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Health Care Drama and the Deciding Vote-a-Rama

Health Care Drama and the Deciding Vote-a-Rama

By Isabel Marcelletti


CNN referred to it as a “strange drama.” The fate of foster children’s health coverage in Medicaid and the Affordable Care Out played out in a chain of political events, indeed.  Here is what happened.

Tuesday: The Ball Gets Rolling

Tuesday evening, the Senate stood at an even split vote on whether health care reform should be brought to the floor of 20 hours of debate. Vice President Pence performed his constitutional duty and broke the tie.

It was 9:30pm and Senators struck down the original Better Care Reconciliation Act, the original repeal and replace plan the Senate Majority introduced previously.

Moving forward, we all had to be aware that when new bills would be introduced under reconciliation: if the Congressional Budget Office (CBO) did not have the opportunity to score proposed legislation, a passing vote would have to amount to 60 Senatorial votes. Once scored, if the legislation falls under the Senate parliamentarian rules, then the legislation can pass with 51 votes.

Wednesday: Straight or Skinny? 

When the Senate reconvened Wednesday morning, voting was postponed from 11:30am to 3:30pm. Senators voted on a straight repeal bill of Obamacare with the Enzi/ Paul Amendment. This amendment included the elimination of Obamacare coverage expansion, which would make it very difficult for our aging out foster youth to acquire affordable health coverage once they reach the end of their Medicaid coverage. Without any plan to replace Obamacare, our senators were deeply concerned that the health system could not handle such a jolt without any replacement for the current system. Estimates from the CBO predicted an increase of 32 million without healthcare if the legislation passed.

When the straight repeal failed, Majority leader McConnell introduced his “skinny repeal” bill which would eliminate Obamacare’s individual mandate and the requirement that businesses with more than 50 workers would have to provide health insurance. These measures would absolutely impact our foster youth. These children are already disadvantaged and an adulthood where medical care would be uncertain would derail physical health and mental health progress that was made possible by Medicaid coverage.

By 6:10pm, two amendments were proposed for the skinny repeal. Of the two amendments, Senator Dean Heller’s piece stood out. His amendment would force his peers to commit to no cuts to Medicaid nor prohibit states from expanding their Medicaid populations. Voice for Adoption applauded the Senator for remembering the vulnerable populations that depend on Medicaid, especially our half a million foster care children. Unfortunately, the amendment stood more as a figurehead for the idea of Medicaid and did not require the federal government to advance its funding for the safety net. Due to these flaws, the amendment was quickly swept under the carpet, without a waiver for a vote.

It was later that night when the CBO emerged with a score for the skinny repeal bill but the Majority did not release it for further review until the next day.

Thursday: The Skinny Repeal

Thursday morning, the Senate chamber was coming to terms with Minority leader Chuck Schumer’s announcement that his fellow party members would offer no more amendments. This was a tactic to prevent the majority from claiming their final bill was “the product of extensive Senate deliberations” as the CBO score revealed that the “skinny repeal” would leave 16 million Americans, adults and children, uninsured.

As the day moved on, the biggest standoff was yet to come. It became apparent that the skinny repeal bill was not ideal but the 20 hours for debate were ticking by. The skinny repeal bill by itself could not become law, many Senators agreed. A new view had emerged that if the skinny repeal bill passed, then the Senate and House could enter bicameral negotiations to fix the skinny repeal. Speaker Ryan did not prescribe to this view because the House had already voted on and passed the American Care Act this May. In his eyes, the House had already done its part.

"The burden remains on the Senate to demonstrate that it is capable of passing something that keeps our promise, as the House has already done," Ryan said. "Until the Senate can do that, we will never be able to develop a conference report that becomes law."

Now we had a bicameral shake down. Soon after Speaker Ryan made it clear that he reserved the right to move the Senate’s skinny repeal forward without reservation, Senators McCain, Graham, and Johnson held a press conference. They stood together on voting no for the skinny repeal unless Speaker Ryan could guarantee that the Senate bill would not be passed by the House.

Senator Graham was adamant when he said, ““If I don’t get those assurances, I’m a ‘no,’ because I’m not going to vote for a pig in a poke. I’m not going to vote for a bill that is terrible policy and horrible politics, just because we have to get something done.”

This stance made the Speaker reconsider his hard line and later, that evening he made the call at 9:45pm to Senator Lindsey. Speaker Ryan said he would convene a conference meeting for the Senate Bill and would meet with his party caucus comprised of Senators and Representatives to smooth out more details. Senator Lindsey found this promise satisfactory and announced he would vote yes for the skinny repeal. Senator Johnson agreed to vote yes soon after.

It was well into the hours of Thursday night. The majority party’s Senator Collins and Senator Murkowski had already vowed to vote no on the skinny repeal and the bill stood at 49 yes votes, 50 no votes. The skinny repeal future was down to Senator John McCain’s deciding vote. 

Friday: The Early Hours

It was around 1:30 am Friday morning. The voting was scheduled to start soon and Senator McCain was still partaking in a “lengthy” conversation with Vice President Pence who was prepared to break a tiebreaker for the skinny repeal. When all was said and done, the greatly respected senior Senator made his way to the minority party’s side of the floor. He had made his decision. The voting commenced and Senator John McCain voted a thumb’s down.

When later asked about his voting rationale, Senator McCain said, “We must now return to the correct way of legislating and send the bill back to committee, hold hearings, receive input from both sides of aisle, heed the recommendations of nation’s governors, and produce a bill that finally delivers affordable health care for the American people. We must do the hard work our citizens expect of us and deserve.”

In coming days, health care reform will occur through proper channels, where party politics will have to be set aside in the name of bipartisanship. The true needs of our foster care children and the rest of the American public will have to be discussed in a bipartisan manner where everyone can have their say. When the next time comes for health care reform, you can count on the fact that every voice will have better representation and not be forgotten in the web of politics.