For the first time since the Patient Protection and Affordable Care Act was passed five-and-a-half years ago, and after dozens of symbolic repeal votes passed the House of Representatives, the U.S. Senate finally approved a bill to gut central portions of the landmark health law.
The bill passed 52-47, with all but two Republicans voting in favor and all Democrats against. The two dissenting Republicans, Sens. Susan Collins of Maine and Mark Kirk of Illinois, cited a provision of the bill that strips federal funding from Planned Parenthood for their opposition. Another Republican who generally supports abortion rights, Alaska's Lisa Murkowski, ended up voting for the bill after much speculation that she would also defect.
The major victory for Republicans comes in the "yea" votes from Marco Rubio, Ted Cruz and Utah Sen. Mike Lee, all of whom had signaled that they would oppose an earlier incarnation of the bill because they believed it did not go far enough in dismantling the health law. Without their votes, the bill could not have passed.
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The votes of conservatives were won by expanding the bill, which originally only targeted certain funding mechanisms of the PPACA, including the individual and employer insurance mandate and the Cadillac tax.
The new bill goes far beyond that, repealing the two main programs responsible for significantly expanding health care coverage in the past two years. It kills the subsidies for the PPACA insurance exchanges and undoes the dramatic expansion of Medicaid that has made residents of participating states eligible for the public health program if they have incomes below 138 percent of the federal poverty level.
It is little more than a symbolic move, since President Obama will veto the bill without hesitation and Republicans have nowhere near the majorities necessary to override his veto. But it's a move that Republicans nevertheless relish, since it forces the president to veto a repeal of his own law and it makes good on a promise to the GOP base that they won't let up on efforts to scrap Obamacare.
However, voting to end the Medicaid expansion and the subsidies that millions of their constituents have come to depend on no doubt carries a political risk that Democrats are already seeking to exploit.
"They want to do this to satisfy a few radical right-wing people who they have joined forces with. Another charade may make some Republican senators feel better, but it won't make law," said Senate Majority Leader Harry Reid.
Indeed, the PPACA repeal will certainly not become law, at least not while Obama is president, and some lawmakers are seeking other ways to kill the Cadillac tax, whose repeal is supported by many Democrats. A bipartisan group is exploring adding a Cadillac tax repeal to an end-of-the-year tax package. It's still unclear whether the president, who has been largely silent on the issue in recent months, will pick a fight over the policy.
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