Sen. John McCain (R-Arizona), a former chairman of the Senate Committee on Indian Affairs, is seen standing at a during a 2016 visit to the St. Michael Indian School on the Navajo Nation. Seated is Sen. John Barrasso (R-Wyoming), a former chairman of the committee. Photo: SCIA

Republican bill to replace Affordable Care Act rejected in close Senate vote

Republican efforts to repeal and replace portions of the Affordable Care Act, popularly known as Obamacare, have been dealt another setback on Capitol Hill.

In an early morning roll call on Friday, the Senate by just two votes rejected a so-called "skinny repeal" that had been unveiled only hours before. Three Republicans -- Susan Collins of Maine, John McCain of Arizona and Lisa Murkowski of Alaska -- joined all 48 Democrats and Independents in the chamber in opposing the measure.

"I’ve stated time and time again that one of the major failures of Obamacare was that it was rammed through Congress by Democrats on a strict-party line basis without a single Republican vote," McCain, a former two-time chairman of the Senate Committee on Indian Affairs, said in a statement after the close 49-51 vote. "We should not make the mistakes of the past that has led to Obamacare’s collapse, including in my home state of Arizona where premiums are skyrocketing and health care providers are fleeing the marketplace."

Tribes have been closely watching the debate due to concerns about the future of Medicaid. The Affordable Care Act, which was signed into law in 2010 by then-president Barack Obama, authorized an expansion of the program, a move that has helped bring more revenues to the severely underfunded Indian Health Service.

Key Democrats prepared an amendment to protect those gains in the event the latest version of H.R.1628, the American Health Care Act, moved forward. Their proposal would have exempted the IHS, as well as tribal, Alaska Native and urban Indian programs, from any Medicaid rollbacks.

"For years, IHS has been woefully — and shamefully – underfunded," Sen. Tom Udall (D-New Mexico), the vice chairman of the Senate Committee on Indian Affairs and the sponsor of Amendment 341, said in a press release on Thursday. "But thanks to the Medicaid expansion, Native Americans across Indian Country are now able to access critical, life–saving services – above the ‘life and limb only’ level – that were previously unavailable."

But it turns out the amendment didn't need to be considered due to the defeat of H.R.1628, which had even taken on a new title -- the Health Care Freedom Act -- ahead of the dramatic vote. Republicans are now regrouping and their top leader in the Senate appears to be open to working with Democrats, who have been locked out of the process so far.

"Now I think it’s appropriate to ask, what are their ideas? It’ll be interesting to see what they suggest as the way forward," Sen. Mitch McConnell (R-Kentucky), the Republican majority leader in the chamber, said in a statement on Friday morning.

The Affordable Care Act, was a significant victory for tribes because it included a permanent reauthorization of the Indian Health Care Improvement Act. Republicans, aided by the administration of then-president George W. Bush, had refused to renew the law for nearly a decade before it was added to the larger health reform package.

After years of intense lobbying, tribes finally convinced Republicans to leave the IHCIA alone when Obamacare repeal efforts gained renewed focus at the start of the 115th Congress in January. H.R.1628 and its numerous iterations all left the landmark law intact, enabling tribes to focus on Medicaid and other concerns.

The text of Senate Amendment 341 follows:
SA 341. Mr. UDALL (for himself, Ms. Cantwell, Ms. Cortez Masto, Ms. Heitkamp, Mr. Franken, Mrs. Murray, Mr. Schatz, Ms. Stabenow, Mr. Tester, and Mr. Merkley) submitted an amendment intended to be proposed by him to the bill H.R. 1628, to provide for reconciliation pursuant to title II of the concurrent resolution on the budget for fiscal year 2017; which was ordered to lie on the table; as follows:

At the appropriate place, insert the following:


(a) Point of Order.--It shall not be in order in the Senate
to consider any bill, joint resolution, motion, amendment,
amendment between the Houses, or conference report that
(1) reduce or limit Federal payments to help cover the cost
of private health insurance with respect to private health
insurance purchased by American Indians or Alaska Natives; or
(2) reduce or limit Federal payments for spending under the
Medicaid program with respect to services provided by the
Indian Health Service, an Indian Health Program, an Urban
Indian Organization, or Indian tribes or other tribal
organizations, or with respect to services provided to
individuals who are American Indians or Alaska Natives.
(b) Waiver and Appeal.--Subsection (a) may be waived or
suspended in the Senate only by an affirmative vote of three-
fifths of the Members, duly chosen and sworn. An affirmative
vote of three-fifths of the Members of the Senate, duly
chosen and sworn, shall be required to sustain an appeal of
the ruling of the Chair on a point of order raised under
subsection (a).

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