GOP Defections Defeat Senate's 'Skinny Repeal' Of Obamacare

The U.S. Senate Friday morning narrowly defeated the so-called “skinny repeal” of the Affordable Care Act following a new report saying premiums would jump 20% and it would lead to 15 million more uninsured Americans next year alone.

The 51-49 vote, considered a last-ditch effort to repeal Obamacare after a week of failed attempts in the GOP-controlled Senate, is a huge defeat for President Donald Trump and his fellow Republicans. The GOP has vowed to repeal and replace the ACA ever since it was signed into law by President Barack Obama in 2010, but once again has been unable to do so.

"This is clearly a disappointing moment,"Republican Senate Majority Leader Mitch McConnell said after the vote. "I regret that our efforts were simply not enough this time."

The Senate legislation, unveiled Thursday night just hours before the vote as the Health Care Freedom Act, eliminated the requirement known as the individual mandate for Americans to buy insurance. Once the mandate goes away, insurers say people would only buy insurance when they got sick and that would trigger big increases in costs for those who maintained coverage.

Without the mandate, 15 million Americans would become uninsured, the Congressional Budget Office said in a report released Thursday night before Friday’s early-morning vote. Joining all 48 Democrats voting against the measure were Republican Sens. John McCain of Arizona, Lisa Murkowski of Alaska and Susan Collins of Maine.

All three Republicans didn't like the secretive backroom discussions initiated by McConnell and have been hoping for a more bipartisan approach to helping improve the ACA. There were no hearings on the Senate legislation and opponents saw serious flaws in the Senate's "skinny repeal," which wasn't helped by Thursday's CBO report.

“Premiums for policies in the nongroup market would increase by roughly 20% relative to current law," CBO said of "all years between 2018 and 2026."

Senators voting for the measure said the legislation was merely a way to get to a conference committee of senators and members of the U.S. House of Representatives. The conferees would then sort out differences before yet-to-be determined legislation would be voted on again by both chambers and potentially sent to the White House for Donald Trump’s signature.

But doctors, hospitals and insurance companies weren’t looking at the Senate’s bill quite the same and were effective at convincing just enough Republicans to vote their way.

“Eliminating the individual mandate will lead to adverse selection, triggering higher premiums and further destabilizing the individual market,” AMA president Dr. David Barbe, a Missouri family physician, said. “The stated goal was to advance policies to lower premiums, but the ‘skinny’ bill would do the exact opposite, harming patients across the country. Further, the bill would result in millions more Americans without health insurance coverage.”

Throughout the week leading up to the Senate vote, health insurers warned legislation without an individual responsibility component would wreak havoc on insurance markets. Such a requirement is needed to make sure the risk pool has healthy people paying claims to help cover costs of the sick.

The health insurance lobby, America's Health Insurance Plans (AHIP), on Thursday said GOP Senate-led "skinny repeal" wouldn’t work to make healthcare more affordable.

"Policies that do not stabilize the market and simply drop incentives for people to buy coverage will repeat what we have seen in the past: premiums will rise rapidly, few or no affordable coverage options will be available and more people will be uninsured," AHIP CEO Marilyn Tavenner said in a letter to Senate leaders. AHIP represents the nation’s largest health insurers, including Anthem , Humana , Centene , Oscar Health and dozens of Blue Cross and Blue Shield plans.

Even if the Senate legislation had passed, it was unclear what would have happened once it reached a conference committee. Melding with House legislation may have led to even more Americans without health insurance coverage.

House Speaker Paul Ryan’s American Health Care Act, which narrowly passed the House in May, would cause more than 20 million Americans to lose coverage in less than a decade. Those coverage losses come largely from a rollback of the ACA’s Medicaid expansion in 31 states.