shows the senate floor on July 25, 2017
Photo courtesy: C Span

By Rose Hoban

Senate Republicans took a dramatic step toward fulfilling their promises to repeal former President Barack Obama’s signature health care law, the Affordable Care Act, on Tuesday by approving a motion to begin debate on an overhaul.

By a vote of 50-50, with Vice President Mike Pence casting the tie-breaking vote, the repeal bill is now opened up to debate and an amendment process over the coming days. As senators voted on the measure, protesters yelled “Kill the bill” from the Senate gallery.

The outcome represents at least a partial victory for President Trump, Senate Majority Leader Mitch McConnell and others who have sought to repeal the ACA — a longtime promise by congressional Republicans.

U.S. Sen. Richard Burr (R-NC)
U.S. Sen. Richard Burr (R-NC)

As expected all Democrats voted against the motion, joined by Republican senators Susan Collins of Maine and Lisa Murkowski of Alaska. Both North Carolina senators Thom Tillis and Richard Burr voted in favor of moving forward.

“Over the last several years, Obamacare has hit hard-working North Carolina families with skyrocketing premiums and fewer choices, while small businesses have struggled to comply with the law’s costly and burdensome regulations,” wrote Tillis on his website late Tuesday. “The status quo of Obamacare is unsustainable, and today’s procedural vote sets the stage for an open amendment process where all Senators – Republicans and Democrats alike – will be able to put forward their ideas to reform our nation’s health care system.”

And Burr said he’s glad the Senate has finally begun debate.

“This debate will allow each and every Senator the opportunity to bring forward their ideas for consideration through an unlimited amendment process,” read a statement on Burr’s website. “It is my hope that at the end of this process we will pass legislation fulfilling our promise to the American people: repealing and replacing Obamacare.”

Close to home

Medical groups have come out strongly against the GOP effort, both nationally and in North Carolina.

The American Medical Association has decried the Senate’s actions, even the more conservative North Carolina Medical Society noted on its website that the organization is closely monitoring the legislation and contacting Burr and Tillis.

“We are watching to ensure that any legislation does not harm access to affordable, meaningful health care for North Carolina,” the post read.

headshot of Tillis
Sen. Thom Tillis, official Senate photo

“Pending federal health care reform threatens to undermine our state’s good work to protect children from abuse and neglect and to help victims recover,” wrote Rob Thompson from NC Child, an advocacy group that’s worked to improve the foster care system.

“When children come to the attention of the child welfare system, they have invariably experienced significant trauma that demands a robust array of services and support to help them recover,” Thompson pointed out. Most of those children are covered by Medicaid, which is likely to be cut under the senate bill.

“We are all one accident, one test result, one diagnosis away from this impacting any of us personally,” said Jenny Hobbs, the mother of three children who each have a rare muscle wasting disease that requires intensive medical management.

Hobbs said some of the other founders of the Advocates for Medically Fragile Kids NC felt overwhelmed and stressed. “A lot of people have said they need to take a social media break tonight because they can’t stand the thought to hear what might happen,” she said, noting that she was feeling disheartened.

According to an analysis by the think tank Urban Institute, spending on Medicaid in North Carolina would be 13.6 percent lower by 2022, and the uninsured rate would increase by 39.4 percent. All told, about 519,000 people of all types would lose coverage, the analysis found, including those with employer-sponsored insurance, individuals in the marketplace and kids on Medicaid.

After passage of the ACA, North Carolina’s rate of uninsured people fell 4.7 percent to a record low of 13.3 percent by the end of 2015, according to an analysis by the NC Institute of Medicine.

In a separate analysis, the IOM found that older low-income adults would be hit especially hard by the bills proposed in Congress. Depending on the county, a 60-year-old who makes $20,000 would end up paying anywhere from $9,740 to $12,380 per year for insurance coverage – that’s after the tax credit proposed by Republicans.

Zigzag course

What happens next is unclear.

The first vote was on the health care legislation that the U.S. House passed in May. But the Senate has not considered that bill, instead crafting their own version. That bill failed late last night with nine Republicans voting against. Burr and Tillis voted for the bill.

The Senate is likely to vote on one or more other bills: it’s expected senators will amend the bill to add language from an old bill that was voted on in 2015. Finally, there’s legislative language floating around that provides for a “skinny repeal” measure that would make fewer changes to existing law.

Senate leader Mitch McConnell (R-KY) said there would be an “open amendment process,” which means that there’s no telling what the final bill will look like. Whatever bill emerges from the Senate, if passed by that body, will then be sent back to the House to be taken up or to a conference committee appointed by the two bodies.

“This is just the beginning,” McConnell said after the vote on the motion to proceed. “We’re not out here to spike the football, but we’ll finish at the end of the week.”

The process allows for 20 hours of debate, and then amendments.

“Members of both parties can offer amendments to try to improve the piece of legislation and at the end, you come to a decision of whether you want to vote for or against the final amended package, that’s where we are,” said John Barrasso (R-WY), a physician, who said he wanted to help people get the care they needed at a lower cost.

When asked if the process he’s using to get the bill moving was “responsible,” McConnell said different people have different ideas of what form the bill should take.

“We’ve watched a similar process seven years ago, they had a lot of differences,” McConnell said, referring to Democrats, who heard amendments to the Affordable Care Act in 2009. But when that bill was being debated, there was more clarity on what was being decided as the process began.

“We’re going to have a thoroughly open amendment process in a situation where 51 votes can change the bill,” McConnell said. “It’s really entirely impossible to predict… exactly what amendments will be offered or what amendments will succeed.”

That also means that when the final result bill comes up for a senate vote, there will not have been enough time for the nonpartisan Congressional Budget Office to weigh in on the economic consequences.

Democrats are saying that if any bill that passes allows Republicans to go into conference with the House and work out the details there. Connecticut Sen. Chris Murphy tweeted late Tuesday that the House bill, “would act as default for any negotiations, and negotiations would be minimal bc Senate GOP would have lost all bargaining power by their inability to produce a bill.”

The original bill passed by the House would slash Medicaid over the coming decade in addition to leaving more than 23 million uninsured.

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Rose Hoban

Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...