian health-policy analysts.
So how did President Donald Trump react? Like this:
Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!
— Donald J. Trump (@realDonaldTrump) July 18, 2017
Reason's Peter Suderman, who has forgotten more about health policy than I'll ever learn, and who counseled Republicans 10 days ago to just start over from scratch, will be in this space tomorrow with more policy analysis.