Medicaid reductions off the table, as GOP turns to plan D: Let Obamacare 'fail' on its own

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Even as providers exhaled Tuesday following the death of a GOP's Better Care Reconciliation Act, Republicans began floating the idea of a direct repeal of the Affordable Care Act. It survived only a few hours, as more than enough Senators said they would not support the idea of repealing without a replacement plan in place.

It left long-term care providers happy that their biggest funding source — Medicaid — apparently would not be severely restricted. (The Senate bill called for reducing planned Medicaid reimbursements by nearly $800 billion.) But it also left caregivers wondering what political leaders would have in store for them next.

It turns out that recent suggestions from President Donald J. Trump described the route Senate Majority Leader Mitch McConnell (R-KY) has chosen: Letting Obamacare fail, which, Trump theorized, would drive Democrats to partner with the Republicans on a solution. Republicans currently control both chambers of Congress and, if they maintained party unity, could pass bills without a single Democrat vote.

Republicans in the Senate failed to bring two Obamacare replacement bills to a vote in recent weeks before the repeal-without-a-replacement idea was floated and imploded quickly Tuesday. That leaves party leaders on their fourth strategic plan.

By mid-Tuesday, it was clear the simple repeal plan lacked support, with Sens. Susan Collins (ME), Lisa Murkowski (AK), Shelley Moore Capito (WV) saying they wouldn't vote for the idea, and Rob Portman of Ohio also suggesting he agreed with them.

McConnell suggested Tuesday he could still bring a vote to the Senate floor, while Trump's strategy was to shuck responsibility for the situation.

“We're not going to own it,” he told reporters. “I'm not going to own it. I can tell you the Republicans are not going to own it. We'll let Obamacare fail and then the Democrats are going to come to us.”

Long-term care providers, who were infuriated by the GOP bills' Medicaid provisions, said Tuesday they were relieved at BCRA's death.

“LeadingAge is pleased that the BCRA will not be considered in the Senate,” the organization said in a statement. “It's clear that our collective voices have been heard through our extensive grassroots efforts. We will continue to oppose any efforts to cut or cap Medicaid.”

Cynthia K. Morton, executive vice president for the National Association for Support of Long Term Care, was similarly happy but also expressed caution.

“I am very pleased to see that the threat of cuts to funding for our nation's seniors is dead for now,” Morton said. “I remain concerned whether there will be any effort to radically reform the Medicaid program.”

Medicaid reform efforts will be something providers will have to contend with for at least the next few years, according to recent comments by Mark Parkinson, the president and CEO of the American Health Care Association/National Center for Assisted Living. Tuesday morning, he said his group is appreciative of those senators who “hit the pause button for this debate.”

A fellow Kansan, Sen. Jerry Moran, joined Republican Sen. Mike Lee of Utah on Monday night in setting off a devastating string of events to their party's efforts to reform health policy. The pair surprised colleagues by saying they could not support the GOP healthcare bill, sending party leaders' efforts into a tailspin.

“We should not put our stamp of approval on bad policy," Moran said on Twitter. He also criticized the way the bill was created through a "closed-door process" and said the Senate must "start fresh" with open hearings and debate.