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28 July 2017

Did John McCain just save Obamacare? What’s next for the Affordable Care Act

To gasps in the Senate, McCain announced he was against the "skinny repeal" bill - and cast the deciding vote.

By Julia Rampen

The last time John McCain, the maverick Republican senator from Arizona, had a chance to shift the course of history, it was 2008 and he was running for President against Barack Obama. 

This time, McCain interrupted his treatment for brain cancer to come back to Washington to vote on the Republican attempt to repeal Obama’s biggest domestic legacy – the Affordable Care Act, aka Obamacare.

President Donald Trump, who ran on a platform of scrapping Obamacare, seemed convinced McCain’s vote was in the bag. He also managed to convince wide sections of the left-wing twitterati, who put aside qualms about attacking an ailing octogenarian. 

But it was McCain who had the last word. To gasps in the Senate, McCain announced he was voting against the “skinny repeal” bill – the deciding vote which sank the bill by 51 votes to 49. 

McCain ended the day with a plea for a return to bipartisan politics, from both the Democrats and Republicans. He 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.”

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So while McCain may have proved himself his own man, what next for Obamacare? Here’s what you need to know:

What were the Republicans trying to do?

The Republicans spent years in opposition vilifying Obamacare, but here’s the problem – even for those Republicans who hate every inch of the Affordable Care Act, replacing it is a huge operation. Now they truly do have the power to take healthcare away from poor and sick voters, some are having doubts. 

So the bill to repeal it was “skinny” – it would have repealed the obligation for employers to offer workers healthcare, and the obligation for individuals to take out health insurance, or pay a penalty in higher taxes. It would have also given states more flexibility to create their own healthcare systems. 

The problem is, the Affordable Care Act isn’t just about legislation, but about playing the rules of the insurance game. In an insurance market, your insurance can only be cheap if the chance of the insurer paying out is low. In other words, for Obamacare to work smoothly, you need young and health people signed up to it rather than just a self-selected group of the sick. Remove the obligation to take out health insurance, and the second scenario looks much more likely. 

So what will they do next?

After the vote, the stunned Senate Majority Leader Mitch McConnell said: “It’s time to move on.” However, Trump tweeted the more cryptic: “Let ObamaCare implode, then deal.”

For all Trump’s bluster, this might be the end of the Republican Party’s Grand Plan to Destroy Obamacare. Whether it means Obama’s legacy is safe, though, is another matter.

The Affordable Care Act might have become a temple of the left, but there are problems with it. For example, insurers have been dropping out, and middle-income Americans are facing an increase in premiums at an average of 25 per cent in 2017. 

If the Republicans truly want to run Obama’s legacy into the ground, they can just sit back and refuse to consider any improvements to the system – a la Trump’s strategy.

On the other hand, McCain has called for more bipartisanship. If moderate Republicans and Democrats were willing to listen to him, they might be able to produce a wonkish bill that addresses some of the real concerns of middle America while preserving the principle of affordable care.

But based on the Trump administration’s progress so far, this kind of co-operation looks unlikely. 

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