by Shoshana Krilow
Vice President, Public Policy and Government Relations


The last time yours truly tried to look into her crystal ball (March 2017) and channel nearly a decade of political and policy gut instinct, the verdict (per a previous blog post) was “that the complete overhaul or ‘repeal and replace’ of the ACA is likely off the table for the foreseeable future.”

Six weeks later, on May 4, 2017, the House of Representatives passed the American Health Care Act. It then moved to the Senate.                    

Thankfully, the politician in me had hedged in March, and also advised not to “count your chickens quite yet.” 

After last night’s Senate vote, it looks like full repeal is not happening anytime soon. Phew. Credibility intact.

As of 1:30 a.m. July 28, 2017, when Senators Susan Collins (R-Maine), John McCain (R-Ariz.) and Lisa Murkowski (R-Alaska) voted against the Senate’s seemingly last-ditch attempt to pass a “skinny” repeal and replace of the ACA, one would naturally assume that the road to health care reform, part two hit another, perhaps final, massive speed bump. However, we know better than to truly predict anything these days or to count Senate Majority Leader Mitch McConnell truly out.

A quick recap:  the Senate’s version of “repeal and replace,” known as the Better Care Reconciliation Act, largely mirrored that of the House-passed bill, the American Health Care Act. Predictably, it encountered the same problems that Speaker Ryan faced from both moderate and conservative Republican senators alike (in addition to the entire Democratic caucus). There were amendments offered, compromises sought and statements made of the bill being dead, when the White House intervened and gave it a much-needed shot of caffeine to bring it back to life.

Although Leader McConnell still did not have the necessary votes to pass specific legislation, his tactical skills and powers of persuasion ultimately convinced 50 senators to vote to proceed to debate a yet-to-be-determined piece of legislation on July 25, 2017. Vice President Pence broke the tie and the Senate began 20 hours of debate followed by a process of unlimited amendments, affectionately called “vote-a-rama.” Ask me another time if those of us wrapped up in vote-a-rama actually see it with much affection…

Over the last couple of days, the Senate voted down a number of repeal and replace options and was seemingly left with one last option termed the “skinny repeal” due to its much narrower focus on just a handful of provisions (such as the individual mandate, an eight-year repeal of the employer mandate, a three-year repeal of the medical device tax, flexibility to opt-out of some insurance market reform regulations, and a few others).

The stated goal of Leader McConnell was to pass something – anything – that would result in further negotiations with the House (called a conference committee) which would then theoretically result in both the House and Senate considering, and passing, compromise legislation. This was not enough for the self-proclaimed maverick, Senator John McCain, and two of his Senate colleagues (arguably mavericks all along), and “skinny repeal” was defeated.

But before you go counting those chickens again, know that Leader McConnell has put the bill back on the Senate calendar and could conceivably revive it before the end of the fiscal year – September 30, 2017. Or, of course, with Republican control of Congress and the White House, “repeal and replace” could theoretically come up again in future years. Once again, though, conventional wisdom (even in these unconventional times) dictates that this bill is truly dead.

So, will Republicans and Democrats work together to find compromise on legislation to provide relief to the American people? Will they stabilize the insurance market and fund cost-sharing reduction subsidies? Will they look for ways to continue the viability of both the Medicare and Medicaid programs?

All of those questions remain unanswered as Capitol Hill is still reeling from late nights, bitter partisanship and White House expectations. But if Mr. McCain – the maverick, the war hero, the Senator in another fight for his life – is to be heeded, perhaps Congress will return to “regular order” and start enjoying those drinks, friendly conversations and robust debates once again to find bipartisan solutions. 

Regardless of how one feels about Senator McCain, last night’s vote or the various health care reform bills, hopefully we can all agree that collaborative efforts to improve the health care system for providers, patients and communities is a worthy goal for everyone.

We are looking forward to it!

About the author. As vice president of public policy and government relations, Krilow leads Vizient’s government relations, monitoring federal legislative and regulatory developments of importance to Vizient and its members. She has worked as a strategic advisor to health sector clients with a particular concentration on Medicare, the pharmaceutical and insurance industries, and the Affordable Care Act. Krilow also brings deep legislative expertise having spent several years on Capitol Hill, where she worked as a health policy advisor for Representative Marion Berry (D-AR) and Senator Joseph Lieberman (I-CT).

Published: July 28, 2017