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House|Senate

115th Congress, Vote 179; Senate #1628

To repeal the ACA by enacting the Health Care Freedom Act, aka “skinny” repeal.


Official Title: To provide for reconciliation pursuant to title II of the concurrent resolution on the budget for fiscal year 2017.

Amendment 667 to H.R.1628: To provide for reconciliation pursuant to title II of the concurrent resolution on the budget for fiscal year 2017
Rejected by Senate on July 27, 2017, 49-51.

Synopsis: Starting on July 25, the Senate began a series of votes on H.R.1628, the House-passed American Health Care Act designed to repeal and replace the ACA.

First there was a vote in which the Senate agreed to take up H.R.1628 in a tie vote with Vice President Mike Pence casting the tie-breaking vote. The Senate then rejected Amendment 270 (the Better Care Reconciliation Act), and also rejected Amendment 271 (the Obamacare Repeal Reconciliation Act) – by a fairly wide margin in both cases.

At that point, the GOP senate moved on to their "skinny" repeal plan, the Health Care Freedom Act, which was written by Senate Republicans during the day on Thursday, and unveiled late that night on the Senate floor (Democratic Senators did not see the bill until it was introduced on the floor, two hours before the vote).

The term "skinny" was used merely to describe the length of the bill (it's only eight pages) and its lack of provisions. Its impact, however, would have been far from skinny if it had been enacted.

The Health Care Freedom Act was introduced by Senate Majority Leader, Mitch McConnell on July 27 as Amendment 667 to replace the text of H.R.1628. GOP senators clearly indicated that their hope was to pass the "skinny" repeal bill so that they could then move to a conference committee with House Republicans.

They did not want the House to take up and pass the Health Care Freedom Act if it were to prevail in the Senate, and actually tried to obtain assurances from House Majority Leader Paul Ryan that the next step would be a conference committee – as opposed to the House simply passing the Senate's eight-page bill.

The Health Care Freedom Act would have repealed some of the ACA provisions that conservatives find most onerous, but given its brevity, it left most of the ACA untouched (again, with GOP Senators counting on the House to work with them in a conference committee to hammer out a repeal-and-replace version that would be sent to President Trump in place of the Health Care Freedom Act).

Amendment 667 would have:

  • Eliminated the individual mandate penalty, retroactive to the start of 2016
  • Eliminated the employer mandate penalty, retroactive to the start of 2016, but only until the end of 2024. After that, it would begin to apply again unless legislation in the meantime were to fully eliminate it. Note that while the employer mandate penalty would have been eliminated, the employer reporting requirements would remain in place (the reporting is often considered the most onerous part of ACA compliance for large employers, particularly if they have long offered health insurance). This has generally been the case with all of the GOP reform proposals.
  • Delayed the medical device tax until the start of 2021.
  • Increased the contribution limits for HSAs until the end of 2020.
  • Eliminated federal funding for Planned Parenthood for one year.
  • Repealed the Prevention and Public Health fund starting in 2019, but increased community health center funding.
  • Expanded access to 1332 waivers.

After the text of the amendment was read, Senator Patty Murray (D, WA) put forth a motion to commit the bill to the Senate Committee on Health, Education, Labor, and Pensions (ie, send it through the normal committee process, rather than holding an immediate vote on the legislation). That motion died on party lines, with all 52 Republicans voting against sending the bill to committee.

At that point, the Health Care Freedom Act was headed for a vote on the Senate floor, but there was a substantial delay before the vote began. During that time, Vice President Mike Pence was on the floor of the Senate taking with Senator John McCain (R, AZ), but Pence left before the vote (his presence would have been necessary to break a tie if the vote had ended up 50-50).

Ultimately, the Senate rejected the bill on a 51-49 vote. The Senate's 46 Democrats, two Independents (who both caucus with the Democrats) and three Republicans voted against Amendment 667. The Republicans in opposition were Susan Collins (Maine), Lisa Murkowski (Alaska), and John McCain (Arizona).

Why supporters pushed for this bill

  • Amendment 667, ie, the Health Care Freedom Act, was a last-ditch effort by Senate Republicans to pass something akin to ACA repeal. It was not as comprehensive as the Obamacare Repeal Reconciliation Act, but that had failed by a wide margin the day before.
  • ACA opponents hoped that by passing Amendment 667, Senate Republicans could end up in a conference committee with House GOP leadership, and work out a compromise solution that would repeal and replace the ACA.
  • Since ACA opponents have spent seven years pushing for repeal, many were ready to pass any legislation that would accomplish that.

