By Jonathan D. Salant | NJ Advance Media for NJ.com
For seven years, congressional Republicans had vowed to repeal the Affordable Care Act, but when they finally occupied the White House and controlled both houses of Congress, they couldn't do it.
House Republicans passed legislation, later derided as "mean" by President Donald Trump, that would increase the number of uninsured Americans by 23 million, according to the Congressional Budget Office. It also would cut Medicaid by $834 billion over 10 years while reducing taxes for corporations and wealthy Americans.
Senate Republicans then wrote a bill in secret that closely tracked the House GOP measure and initially would have left 22 million more Americans without insurance. That bill would have cut Medicaid by $772 billion.
When that measure failed to garner enough support, Senate Republican leaders offered a revised version. That, too, faced strong opposition from enough GOP senators to doom it.
Both measures would have penalized states like New Jersey that expanded Medicaid under the Affordable Care Act, allowed insurers to raise rates on older Americans, and threatened the ability of those with pre-existing conditions to buy affordable insurance.
Trump, who strongly supported the Senate bill despite his initial promises to cover everyone and to not reduce Medicaid funding, wound up urging lawmakers to simply repeal the existing law without a replacement, which would have left 32 million Americans without insurance.
Senate Republicans didn't even have enough support to do that.
Here are the winners and losers from the Republicans' health care failure.
President Donald Trump discusses the Republican failure to repeal the Affordable Care Act.. (EPA | Michael Reynolds)
Loser: Donald Trump
Who would have thought that the high point of the effort to repeal and replace the Affordable Care Act would have been a celebration in the Rose Garden after House Republicans passed their legislation on their second try?
Trump later derided the bill as "mean," before strongly backing a Senate version that was very similar.
He insisted until the end that the existing health care law was failing, an assertion refuted by the Congressional Budget Office and independent studies.
Winner: New Jersey
The Republican health care bills would have slammed the Garden State, which expanded Medicaid under the Affordable Care Act and would have lost its extra federal funding. In addition, both bills would have given New Jersey and other states a fixed sum to cover its Medicaid enrollees, ending an entitlement program in which federal funds vary based on need.
State taxpayers would have to pay an extra $810 million to cover the 560,000 residents now receiving health care under the Medicaid expansion, according to the Center on Budget and Policy Priorities, a progressive research group in Washington.
Even Gov. Chris Christie, a Trump ally, said state officials were "certainly going to express our concerns" over the Republicans' Medicaid cuts.
Loser: Rep. Tom MacArthur
After House Republican leaders pulled their original health care bill in the middle of debate due to lack of support, Rep. Tom MacArthur (R-3rd Dist.), a former insurance executive, stepped up to try to save the effort.
He won the support of the most conservative Republicans with an amendment that would allow states to seek exemptions from the package of essential health benefits that all insurance policies had to offer. The GOP passed the bill with just two votes to spare.
The bill he championed would have more than doubled the number of uninsured residents in his district, higher than anywhere else in the state, according to New Jersey Policy Perspective a progressive research group. His efforts were blasted at a five-hour town hall meeting.
Trump hosted a fundraiser for MacArthur at his Bedminster golf club, but the sophomore lawmaker found himself in a more competitive race for re-election and he already has drawn a top-tier Democratic challenger, Andy Kim, a former White House national security aide.
MacArthur said it would be "really inappropriate and cynical" to look at the bill "through the lens of does this help or hurt me personally."
"I didn’t engage in health care reform so I cold put some political points on a board," he told reporters outside the House chamber. "It was an effort to repair a crumbling system and help people’s costs come down while we took care of vulnerable people."
Kim sent out a fundraising email after the Republican effort collapsed.
"Secret meetings, back room deals, rushed votes, no public hearings, and proposals that will hurt millions of Americans -- that isn't leadership and the American people deserve better with so much at stake," he wrote..
Winner: Rep. Leonard Lance
Rep. Leonard Lance (R-7th Dist.) was one of the first GOP members to come out against the repeal bill and never wavered in his opposition.
As one of only 23 House Republicans representing a district carried by Hillary Clinton last year, Lance is considered New Jersey's most vulnerable GOP incumbent and is one of four lawmakers in the state on the Democratic Congressional Campaign Committee's initial target list along with LoBiondo, MacArthur and Frelinghuysen.
Asked if he felt vindicated by the bill's failure, Lance declined to answer directly.
"I do not like those who gloat in political life," Lance said. "That is not my view of public policy."
Loser: Rep. Rodney Frelinghuysen
The most powerful member of the New Jersey congressional delegation, Rep. Rodney Frelinghuysen (R-11th Dist.) initially opposed the House Republican health care bill but switched positions and voted for it.
“When it comes to the Affordable Health Care Act, doing nothing is not an option," Frelinghuysen said. "There are serious problems with Obamacare and I do not believe the Senate should be throwing in the towel at this point. They need to get back to work. Our ultimate goal remains repealing and replacing the ACA with a system that provides access to quality and affordable health care.”
