On Tuesday, a vote to begin debate on a bill to repeal the Affordable Care Act squeaked by the Senate in a 51-50 vote, with Vice President Mike Pence casting the tie-breaking vote. The narrow victory—which required Sen. John McCain to return from Arizona despite a recent brain cancer diagnosis—illustrates the “deep divide” in Congress, said Thomas Vicino, associate professor of political science, public policy, and urban affairs and chair of the Department of Political Science.
Just hours after the procedural vote, Senators soundly rejected the first of what will surely be many repeal-and-replace bills, further illustrating that divide.
‘A small victory’ for the GOP that will ‘keep the process moving’
Indeed, the very fact that McCain returned to cast his vote underscores that division, Vicino said. “If Congress were not as divided, McCain’s vote might not have been as crucial. Obviously, however, Republicans really needed it.”
The vote follows months of debate in both the House of Republicans and Senate over what, exactly to do about the Affordable Care Act, also known as “Obamacare.” As recently as last week it appeared that Republicans wouldn’t have the Senate votes to pass Tuesday’s procedural vote. As it was, two GOP senators, Susan Collins of Maine and Lisa Murkowski of Alaska, voted against considering their party’s healthcare bill.
The narrow victory is as still pretty much as big a victory as Republicans could have hoped for, said political science professor John Portz.
“If they got those two votes [Collins’ and Murkowski’s], then they wouldn’t have needed Pence to break a tie, but we knew the Democrats weren’t going to vote for this,” Portz said. “It’s a small victory, but it does keep the process moving.”
The fierce debate over the Affordable Care Act in Congress misses the larger point about healthcare, though, Vicino said. He cited a recent poll that showed only 13 percent of Americans supported moves to repeal the legislation without a replacement.
“There’s a real disconnect between what’s happening in Congress and what we see outside,” Vicino said.
The issues with healthcare more broadly, he said, stem from issues with the market.
“If the market for healthcare was operating perfectly and freely, we would see more competition and costs would decrease; this is as much as an economic issue as it is a political issue,” Vicino said. Instead, there is a high demand and short supply of affordable, quality healthcare, which is where public policy plays an important role.
“There’s a problem in the market, and the role of public policy is to fix market failures,” he said. “The bigger point here is that when the market does not effectively provide public goods like healthcare or education, we rely on public policy to correct the market.”
What comes next
Vicino said that if Congress repeals the Affordable Care Act, big challenges remain. “We still need a solution for the millions of Americans that lack access to quality, affordable healthcare.”
While Tuesday evening’s repeal-and-replace bill failed, 43-57, this is just the beginning of a long debate over how to pass final healthcare legislation. The Senate will continue to debate and amend bills, with new votes expected as early as this weekend.