Last month, the GOP’s latest effort to repeal the Affordable Care Act—otherwise known as Obamacare—came to (yet another) unceremonious end. Stymied by looming deadlines and a lack of Republican support, the Graham-Cassidy bill was pulled before it was voted down like its predecessor. However, another revival of this push is inevitable—it’s died and come back to life more times than a Game of Thrones character. But just how unusual are the means Republicans are using to try and push a repeal through the Senate? Have they hit a dead end? One fun way to examine this process is to compare it to the passage of the very bill Republicans are so against: Obamacare.
The Origins of the ACA
July 14, 2009: After two hearings that lasted from March through May and June through early July, the House releases its version of what will eventually become the ACA.
July 15: The Health, Education, Labor, and Pension (HELP) committee on the Senate introduces a draft of its Senate bill to which a mere 500 amendments were made.
October 2: The Senate Finance committee releases its own draft of the ACA, amending it just 564 times. However, this creates two competing bills in the Senate.
November 7: After several rounds of negotiations, the house passes its draft of the ACA 220-215. One Republican votes in favor of it.
November 18: Senate Majority Leader Harry Reid releases a unified version of the two Senate bills that he worked secretly to create. He inserts the bill’s text as an amendment into another bill already on the Senate calendar so debate can start sooner
November 21: The Senate votes 60-39 along party lines to proceed with debate on the bill.
December 14: Public debate on the bill ends. Reid continues to negotiate privately with moderate Democrats to win their support. After cutting deals with key Senators, he pushes for a vote before Christmas recess.
December 22-24: Over the span of these three days, the Senate votes along party lines to pass the text of the ACA as well as all relevant amendments. Passage of the bill is finalized by the 24th.
January 19, 2010: Democrats lose the Massachusetts special election. With it, they lose their super-majority in the Senate and their ability to pass any changes the House makes without Republican support. It also puts them at risk of a filibuster.
March 11: Harry Reid decides to use the process of budget reconciliation to pass any changes the House makes to the bill as reconciliation only needs a simple majority of 51 to pass instead of the normal 60 vote threshold.
March 21: The House passes the new version of the ACA and all reconciliation related changes simultaneously. They pass 219-212 with no Republicans voting for the bill.
March 23: President Obama signs the Affordable Care Act into law.
The GOP complained about the passage of Obamacare, stating that the bill was confusing and too long to be understood, that it was rushed and passed in the dead of night, and that the bill was muscled through without Republican input. This process was one of the many reasons they continued to rally against the ACA going forwards.
The Graham-Cassidy Repeal Act
March 6, 2017: The House introduces a repeal and replace bill called the American Health Care Act (AHCA).
March 16: The House Budget Committee narrowly passes the bill. No public or substantial private debate has been held on it. The committee votes prior to seeing a CBO score.
March 24: Due to a lack of support, Speaker of the House Paul Ryan pulls the bill prior to a vote.
April 26: An amended version of the AHCA is introduced. It is endorsed by several key members of the House Freedom Caucus, giving it the ability to pass.
May 4: The House passes the AHCA 217-213. No public debate was held on the bill prior to its passage.
June 22: The GOP leadership secretively crafts and releases its own bill called the Better Care Reconciliation Act (BCRA) knowing that there are major concerns with the AHCA.
July 17: Senate Majority Leader Mitch McConnell decides that the Senate will only vote on repeal because the Senate lacks the votes to pass the BCRA replacement, even with amendments.
July 20: Some senators won’t vote for repeal only while others don’t like the BCRA. To compromise, GOP leadership releases an updated version. Republicans are unsure of what they will be voting on: a straight repeal or the new ACA replacement bill.
July 27–28: The Senate decides to vote on what is colloquially known as “skinny repeal,” a bill that would only repeal part of the ACA. The bill is voted on in the dead of night and is shot down in dramatic fashion at 2:00 AM, though people thought they had the votes to pass it.
September 13: Senators Lindsay Graham and Bill Cassidy introduce a new repeal bill, but it must be passed quickly before September 30th to avoid a filibuster.
September 26: The Graham-Cassidy bill fails to generate enough support and is pulled before the scheduled vote where it would have failed.
So how radical a departure from procedure was the repeal push? Though the Republican attempts at repeal were no less partisan—and at times no less secretive—than the Democrats passage of the ACA, they allowed almost no public input on the process. This lack of public debate was a significant departure from the norm, especially when you consider how many Americans would have been affected by this bill—negatively or positively.
When passing Obamacare, the House and the Senate had several months of public debate and hearings on their healthcare bills, and they amended each version over 500 times. In contrast to this, there were no public hearings on the Republican legislation, and Republicans did not wait for CBO scores before scheduling committee or roll-call votes on their bills, treating the independent assessment like an afterthought. However, both bills were incredibly partisan in their passage; Democrats generated almost no Republican support for the ACA, and Republicans failed to get the support of a single Democrat to repeal it. Both bills were also secretive in their creation and involved the Senate Majority Leaders holing up in their offices to create them in secret.Perhaps, given all the fuss surrounding Obamacare, we should expect a contentious repeal, but we can only hope that the next time the idea of repeal is raised, the Senate will have a little more respect for public opinion.
