Horsey: Defeat of 'skinny repeal' bill leaves U.S. health care in Trump's careless hands

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Republican senators spent the week rummaging through scraps of health care legislation hoping to stitch together a scheme that would keep alive their effort to repeal Obamacare. In the wee hours of Friday, they attempted to pass a bare bones "skinny repeal" bill, but Arizona Sen. John McCain, in what may be his ultimate maverick moment, joined with two other GOP colleagues and the united Democrats to provide the one-vote margin that shattered the hopes of Obamacare foes.

Displaying the topsy-turvy logic that had overtaken the repeal effort, Mr. McCain's Senate wing man, South Carolina Sen. Lindsey Graham, dubbed the skinny repeal bill a "disaster" and a "fraud" but still voted for the lousy legislation to keep open a path to a conference committee with the House, where a whole new bill might have been slapped together.


The defeat of this final gambit can be attributed to one crucial factor: After complaining about Obamacare for seven years, Republicans failed to offer up any legislation that would not make the present flawed health care regime dramatically worse.

Through the summer, Majority Leader Mitch McConnell was unable to get his caucus united around a health care plan. A stalwart few centrist GOP senators refused to vote for any bill that would take away health care access from tens of millions of Americans. Those defectors included Alaska Sen. Lisa Murkowski and Maine Sen. Susan Collins, the two who joined with Mr. McCain to kill the skinny repeal scheme. Mr. McConnell also had been unable to placate several hyper-conservative senators who were more than willing to toss millions of people off the health care bus as long as it bumped government out of the driver's seat.


As he worked the problem, Mr. McConnell got little help from the Republican president who conned voters with the promise it would be easy to get fantastic health care at a fraction of the cost. Unlike past presidents with big legislation to sell, Donald Trump gave no televised speeches on health care. He did not go on the road to campaign for repeal. His limited lobbying of GOP senators was, by turns, erratic and bullying. When he invited senators to the White House to cajole them into giving him legislation to sign, it was apparent to those being lobbied that Mr. Trump had no health care ideas of his own and scant understanding of the various bills being pushed on Capitol Hill.

The only thing Mr. Trump contributed to the debate was his shocking pledge to let the current American health care system crumble and implode while he stands by doing nothing. "Let Obamacare fail," Mr. Trump declared, as if he has no responsibility to the American people to make sure the system stays afloat until something better is available. As New Jersey's Democratic Sen. Cory Booker said on CNN after Mr. Trump made his remark, the president's cavalier attitude is "cynical and sinister."

Republicans did make the very sound point that, during the years Obamacare has been settling into place, health insurance costs for a great many people have shot up while insurance providers have abandoned less profitable markets. Mr. McCain, himself, said in a press conference on Thursday that there is only one health insurer in each of his state's counties. That is a serious problem, but it was not seriously addressed in any of the varied proposals offered as Obamacare replacements. The only GOP priority was to deliver on the party's longstanding promise to undo what President Barack Obama and the Democrats did in 2010. Other than a huge tax cut for the wealthy, though, they never firmed up the details of a workable replacement plan.

In this moment of defeat, it would be a great thing if McConnell and his caucus were to take the path Mr. McCain has suggested and get to work on a bipartisan health care fix through the normal committee process. That seems unlikely to happen. Mr. McConnell sounded bitter and bruised after the vote and not in the mood for magnanimity and compromise.

The frightening reality is that, for now, the fate of America's health care system rests in the hands of a president who seems perfectly willing to let it disintegrate into chaos.

Two-time Pulitzer Prize winner David Horsey is a political commentator for the Los Angeles Times. Go to to see more of his work.