简体中文
Republican US Senate leaders, struggling to keep a
seven-year promise to end Obamacare, turned their focus on Wednesday to
passing a slimmed-down "skinny" repeal measure that would throw the
issue into negotiations with the House of Representatives.
The
last-ditch effort came after senators voted 55-45 against a straight
repeal of Obamacare, which would have provided for a two-year delay in
implementation to give Congress time to work out a replacement. Seven
Republicans opposed the measure.
It
was the Senate's second failure in 24 hours to repeal the 2010
Affordable Care Act, popularly known as Obamacare, which expanded health
insurance to about 20 million people, many of them categorized as being
from low-income households. On Tuesday, senators rejected the
repeal-and-replace plan Republicans had worked on since May.
The
failures underscored the party's deep divisions on the role of
government in helping provide access to healthcare as the Senate
conducted its second day of a freewheeling debate that could stretch
through the week.
Republicans
said they were still working out what would be in a skinny repeal, which
could simply eliminate mandates requiring individuals and employers to
obtain or provide health insurance, and abolish a tax on medical device
manufacturers.
Senator John
Thune, the No. 3 Senate Republican, said the party was trying to "figure
out what the traffic will bear, in terms of getting 50 of our members
to vote for things that will repeal as much of Obamacare as possible."
Republicans hold a 52-48 majority in the Senate.
Any
Senate legislation would be enough to kick the issue to a special
negotiating committee with the House, which passed its own version in
May. If that panel can agree on a new bill, the full House and Senate,
both controlled by Republicans, would again have to approve the
legislation, a process that could last months.
"I
think people would look at it not necessarily based on its content, but
as a forcing mechanism to cause the two sides of the building to try to
solve it together," Republican Senator Bob Corker said. "That’s going
to be the last chance," he added.
Senator John Cornyn, the No. 2 Senate Republican, told
reporters there was growing support for a slimmed-down approach that
would kick the can to negotiators.
"I think there is plenty of agreement," he said.
President
Donald Trump has come down hard on his fellow Republicans for failing
to act on Obamacare, something he promised repeatedly to repeal and
replace in his election campaign last year. Some Senate Republicans were
growing uncomfortable with the chaotic debate.
"We've
got to have a more organized process," Republican Senator Ron Johnson
said, noting the skinny repeal would simply delay acting on the core
issue. "We just don't have the courage and really the intestinal
fortitude to suck it up and do this right."
Late on Wednesday, only 10 senators voted for a largely
symbolic amendment stating lawmakers' commitment to preserve a part of
Obamacare that helped states expand the government's Medicaid insurance
program for the poor to cover a wider net of people.
Democrats
refused to approve any amendment to a bill they dislike and the vote
primarily highlighted deep divisions among Republicans. The amendment
was introduced by Senator Dean Heller, who faces a tough re-election
fight in Nevada next year, and supported by Senators Susan Collins, John
McCain and other party moderates who have expressed skepticism about
the repeal-and-replace process.
Trump attacked one of those senators, Lisa Murkowski of
Alaska, by name in an early morning tweet on Wednesday. Murkowski, one
of two party members who voted on Tuesday against opening debate on a
bill to end Obamacare, told MSNBC she was not worried about the
political fallout.
"Every day shouldn't be about winning elections. How about just doing a little bit of governing around here?" she said.
Healthcare industry organizations are similarly troubled and have urged a more bipartisan effort.
The
Blue Cross Blue Shield Association, which represents health insurers
across the country, said that if the individual mandate is repealed, it
must be replaced with incentives for people to buy health insurance and
keep it year-round.
The mandate
is considered critical to helping hold down the cost of premiums,
because it means that healthy people as well as the sick, who incur high
medical costs, buy insurance.
The group also said the government needed to fund subsidies for medical expenses and provide funds to cover high-cost patients.
Anthem
Inc (ANTM.N), a health insurer with more than 1 million customers in
Obamacare individual insurance plans, threatened to further shrink its
2018 market participation because of uncertainty about the government
paying for the subsidies that make the plans affordable for millions of
Americans.
