Just after 1:30 a.m. ET on July 28, the Republican U.S. Senate failed 49 – 51 to pass its latest attempt to repeal the Affordable Care Act (ACA), widely known as Obamacare.
Signaling a major defeat for President Donald Trump’s legislative agenda, a grim Majority Leader Mitch McConnell said on the Senate floor after the vote that it was “time to move on,” adding that he would still like to see Congress try to improve America’s healthcare and insurance system. Senate Minority Leader Chuck Schumer agreed in a floor speech of his own, and he called for the Senate to return to “regular order” after the intense partisan wrangling of recent years.
Three Republican senators – John McCain (AZ), Lisa Murkowski (AK) and Susan Collins (ME) – along with all Democratic senators voted against what was labeled by Senate leadership as a “skinny repeal” that could have removed insurance coverage from over 15 million Americans currently covered by the Obamacare. The legislation was a less robust version of Republican-led repeal bills that also failed over the past week, which would have left even more Americans unprotected.
Indian country played a role in the proceedings, with tribal citizens who have received improved healthcare – due to the ACA and its inclusion of the Indian Healthcare Improvement Act as well as expansion of Medicaid services – pressing their senators to vote against repeal and replacement bills that could harm their care and coverage. Many tribal leaders and Indian health advocates had met over the past months with legislators about their concerns, and Senate Democrats held a symposium earlier in July focused specifically on the harmful impacts to Native Americans if ACA were repealed.
Alaska Natives – who played a crucial supportive role during Murkowski’s tough re-election campaign in 2010 during which McConnell turned his own support to a different candidate – widely communicated their desire for Obamacare to be strengthened, not eliminated.
This Alaska Native support, combined with Murkowski’s popularity as an independent moderate in her state, played a substantial role in her ability to rebuff threats from current Interior Department Secretary Ryan Zinke, who told her that her legislative projects and suggestions for Interior nominees would be threatened if she continued to oppose Trump’s ACA repeal efforts. Sen. Dan Sullivan (R-AK) explained this threat from Zinke to news outlets based in his and Murkowski’s home state, and Sullivan said he pushed back against Zinke’s complaints.
"I did have a conversation with the secretary, and he told me what I already knew, which was that the president wasn't pleased with the vote that I had taken, and I knew that," Murkowski told CBS News.
Whether Zinke and Trump, who singled out Murkowski on his Twitter feed with harsh words surrounding this issue, will make good on their promises to work against her and Alaska remains to be seen.
Another key player with deep ties to Indian country was McCain, former chair of the Senate Committee on Indian Affairs, who gave an impassioned speech on the Senate floor earlier in the week after he was very recently diagnosed with a serious form of brain cancer, calling for bipartisan work to improve Obamacare.
While McCain did vote for some repeal and replace efforts offered by his Republican leadership, even this week, he ultimately lived up to his maverick reputation with a vote against the last one, saying that it was “the right vote.”
“We must now return to the correct way of legislating and send the bill back to committee, hold hearings, receive input from both sides of aisle, heed the recommendations of nation’s governors, and produce a bill that finally delivers affordable health care for the American people,” McCain said in a statement after his vote. “We must do the hard work our citizens expect of us and deserve.”
On the Democratic side, senators had been preparing an Indian-focused amendment if Republicans were successful in their repeal efforts. On the evening of July 27, just hours before the repeal failed, Sens. Heidi Heitkamp (D-ND), Tom Udall (D-NM), vice chairman of the Senate Committee on Indian Affairs, and Martin Heinrich (D-NM) announced that they had offered an amendment to protect healthcare for Indians.
“Heitkamp, Udall, and Heinrich's amendment would send the Republican health care repeal bill to committee to be amended to exempt the Indian Health Service, tribal health care facilities, and other urban Indian health providers from any Medicaid cuts if Republicans succeed in repeal,” according to a press release issued by the senators. “The amendment would also make sure that American Indians and Alaska Natives are not harmed by changes to the private insurance market that create barriers to individual coverage.”
The senators noted that almost 287,000 American Indians and Alaska Natives from 492 tribes have benefited from the ACA’s Medicaid expansion. In addition, they said that 30,000 individual Native Americans were covered due to the ACA’s individual marketplace and Indian cost-sharing subsidies.
The Democrats also seemed willing to compromise to achieve better healthcare for Indians. “Access to health care is a treaty and trust obligation to Native communities,” Heitkamp said in a statement. “It’s past time that Republicans join us and work across the aisle to find real, bipartisan solutions to improve health care instead of taking an axe to it.”