Why opponents tried to stop the bill

  • Democrats universally opposed Amendment 667. Although the bill was written the same day it was introduced, the CBO was able to quickly provide a brief analysis of the impact of the legislation, projecting that an additional 15 million people would be uninsured under the Health Care Freedom Act by 2026 (and the majority of that spike in the uninsured rate would happen as early as 2018). Increasing the ranks of the uninsured is anathema to Democrats and most ACA supporters.
  • The CBO also projected that premiums from 2018 to 2026 would be about 20 percent higher under the Health Care Freedom Act than they would be under current law.
  • Senator Collins reiterated her long-held position that repealing and replacing the ACA (or fixing the ACA) should be a bipartisan process, conducted via the normal legislative process, rather than a secret, rushed, partisan process.
  • Senator Murkowski has also remained firm in her position that health care reform should be done via bipartisan committee. Murkowski and Collins were the only two GOP senators who voted earlier in the week against proceeding to debate on the House-passed legislation, noting at that point that the correct course would be a bipartisan committee process.
  • GOP Senate leadership tried to extract an ironclad promise from Speaker Ryan that if the Senate passed the Health Care Freedom Act, the House would proceed to conference committee rather than simply passing the bill as it arrived from the House. Ryan said the House would be "willing" to go to conference committee, but there were serious concerns that the House would instead take up the bill as-is. The possibility that the Health Care Freedom Act could be signed into law – which would have completely destabilized the individual insurance market – was a significant point of opposition to the bill. Regardless of "promises," there is no mechanism for one Congressional chamber to regain control over a bill once they pass it and send it to the other chamber. This concern was part of Senator McCain's reason for voting against Amendment 667. McCain also noted that "skinny" repeal "fell short of our promise to repeal and replace Obamacare with meaningful reform."
07/28/2017 Status: Senate amendment rejected

More: select a member to see his or her other key health care votes.

Yes (49)
R Dan Sullivan AK
R Richard Shelby AL
R John Boozman AR
R Tom Cotton AR
R Jeff Flake AZ
R Cory Gardner CO
R Marco Rubio FL
R John Isakson GA
R David Perdue GA
R Joni Ernst IA
R Charles Grassley IA
R Michael Crapo ID
R James Risch ID
R Todd Young IN
R Jerry Moran KS
R Pat Roberts KS
R Mitch McConnell KY
R Rand Paul KY
R Bill Cassidy LA
R John Kennedy LA
R Roy Blunt MO
R Thad Cochran MS
R Roger Wicker MS
R Steve Daines MT
R Richard Burr NC
R Thom Tillis NC
R John Hoeven ND
R Deb Fischer NE
R Benjamin Sasse NE
R Dean Heller NV
R Robert Portman OH
R James Inhofe OK
R James Lankford OK
R Patrick Toomey PA
R Lindsey Graham SC
R Tim Scott SC
R Mike Rounds SD
R John Thune SD
R Lamar Alexander TN
R Bob Corker TN
R John Cornyn TX
R Ted Cruz TX
R Orrin Hatch UT
R Mike Lee UT
R Ron Johnson WI
R Shelley Capito WV
R John Barrasso WY
R Michael Enzi WY
No (51)
Our
Pick
R Lisa Murkowski AK
R John McCain AZ
D Dianne Feinstein CA
D Kamala Harris CA
D Michael Bennet CO
D Richard Blumenthal CT
D Christopher Murphy CT
D Thomas Carper DE
D Chris Coons DE
D Bill Nelson FL
D Mazie Hirono HI
D Brian Schatz HI
D Tammy Duckworth IL
D Richard Durbin IL
D Joe Donnelly IN
D Edward Markey MA
D Elizabeth Warren MA
D Benjamin Cardin MD
D Chris Van Hollen MD
R Susan Collins ME
I Angus King ME
D Gary Peters MI
D Debbie Stabenow MI
D Alan Franken MN
D Amy Klobuchar MN
D Claire McCaskill MO
D Jon Tester MT
D Heidi Heitkamp ND
D Margaret Hassan NH
D Jeanne Shaheen NH
D Cory Booker NJ
D Robert Menéndez NJ
D Martin Heinrich NM
D Tom Udall NM
D C. Cortez Masto NV
D Kirsten Gillibrand NY
D Charles Schumer NY
D Sherrod Brown OH
D Jeff Merkley OR
D Ron Wyden OR
D Robert Casey PA
D John Reed RI
D Sheldon Whitehouse RI
D Timothy Kaine VA
D Mark Warner VA
D Patrick Leahy VT
I Bernard Sanders VT
D Maria Cantwell WA
D Patty Murray WA
D Tammy Baldwin WI
D Joe Manchin WV