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How did the Republican attempt to repeal Obamacare fail?

July 27, 2017

The Republican congressional attempt to repeal Obamacare has failed. But why did Trump's party want to undo it, and how this policy priority end up crashing-and-burning? DW takes a look at what went down.

Gesundheitsreform in den USA. Stethoskop auf der US Flagge
Image: picture alliance/dpa/U. Baumgarten

A key priority of US President Donald Trump's 2016 presidential campaign was the repeal of the Affordable Care Act (ACA) - the landmark legislation known as Obamacare passed by Congress and signed into law by President Barack Obama in March 2010. The measure provided coverage to some 20 million previously uninsured Americans by mandating insurance, subsidizing plans for lower-income earners, and expanding a pre-existing government healthcare program for the poor known as "Medicaid," among other things.

However, Obamacare has faced Republican criticism. According to its opponents, Obamacare represents an overreach by the federal government into individual freedom of choise that will also cause the federal deficit to rise. Many Republicans also think insurance plan prices would be better constrained on a competitive, open market rather than a regulated one.

Since taking office, Trump has been working with Republican members of Congress to pass a bill that would either repeal and replace, or just repeal, all or key provisions of Obamacare that have faced criticisms, such as the fines for uninsured people or businesses that don't contribute to their employees' coverage.

The attempt to repeal Obamacare spawned seven different Congressional bills in total - three in the House and four in the Senate - and even more voting processes. Republicans wanted a bill passed before the August congressional recess, but all their attempts failed. What happened and where do things currently stand?

How Obamacare repeal failed in Congress

What happened in the House of Representatives?

Republicans in the lower house were the first to propose, debate and pass legislation aimed at dismantling Obamacare. Two initial bills were voted down before a final bill, The American Health Care Act of 2017 (AHCA), was approved in a 217-213 vote on May 4. This bill was then passed to the Senate, where it served as the base for multiple amended versions.

What happened in the Senate?

Three amended version of the House's base bill eventually were brought to the Senate floor after an initial vote on Tuesday, July 25 to open the debate: The Better Care Reconciliation Act (BCRA), the Obamacare Repeal and Reconciliation Act (ORRA), and the Health Care Freedom Act (HCFA).

  1. BCRA - This was a repeal and replace bill, what Republican lawmakers initially wanted to pass in order to undo Obamacare. The changes would have caused 22 million Americans to lose insurance coverage. It was voted down 43-57 on Tuesday, July 25.
  2. ORRA - Considered a "clean" repeal bill, this version's proposals are modeled on 2015 repeal legislation vetoed by Obama. In a crucial difference to the BCRA, the bill did not include any provisions for replacing Obamacare. It would have caused 32 million Americans to lose their insurance. It failed in a 45-55 vote on Wednesday, July 26.
  3. HCFA – Known as the "skinny" repeal, this version was a bare-bones measure to repeal targeted parts of Obamacare, such as the insurance mandates.  It only came into existence on July 27 as a last-ditch effort by Senate Republicans to bring together the moderate and hard-line conservatives. It would have caused 15 million Americans to lose coverage. The "skinny" repeal's proposals fell short of the Republican's major policy goals, but it would have kept repeal legislation alive and offered the chance – though not the guarantee – to beef up the bill later.
Repulican Senator John McCain heads to the Senate on his way to vote against the repeal of Obamacare
Senator John McCain, who is battling cancer and returned to the Senate for the health care votes, cast the deciding "no" on the final bill aimed at undoing ObamacareImage: picture-alliance/MediaPunch/CNP/R. Sachs

Why did the 'skinny' repeal fail?

After debate that stretched into the night, the Senate rejected the "skinny" repeal on July 28, with Republican John McCain joining two consistenly dissenting Republican senators, Susan Collins and Lisa Murkowski, to cast the deciding votes in the 49-51 outcome. Despite other Republicans' assurances, McCain was not convinced that the pithy bill would, in fact, be expanded before being made into a law. The damage that the "skinny" repeal in its current state would have caused - both cost-wise, by causing premiums to skyrocket, and politically, by not not being an extensive Obamacare repeal as Republicans had promised  - was not a risk the Arizona senator was willing to take.

What happens now?

No one is sure, as there is no clear way forward. Any repeal bill would have to start from the beginning of the legislative process, and Congress recesses during August. McCain called on Democrats and Republicans to work together to improve health care, but Senate Majority Leader Mitch McConnell said, "It's time to move on" to other policy areas. And Trump tweeted his two cents: "let ObamaCare implode."