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Protesters gather outside the Capitol Building prior to an all night round of health care votes. Photo by Aaron P. Bernstein and Reuters

Who wins and who loses after last night’s health care vote

In a major blow to their party and President Donald Trump, Senate Republicans failed on Friday to pass a scaled-back version of health reform in a tense overnight Senate vote. The loss dealt what may have been a fatal blow to efforts to repeal the Affordable Care Act. In the wake of that vote, we break down the winners and losers.


Low-income individuals: Medicaid and the Medicaid expansion both stay as they are now. That means no immediate reductions overall. And millions of people who make between 100 and 138 percent of poverty ($16,643 for individuals) and receive Medicaid because of the expansion of the Affordable Care Act will still receive benefits.

Planned Parenthood: The Senate and House both hoped to block Planned Parenthood funding for a year as part of health care reform. The Congressional Budget Office found that would cost the organization (and save the federal government) $178 million next year. Now, for at least the moment, that is off the table.

The Centers for Disease Control and public health: Nearly every version of ACA repeal would have gutted the Prevention and Public Health Fund. That’s a $1 billion pool of money which the ACA mandates must be spent on improving public health. Much of that money goes directly to the Centers for Disease Control. The death of the GOP bills means more life for this money.

Rural America: In much of rural America, hospitals represent the greatest employer and economic engine. But rural hospitals stridently opposed the Republican bills, arguing they would leave them footing more of the bills for the uninsured (and more uninsured). The status quo is still not ideal for many rural hospitals, but it’s better than what they saw in the GOP repeal plans.

Regular order: Seven months of closed-door talks and no public hearings have now resulted in little more than a political body blow to Senate Republicans. Now, the more tedious but often more successful traditional process takes over: committee hearings and work on a deal by the Senate Health Education and Public Works committee.

Many Republicans: Moderate Republicans and Republicans in states with large Medicaid populations may have dodged a political bullet here. The repeal bills, especially those with Medicaid reductions, were raising sharp concern and pushback for these members.

The losers

Tax Reform: The dream of a once-in-a-generation overhaul of the tangled U.S. tax code took a significant hit when the health care bill went down. Republicans had hoped to use savings (likely from Medicaid reductions) to help fund tax cuts. That’s out now. And so, by the way, is another big funding idea known as the border adjustment tax. This all adds to the already tricky task of agreeing on which Americans should pay more and how many can pay less.

Long-term debt: Republican plans to dramatically scale back Medicaid met with wide resistance for the number of people who would lose care. But the idea did achieve some important long-term savings in Medicaid, a program whose costs are forecast to soar in coming years. Now that cost threat remains.

Mitch McConnell and Paul Ryan: Both the Senate and House Republican leaders worked overtime behind the scenes to try to pass ACA repeal. Neither faces an immediate challenge for their job, but this could be a serious chink in their armors.

Many other Republicans: Many Republicans now face angry core constituents who feel strongly that the Affordable Care Act harms their lives. And that the GOP promised to do away with it, but has so far failed.

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