Latest Republican Effort to Repeal ACA Fails in Dramatic Early Morning Vote

In the wake of the failure of a Senate bill last month that would have repealed select portions of the Affordable Care Act (ACA)—the so-called “skinny” ACA repeal package—APA is calling for a renewal of bipartisan efforts to improve the ACA for the benefit of all Americans.

“With today’s vote, psychiatrists and other health providers can thank the Senate that our patients will not lose access to health care,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A., in a statement on July 28, hours after the Senate’s reform effort failed. “The American Psychiatric Association has repeatedly reached out to members of Congress to express our concerns that proposed bills in the House and Senate would take away treatment for mental health and substance use disorders, as well as reduce the number of people with health insurance.

“There are challenges with our current health care system that Congress can and must address to improve the system overall,” Levin continued. “We need to stabilize health insurance markets and make sure all Americans have options to purchase comprehensive insurance at affordable rates, as well as continued access to mental health and substance use disorder services.”

The “skinny” or partial ACA repeal package—known as the Health Care Freedom Act—was defeated by a vote of 49 to 51 with Republican Sens. Susan Collins (Maine), Lisa Murkowski (Alaska), and John McCain (Ariz.) joining all 48 Democrats in opposing it. Among other provisions, the bill would have repealed the individual mandate to buy insurance and the employer mandate that requires businesses with 50 or more full-time-equivalent employees to provide health insurance to at least 95 percent of their full-time employees and dependents up to age 26; failure to do so results in a penalty. The bill also would have eliminated guaranteed coverage of essential health benefits, including mental health benefits.

The “skinny” bill was the latest—and possibly the last—effort by Congressional Republicans to do away with, or substantially revamp, the signature achievement of the Obama presidency.

The legislative odyssey began with passage by House Republicans of the American Health Care Act (AHCA) in May. The Congressional Budget Office estimated that the AHCA would result in 14 million more people uninsured in 2018 than under current law, and 23 million more people without insurance by 2016. The bill would have eliminated the extension of Medicaid to individuals at or below 138 percent of the federal poverty level (a key provision of the ACA that provided millions with new insurance) and would have instituted a system of per capita caps on Medicaid payments.

In June, Senate Republicans crafted a bill (the Better Care Reconciliation Act, or BCRA), modeled on the AHCA, that never made it to the floor for a vote—largely because of the intransigence of Collins and Murkowski. The following month Republicans tried again with a re-tooled BCRA that was introduced after Senate Majority Leader Mitch McConnell (R-Ky.) announced he was delaying the start of the August recess by two weeks to allow more time to address the legislation.

The re-tooled BCRA retained deeply problematic provisions including steep Medicaid cuts and elimination of essential health benefits. When that bill also failed to advance on the floor, Republicans opted for the “skinny” repeal, hoping that a House-Senate conference would later work out a more comprehensive repeal of the ACA.

In a dramatic ending, the skinny bill was defeated in an early morning vote when McCain, who had returned from Arizona following surgery for a blood clot and a diagnosis of brain cancer, cast the deciding vote.

APA has taken a leadership role in consistently opposing the efforts to repeal and replace the Affordable Care Act. APA leaders and staff have engaged Capitol Hill lawmakers and staffers; worked as a leader in coalitions, including the Mental Health Liaison Group (a group of medical and advocacy organizations that focuses on mental health issues); and facilitated “fly-ins” with leaders coming to Washington, D.C., to advocate on Capitol Hill and participate in press conferences with other major medical specialty groups.

Following the July 28 vote on the skinny bill, Levin said, “This is a significant victory for the nation, APA’s members, and their patients. We now anticipate there will be hearings and bipartisan discussions about legislation to stabilize the individual market when Congress returns from the August recess. APA stands ready to work with members of Congress on sustainable solutions so that every American has access to quality health care, including mental health care.” ■