McCain decision leaves GOP, ObamaCare and repeal at crossroads

Sen. John McCainJohn Sidney McCainCongress must use bipartisan oversight as the gold standard The Hill's Morning Report — Ford, Kavanaugh to testify Thursday as another accuser comes forward Trump hits McCain on ObamaCare vote MORE’s (R-Ariz.) announcement that he will oppose the latest GOP ObamaCare repeal bill has left both parties wondering about the health care law’s future.

Some Republicans are still pushing for repeal, given the tiny chance that they could still scrounge up enough votes before Sept. 30, the deadline for using budgetary rules that prevent a filibuster on the measure.

Vice President Pence said Friday that he and President Trump are “undeterred” in their effort to repeal the law, while Democrats say that they are on guard and will keep up the pressure.

But it seems more likely that the debate could be moving into a new stage.

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Democrats are pushing for bipartisan talks in the Senate Health Committee, which Republicans shut down earlier this week.

McCain cited those talks in opposing the new bill, and Trump has given more nods toward working with Democrats in recent weeks. The president also wants to turn to tax reform, which is taking up an increasing amount of his workload.

A key issue in the bipartisan talks would be addressing payments known as cost-sharing reductions that help insurers provide coverage to low- and middle-income people.

Trump has threatened to cancel those payments in an effort to make ObamaCare “implode.” And he still could.

The bipartisan Senate talks were aimed at providing congressional approval for those funds to cement their legality and prevent Trump from canceling them. Insurers say that step would be critical in giving them certainty and preventing premium increases.

Sen. Lamar AlexanderAndrew (Lamar) Lamar AlexanderOvernight Health Care: GOP plays defense over pre-existing conditions | Groups furious over new Trump immigration proposal | Public health advocates decry funding transfer over migrant children Overnight Health Care: Senators target surprise medical bills | Group looks to allow Medicaid funds for substance abuse programs | FDA launches anti-vaping campaign for teens The Hill's Morning Report — Sponsored by United Against Nuclear Iran — Kavanaugh confirmation in sudden turmoil MORE (R-Tenn.), chairman of the Health Committee and the lead Republican negotiator, has not yet commented after McCain’s announcement.

It is highly unlikely that an end to the ObamaCare repeal effort would usher in an era of bipartisanship on health care.

House conservatives and liberal Democrats in the House and Senate have very different ideas on how to move forward on health care, something underlined by a CNN debate scheduled for Monday. Its participants include Sen. Bernie SandersBernard (Bernie) SandersCarbon tax could give liberals vast power to grow federal government Poll: Gillum leads DeSantis by 4 points in Florida Judd Gregg: Two ideas whose time has not come MORE (I-Vt.), whose single-payer system is gaining steam with Democrats, and the authors of the latest GOP ObamaCare repeal bill, Sens. Bill CassidyWilliam (Bill) Morgan CassidyOvernight Health Care: GOP plays defense over pre-existing conditions | Groups furious over new Trump immigration proposal | Public health advocates decry funding transfer over migrant children Overnight Health Care: Opioids package nears finish line | Measure to help drug companies draws ire | Maryland ObamaCare rates to drop Overnight Health Care: HHS diverts funds to pay for detaining migrant children | Health officials defend transfers | Lawmakers consider easing drug company costs in opioids deal MORE (La.) and Lindsey GrahamLindsey Olin GrahamGOP opens door to holding Kavanaugh committee vote this week Press: Judge Kavanaugh must withdraw Kavanaugh: 'I will not be intimidated into withdrawing' MORE (S.C.).

Without any bipartisan action or a final long-shot repeal attempt, ObamaCare, which has extended coverage to roughly 20 million people, will remain on the books.

Despite worries that there would be counties next year without any insurance options, insurers have stepped in to fill every area. Standard & Poors found in July that ObamaCare markets are “stabilizing.”

Democrats believe there are plenty of risks to the law, however, as long as Trump is in the White House.

They accuse the president of threatening to “sabotage” the law — both with his threats on the insurer payments and a 90 percent cut to funds used to advertise and enroll people in the insurance exchanges.

Within hours of McCain’s statement on Friday, Democrats were pointing to an announcement that the administration would be taking healthcare.gov offline from 12 a.m. to 12 p.m. every Sunday during the enrollment period.

“More sabotage of our health care system,” Matt House, a spokesman for Senate Democratic Leader Chuck SchumerCharles (Chuck) Ellis SchumerTrump, GOP regain edge in Kavanaugh battle READ: President Trump’s exclusive interview with Hill.TV The Hill's 12:30 Report — Trump slams Sessions in exclusive Hill.TV interview | Kavanaugh accuser wants FBI investigation MORE (N.Y.), wrote on Twitter.

A spokesman for the Centers for Medicare and Medicaid Services said the downtime is part of regularly scheduled “maintenance outages” that happen every year. “This year is no different,” the spokesman said.

Frederick Isasi, executive director of Families USA, a leading pro-ObamaCare group, said that repeal is still a “very, very real threat for millions and millions of Americans.”

But beyond that threat, he warned: “It's a real concern that the administration is trying to sabotage the ability of Americans to get high-quality affordable coverage.”

He warned that if enrollment efforts fall off, fewer healthy people will be enrolled in ObamaCare, which will harm the long-term sustainability of the exchanges.

McCain’s opposition is a major blow to the seven-year effort to repeal the law.

It almost certainly dooms the current legislation, given opposition to the bill from Sen. Rand PaulRandal (Rand) Howard PaulA Senator Gary Johnson could be good not just for Libertarians, but for the Senate too Conservatives left frustrated as Congress passes big spending bills Senate approves 4B spending bill MORE (R-Ky.), and Sen. Susan CollinsSusan Margaret CollinsRosenstein faces Trump showdown Kavanaugh: I'm asking for a 'fair process' Collins: Second Kavanaugh accuser should speak with Senate panel under oath  MORE (R-Maine) said in a statement that she is leaning against it. Collins is seen as a long-shot to vote for repeal, and Republicans can only afford two defections.

It’s also possible there are other GOP senators who do not want to back the bill.

It’s of course still possible Republicans could make another effort at repeal either before or after Sept. 30.

Sen. Orrin HatchOrrin Grant HatchGOP opens door to holding Kavanaugh committee vote this week Press: Judge Kavanaugh must withdraw Hatch: Second Kavanaugh allegation is 'phony' MORE (R-Utah) has even floated the idea of pairing ObamaCare repeal with tax reform under a new budget resolution that would again allow Republicans to avoid a Democratic filibuster.

Yet such a plan would put tax reform at risk, something that seems unlikely at this stage.

Rep. Mark Meadows (R-N.C.), chairman of the conservative House Freedom Caucus, sounded a note of disappointment but did not criticize McCain after his announcement.

“Certainly today's news is not a positive sign for people yearning for lower insurance premiums but to criticize Senator McCain would be to allow my disappointment to manifest itself in a manner that won't produce a different outcome,” Meadows said. “Amendments and a floor vote should still be allowed.”

Scott Wong contributed.