The Senate’s top Republican admitted Wednesday that the party’s hopes for repealing Obamacare are dead in Congress after Democrats captured control of the House, leaving in place a law that few think is working.
Both sides say they want to work on fixes, but they have widely differing views on what’s necessary — Democrats want more government involvement, Republicans want less — and it’s not clear where they’ll find middle ground.
Democrats insisted they have the upper hand after they made preserving Obamacare’s protections for pre-existing conditions a major campaign issue.
“Health care was on the ballot, and health care won,” said House Minority Leader Nancy Pelosi, who is in line to become speaker in the new Congress next year.
Meanwhile, three ruby red states voted Tuesday to expand Medicaid under the Affordable Care Act, entrenching the law even further and making more than 300,000 people eligible for taxpayer-funded insurance once Republican governors begin drawing down federal funds.
It’s a remarkable turnabout from eight years ago, when Republicans rode a tea party surge against Obamacare to swipe the majority from Mrs. Pelosi.
After President Trump won the White House, Republicans who controlled both the House and Senate attempted to repeal the 2010 health law. They fell just shy in the Senate, as Sen. John McCain and two other Republicans gave it a thumbs down.
The GOP expanded its Senate majority in Tuesday’s elections and may have had enough seats to approve repeal — but squandered the House, leaving them without a path.
“I think it’s pretty obvious, the Democratic House is not going to be interested in that,” said Senate Majority Leader Mitch McConnell ruling out new attempts on Capitol Hill.
The GOP’s one shot may run through the courts, where state leaders are pressing a lawsuit in Texas that says Congress’ decision to gut Obamacare’s “individual mandate” should invalidate the rest of the law.
That effort faces long odds, however, leaving Mr. Trump to nibble around the edges of the law’s mandates and coverage rules.
His administration on Wednesday said it will demand more audits of the state-run Obamacare exchanges, to make sure enrollees are truly eligible. And it will require insurers to send separate bills for the portion of a consumer’s premium attributable to abortion coverage, so federal subsidies aren’t spent on it.
“We would have had a large-scale, a very good health care plan,” Mr. Trump said during a White House press conference Wednesday. “Now we’re doing it a different way.”
House Democrats said they will resist Mr. Trump’s “sabotage” of Obamacare and work to strengthen Medicaid and Medicare.
The caucus will be tempted, however, to plug holes in their signature program by approving a “public option” to compete with private plans in the marketplace.
From the left, star newcomer Alexandria Ocasio-Cortez and other liberals are voicing support for the type of single-payer, government-run plan championed by Sen. Bernard Sanders of Vermont.
Those ideas won’t go far in the GOP-led Senate, though.
“I fully expect Democrats in the House to put forward bills to strengthen the ACA, potentially including some version of a public plan available as an option for some people. And, I fully expect those bills to go nowhere,” said Larry Levitt, senior vice president at the nonpartisan Kaiser Family Foundation.
He said the action turns to the 2020 presidential race, where Democrats on the left will embrace Sanders-style plans, and those more toward the middle of the political spectrum will offer less sweeping changes.
For now, liberals are toasting victories in red Nebraska, Idaho and Utah. A majority of voters in each state opted to accept expanded Medicaid under Obamacare and to claim the federal dollars that flow from that decision.
All told, more than 300,000 people could gain coverage.
“This election proves that politicians who fought to repeal the Affordable Care Act got it wrong. Americans want to live in a country where everyone can go to the doctor without going bankrupt,” said Jonathan Schleifer, executive director of the Fairness Project, which gathered signatures to get the measures on ballots.
Montana voters appeared to have rejected a ballot measure to raise tobacco taxes to fund its expansion, though votes were still being counted Wednesday.
If the measure fails, the state will have to find a different way to fund its expansion or risk allowing coverage to expire for 90,000 residents.
In Wisconsin, Democrat Tony Evers edged out Republican Scott Walker for governor after campaigning on Medicaid expansion, and Maine governor-elect Janet Mills, a Democrat, is poised to implement the successful 2017 referendum on expansion that Republican Gov. Paul LePage has impeded.
Elsewhere, Kansans rejected Republican Kris Kobach and elected Democrat Laura Kelly as their next governor, boosting expansion’s prospects in that state after Republican Gov. Sam Brownback vetoed the state legislature’s previous attempt.
But Florida’s next governor, Ron DeSantis, strongly opposes Obamacare, killing liberals’ hopes for expansion in a huge state.
Medicaid expansion has been the quiet workhorse of President Obama’s law, extending coverage to roughly 12 million people across 33 states and the District of Columbia. States must pay a growing share of the cost of expansion, up to 10 percent starting in 2020.
Republicans in holdout states say that’s still too expensive and they worry the federal government will change the deal to make it even worse.