United States

John McCain’s opposition and the failure of “skinny repeal”

As the bill moved to the Senate for consideration, a number of opinion polls indicated that it was deeply unpopular with the public. Agitated protest over the proposed changes to Obamacare greeted members of Congress when they met with constituents during legislative breaks. Under the direction of majority leader McConnell, the Republican leadership crafted a Senate version of the bill behind closed doors. When the Senate version emerged, retitled the Better Care Reconciliation Act (BCRA) of 2017, it took an approach similar to that of the House bill, though it called for earlier and more substantial cuts to Medicaid funding. Meeting with opposition from both hard-line conservative and moderate Republican senators, the BCRA lacked the support necessary to obtain the quick passage McConnell had sought before the congressional recess for the July 4 holiday, and a vote on it was delayed.

When a more modest version of the Senate bill, branded “skinny repeal,” resurfaced at the end of the month, it maintained most of the tax increases that had funded the PPACA, but it allowed states to opt out of pivotal consumer protections such as forbidding insurers from charging higher rates for preexisting conditions. With Democrats in lockstep opposition, the bill failed 51–49 when John McCain returned to the Senate from his battle with brain cancer to join fellow Republican senators Susan Collins (Maine) and Lisa Murkowski (Alaska) in turning thumbs down in a dramatic post-midnight vote. In September McCain—who had come to believe that health care reform required a circumspect bipartisan approach—joined Murkowski, Collins, and Rand Paul in opposing last-ditch repeal legislation offered by Republican Senators Lindsey Graham (South Carolina) and Bill Cassidy (Louisiana). This time McCain’s opposition was less because of objections to the bill’s substance than to the effort to ramrod it through Congress. By February 2018 the Republican congressional leadership had resigned itself to its inability to pass legislation to comprehensively repeal Obamacare, though removal of the “mandate” (the penalty for failing to purchase health insurance) would be part of the sweeping tax reform passed later in the year. Moreover, the Trump administration shifted its attack on the PPACA to support for the lawsuit filed by some 20 states that sought to overturn all provisions of the act on legal grounds.