He is in a competitive race for re-election in a district that gave less than 50 percent of its votes to Trump in 2016, and has drawn two Democratic challengers so far, Mikie Sherrill, a former Navy pilot and federal prosecutor, and Passaic County Freeholder John Bartlett.
The Cook Political Report, a Washington-based publication that tracks congressional races, rated Frelinghuysen as just a slight favorite for re-election.
U.S. Sens. Robert Menendez, left in back, and Cory Booker, right in back, each hold pictures of New Jersey residents helped by the Affordable Care Act. They joined their colleagues on the Capitol steps to oppose Senate Republican efforts to repeal and replace the law. (Jonathan D. Salant | NJ Advance Media for NJ.com)
Winner: New Jersey's U.S. senators
U.S. Sens. Cory Booker and Robert Menendez (D-N.J.) held press conferences both in Washington and New Jersey, and engaged in other protests against Senate Republican efforts to repeal and replace the Affordable Care Act.
Senate Majority Leader Mitch McConnell (R-Ky.), center, is accompanied by, from left, Sen. John Barrasso (R-Wyo.), Sen. Roy Blunt (R-Mo.), and Senate Majority Whip John Cornyn of Texas, as he speaks at a news conference on Capitol Hill. (AP Photo | Carolyn Kaster)
Loser: Congresional Republican leaders
Despite the unpopularity of their legislation, House Speaker Paul Ryan (R-Wis.) and Senate Majority Leader Mitch McConnell (R-Ky.) pushed ahead with repeal legislation that would leave more than 20 million more Americans without coverage and take more than $700 billion out of Medicaid, the health care program for the poor, disabled and elderly. Both bills would use those savings to cut taxes for corporations and wealthy Americans.
Republicans used a parliamentary maneuver known as reconciliation to allow them to pass the legislation without Democratic support.
GOP leaders rebuffed Democratic efforts to work with them to make changes to the law, and then complained that the Democrats wouldn't support their efforts to repeal it.
Winner: Rep. Frank Pallone Jr.
As the top Democrat on the House Energy and Commerce Committee, which has jurisdiction over health care, Rep. Frank Pallone Jr. (D-6th Dist.) helped lead the fight against the Republican repeal legislation.
Now he said he will reach out to Republicans on his committee and elsewhere to try to improve the health care law.
"There have been Republicans all along who've indicated to us that they wanted to just work to improve the bill and not repeal it," Pallone said. "Now, I think, is the opportunity for them to step forward and I certainly will reach out to them, including the ones on my committee, and say that’s what we should be doing."
Loser: Secrecy
Both the House and Senate versions of the Republican health care legislation were rushed through without public hearings.
House Republican leaders held their vote without waiting for an analysis by the Congressional Budget Office, which found that their bill would leave 23 million more Americans without health care than under current law.
While three House Republican committees debated the legislation, in some cases working through the night to do so, McConnell drafted the Senate bill in secret, bypassing hearings and committee meetings.
Contrast that to the debate over the original Affordable Care Act. The Senate Health Committee alone spent almost 60 hours over 13 days, and the Senate Finance Committee spent eight days wading through more than 130 amendments and holding 79 roll-call votes, according to the New York Times. Then the full Senate debated the legislation for 25 days.
Winner: Bipartisanship
Members of the Tuesday Group of more moderate Republicans and the moderate New Democrat Coalition, including New Jersey Reps. Lance, Frank LoBiondo (R-2nd Dist.) and Donald Norcross (D-1st Dist.), met for lunch to discuss changes to the health care law that both sides could support.
"It is now important for Democrats to work with Republicans to make the improvements that are definitely necessary," Lance said.
Senate Democrats, too, said they willing to work across party lines.
“The only way we’re going to lower premiums, improve coverage and create a more sustainable health care system is for Republicans to work with Democrats on real solutions to strengthen the Affordable Care Act, not kill it.," Menendez said.
"Rather than rooting for failure, or sabotaging the gains we’ve made – and literally putting millions of American lives at risk – Republicans should join us," he said.
The medical community, which unanimously opposed the Republican repeal bills, also called on both sides to work together.
"Congress must begin a collaborative process that produces a bipartisan approach to improve health care in our country," said Dr. David O. Barbe, president of the American Medical Association.
More on the fight to repeal Obamacare
Trump wants to repeal Obamacare without replacing it. Here's what it would mean to N.J.
How Trump reacted to demise of Republican Obamacare repeal effort
What Trump has to say about latest Obamacare repeal bill
Trump's Obamacare repeal is stuck. Here's how it got that way, and what's next
There's a new Obamacare repeal bill in the Senate, and it would still slam New Jersey
Jonathan D. Salant may be reached at jsalant@njadvancemedia.com. Follow him on Twitter @JDSalant or on Facebook. Find NJ.com Politics on Facebook.
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