WASHINGTON — When the vice president has to cast a vote to break a tie in the Senate on whether to debate U.S. health care policy, it's obvious that passing legislation related to the Affordable Care Act is going to be a heavy lift in Congress.

Democrats, who boasted of a veto-proof majority to avoid a Senate Republican filibuster, got the ACA passed in 2010. Now, they're in the minority in both the Senate and the House.

Yet in the rush to reject the ACA, there lacks unanimity among Republicans in each chamber to make changes.

The first House effort to pass the American Health Care Act never got to a vote. A second version passed 219-215.

The Senate's Better Care Reconciliation Act never came to a vote, either, when enough Republican senators gave it a thumbs-down for leaders to recognize its chance of passage was nil. The procedural vote July 25 required not only Pence's tiebreaker but the return to the Senate floor of Sen. John McCain, R-Arizona, who had undergone eye surgery that revealed brain cancer, to create the tie in the first place.

Later July 25, the Senate rejected a revised version of the Better Care Reconciliation Act, and on July 26 the Senate rejected an effort to repeal major parts of the act without a replacement.

"There's no such thing as perfect legislation. As things pass, you realize that things don't work out as well as it should," said former Rep. Bart Stupak, a Michigan Democrat who fought to retain pro-life provisions in the ACA and who has written a book, "For All Americans," about the legislative tussling behind the ACA's passage. After it became law, he and other pro-life Democrats pressed President Barack Obama to sign an executive order banning federal funds for abortions.

Stupak said the ACA was modeled after "the Massachusetts plan that was instituted by then-Gov. Mitt Romney," a Republican. "Surely we would get other Republicans to join us" for a bipartisan piece of legislation," he said. "That didn't happen. But we did end up with the insurance exchanges. But no one anticipated that 30-some states would never participate."

"Presidents have been imploring Congress to pass a national health care plan" for a century, said Stupak, a Catholic, noting that President Bill Clinton's plan in 1993 — when he famously assigned his wife, Hillary, to lead the task force to design the bill — never got out of committee. "I'm pleased we got it done," Stupak said of the ACA. "Does it need work? Yes."

Jim Capretta, a resident fellow and health care policy expert at the American Enterprise Institute, said, "Mustering the political will" to pass the ACA "resulted in a fairly large number of moderate- and low-income people getting health insurance in a more stable way than what they were used to getting, and that's quite an achievement."

"The Affordable Care Act passed with only Democratic votes. I think that's the primary reason why that's unstable now. You don't get buy-in from the other party," he added, making the law "subject to a lot of dispute and disagreement, and half the country sort of distrustful of what was passed." With both parties working together, Capretta said, it shields it from "elements of either party to attack it. That's why (with) big policy changes, you're better off trying to do it in a bipartisan way."

But to hear first-term Republican Rep. Francis Rooney of Florida — a former U.S. ambassador to the Vatican — bipartisanship is hard to come by. "There has been no evidence of any Democrat wanting to team up to repeal and replace Obamacare and give America patient-centric, choice-oriented care," he said.

"Unfortunately, the country is very polarized, and we have two radically different views on the size of government," Rooney said later. "I don't know how well they're going to be reconciled. I tend to think that our way is the right way."

"Republicans are not bad people. We may disagree on some concepts, but I think everybody agrees on the essentials," Stupak said. If Republicans want to repeal the ACA's individual mandates imposing a fine on people who will not buy insurance, for instance, he added, "once again, you go back to the health care infrastructure. Who pays for it?"

And if up to 32 million Americans would be without health insurance by 2026 — as the Congressional Budget Office said in scoring the since-scuttled Better Care Reconciliation Act — "then what would you would do with them?" Stupak asked. 

Catholic leaders push for health care remedy 

By Carol Zimmermann | Catholic News Service | Twitter: @carolmaczim 

WASHINGTON — After the Senate voted July 25 to proceed with the health care debate, Bishop Frank J. Dewane of Venice, Fla., urged senators of both parties to "work together to advance changes that serve the common good."

In a statement July 25, Bishop Dewane wrote that the health care reform proposals currently under consideration would "harm millions of struggling Americans by leaving too many at risk of losing adequate health coverage and continue to exclude too many people, including immigrants."

"We are grateful for the efforts to include protections for the unborn, however, any final bill must include full Hyde Amendment provisions and add much-needed conscience protections. The current proposals are simply unacceptable as written, and any attempts to repeal the ACA (Affordable Care Act) without a concurrent replacement is also unacceptable," added the chairman of the U.S. Conference of Catholic Bishops' Committee on Domestic Justice and Human Development.

He also stressed that "current and impending barriers to access and affordability under the ACA must be removed, particularly for those most in need. Such changes can be made with narrower reforms that do not jeopardize the access to health care that millions currently receive."

Dominican Sister Donna Markham, president and CEO of Catholic Charities USA, wrote in a statement July 26 that she was disappointed with the Senate's vote to attempt to repeal and replace the ACA "without a clear plan to protect access to affordable health care coverage."

She stated that throughout the health care reform debate, Catholic Charities has insisted that any reform must protect those who have health care coverage and provide more health insurance to those without it.

"We urge senators to work together to reject dramatic cuts to Medicaid coverage and provide a health care bill that truly expands coverage, reduces costs and respects human life and dignity, especially for those who are most in need," she stated.