Senate Republicans have taken the first big step toward repealing Obamacare, setting in motion a legislative process that could undo the largest expansion of government in a generation and leave more than 20 million Americans without health insurance.
In a mostly party-line vote that took place early on Thursday, the Senate passed a special budget resolution that instructs committees to write legislation stripping the health care law of its funding and spending provisions, effectively ending Obamacare’s coverage expansion.
Budget resolutions don’t need presidential signatures, since they are basically internal congressional messages to committees. But they still require approval from both chambers, which means this one still needs a yes vote from the House.
That is likely, though not quite certain, to happen within the next few days.
Passing this resolution is a critical first step in rescinding Obamacare because it would allow Congress to consider legislation through the budget “reconciliation” process, with its special rules that make it impossible for Democrats to block action in the Senate by wielding the filibuster.
That means Republicans could pass legislation even with their small, four-seat majority in the Senate, and then send the final bill to President-elect Donald Trump. The incoming president reiterated during a Wednesday press conference his belief that “Obamacare is a complete and total disaster” because of rising premiums and declining insurance options for people buying their own coverage in some parts of the country.
The Senate vote was 51 to 48, with only Sen. Rand Paul (R-Ky.) breaking ranks with his party to vote against the resolution. And it took place with relatively little legislative drama ― despite rumblings, from earlier in the week by a dozen Republican senators anxious about the prospect of voting to repeal the health care law without prior agreement on what would take its place.
One of the senators making those arguments was Sen. Bob Corker (R-Tenn.), who introduced an amendment on Tuesday that stipulated the committees would have until March to finish their work. He withdrew the amendment before Thursday’s vote.
But Corker said he had assurances that the committees could take time to craft a replacement, according to Politico. And throughout the day, Republicans were still raising questions about a hasty repeal effort ― chief among them, what would happen to the more than 20 million people who now get insurance because of Obamacare?
GOP leaders have tried to assure these members by promising an “orderly transition” of two or three years, during which elements of Obamacare would remain in place so that people currently insured would keep their coverage.
But lawmakers including Sen. Lamar Alexander (R-Tenn.), who is chairman of the Health, Education, Labor and Pensions Committee, have indicated they want to see the plans ― both for the transition and afterward ― before voting on a repeal.
How the debate proceeds from here is uncertain. The most unexpected Obamacare news of the day actually happened at Trump’s Wednesday press conference, when he issued his first extended remarks on the health care law since December.
Trump didn’t endorse the leadership strategy of a quick repeal vote, with a replacement to come later. But he also didn’t side with those Republicans who want to push back both votes until later. Instead, he suggested the two votes should happen simultaneously and quickly.
That would not seem to be possible, given that Republicans have not yet reached a consensus on even the broad outlines of an Obamacare alternative ― and translating an outline into actual legislation, with legal language and dollar figures, could take weeks if not months.
The big issue looming over the GOP effort is that most of the Republicans, including Trump, have promised their schemes would provide better coverage than Obamacare does. But in part because conservative schemes typically envision substantially less federal spending, the end result of repeal ― with or without a replacement ― is almost certain to be fewer people with insurance, less comprehensive coverage for those who have it, or some blend of the two.
Democrats did their best to make this point, right up until the final vote when, during the roll call, they took turns giving their reasons for voting against the resolution.
“You are stealing health care from Americans ― I vote no,” Sen. Maria Cantwell (D-Wash.) said.
“Because health care shouldn’t be just for the healthy and wealthy ― I vote no,” said Sen. Richard Blumenthal (D-Conn.).
Thursday’s vote is a reminder of how high a priority Republicans put on the repeal of Obamacare, and how deeply unpopular the program is with conservative voters and even some non-conservative voters. But polls have suggested most Americans either don’t want to repeal the law or, at the very least, want to see what the alternative would be first.
Igor Bobic and Matt Fuller contributed reporting.