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Analysis: GOP Failure To Replace The Health Law Was Years In The Making

Seven years of Republican vows to “repeal and replace” the Affordable Care Act came to a crashing halt Tuesday, when it became clear that the Senate could not muster the necessary votes for any of three separate proposals that have been under consideration.

The failure, at least for now, breaks one of the key promises Republicans have made to their voters since 2010, when the ACA first became law.

“This has been a very challenging experience for all of us,” Senate Majority Leader Mitch McConnell (R-Ky.) told reporters Tuesday afternoon. “It’s pretty clear that there are not 50 Republicans at the moment to vote for a replacement for Obamacare.”

Monday night’s declaration of opposition by conservative Sens. Mike Lee (R-Utah) and Jerry Moran (R-Kan.) effectively scotched even the chance to start debate on the version of a bill unveiled last week.

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McConnell added that the Senate would vote early next week on a plan, originally approved in 2015 and vetoed by President Barack Obama, that would repeal parts of the health law. That approach would delay the effective date for two years to give lawmakers time to come up with a replacement.

However, the opposition of moderate Sens. Susan Collins (R-Maine), Shelley Moore Capito (R-W.Va.) and Lisa Murkowski (R-Alaska), ensures that vote will fail, too.

“To just say ‘repeal and trust us, we’re going to fix it in a couple of years,’ that’s not going to provide comfort to the anxiety a lot of Alaskan families are feeling right now,” Murkowski told reporters.

In retrospect, Republicans’ inability to overhaul the health law should not come as much of a surprise. Here are some of the reasons:

1. It’s hard to take things away from people.

Once launched, federal programs that provide people with benefits they find important and valuable are very difficult to rescind. In the case of health care, people’s lives can be at stake. In the current debate, patients who feared what would happen to their health coverage made their concerns known — loudly — to lawmakers.

2. Republicans have long been divided on health care.

Republicans’ dirty little secret the past seven years is that the only thing they fundamentally agreed on when it comes to health care was the slogan “repeal and replace.” There’s a reason they failed to have a plan ready when Donald Trump was elected president — all efforts to reach a consensus had thus far failed.

“I did not come to Washington to hurt people,” said Capito in a statement. “I have serious concerns about how we continue to provide affordable care to those who have benefited from West Virginia’s decision to expand Medicaid.”

But the more conservative members, notably Sen. Rand Paul (R-Ky.), have other priorities. “All of us promised we would repeal Obamacare,” Paul told reporters Tuesday. “If you’re not willing to vote the way you voted in 2015 then you need to go back home and you need to explain to Republicans why you’re no longer for repealing Obamacare.”

3. Presidential leadership on hard issues is important.

President Trump has been all over the place in what he said he wanted from a health bill. It was his original insistence that “repeal and replace” happen simultaneously that moved Congress away from its 2015 strategy of repealing first and replacing later. He hosted a celebration in the White House Rose Garden when the House passed its bill, then subsequently called the measure “mean” during a strategy meeting with Senators.

When it became clear Monday night that the Senate effort was foundering, Trump tweeted: “Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate.” But within hours he instead suggested, “As I have always said, let ObamaCare fail and then come together and do a great healthcare plan.”

The president “gave them an impossible assignment with his promises (more, better, cheaper for all) and neither policy nor bully pulpit help at crunch time,” said Len Nichols, a professor of health policy at George Mason University. “And now he’ll blame them for failing.”

Added Thomas Miller, of the conservative American Enterprise Institute: “We now have a randomized clinical trial that proves one cannot lead and govern via Twitter.”

4. Health care is complicated. Really.

Health care has not traditionally been a major voting issue for Republicans, and thus it has been a low priority — compared with issues like taxes and trade — for the officials they elect.

Adding to the complexity is that the Republicans’ bench is nowhere near as deep as the Democrats’ when it comes to health policy expertise. Democrats have toiled on these issues for years. Even before the Affordable Care Act, many had served in Congress for decades and learned from the mistakes that were made on efforts like the failed health bill under President Bill Clinton.

5. Some parts of the ACA really are popular, even among Republicans.

The requirement for most people to have insurance or else pay a fine — the individual mandate — has consistently been unpopular among voters of all political stripes. But many other major provisions of the health law, such as guaranteeing coverage for people with preexisting conditions, remain broadly popular.

In fact, in recent months, the Affordable Care Act has been growing in popularity. Most polls show it more than twice as popular as GOP efforts to overhaul it.

“Republicans have to admit that some of the things in the ACA, we actually liked,” said Murkowski.

That left a huge gap between Republicans who wanted to maintain the popular benefits and those who wanted to repeal the law entirely. A gap that, so far, Republicans have been unable to bridge.

Rachel Bluth contributed to this story.

Congress Squares Off Over Drug Pricing And A Controversial Drug Discount Program

House Democrats are calling foul on Republican assertions that cuts to a little-known discount drug program will eventually reduce skyrocketing drug prices.

At a hearing Tuesday, Rep. Diana DeGette (D-Colo.) said high drug prices should be investigated separately from the focus on oversight of the drug discount program, known as 340B.

“I think we need an investigation, a robust investigation, and a series of hearings that explore in-depth the reasons for exorbitant cost of drugs and why the prices continue to rise,” DeGette said.

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Last week, Health and Human Services Secretary Tom Price proposed steep cuts in what Medicare reimburses some hospitals for outpatient drugs under the 340B program. In a release, Price said such cuts would be “a significant step toward fulfilling President [Donald] Trump’s promise to address rising drug prices.”

DeGette countered Tuesday that the proposal “would do nothing” to address high drug prices and said making that connection “seems more like fantasy than reality.”

Also on Tuesday, there were other hints at Trump Administration efforts to address drug pricing. Food and Drug Administration Commissioner Scott Gottlieb talked in a public meeting about lowering drug prices on a different front — saying that the agency needs to increase generic drug competition.

Trump routinely criticized high drug prices on the campaign trail last year and promised to take action during his presidency. In June, a leaked draft of an executive order on drug prices, first reported by The New York Times, spoke of facilitating more drug competition but also targeted the 340B program. That strategy immediately drew criticism from Sen. Al Franken (D-Minn.), who said scaling back the program would drive up what hospital patients pay for drugs and force Americans “to choose between health and other basic life necessities, like putting food on the table and a roof overhead for the family.”

The federal 340B program requires pharmaceutical manufacturers to provide outpatient drugs at a significant discount to hospitals and clinics that serve a largely low-income population.

After buying the discounted drugs, the hospitals and clinics can bill Medicare or other insurers at their regular rate, pocketing the difference.

About 40 percent of hospitals nationwide participate in the program and, as House members pointed out Tuesday, the program has grown dramatically in recent years to become a significant force in the pharmaceutical marketplace. The Medicare Payment Advisory Commission estimated that hospitals and other participating entities spent more than $7 billion to buy 340B drugs in 2013, three times the amount spent in 2005.

Advocates of the program say the discounts — and the money hospitals make on payments from Medicare — are necessary to combat skyrocketing drug prices.

But federal reports in recent years from the Medicare advisory board, as well as the Government Accountability Office and the Office of Inspector General, have raised concerns about oversight and abuse of the 340B program.

Rep. Joe Barton (R-Texas) noted “this is a difficult hearing” because while the program was created with good intent, its complexity makes it challenging to understand. For example, hospitals and clinics aren’t required to pass any discounts they receive on to patients — they can direct the money to their general fund.

Looking at his colleagues, Barton said: “We all support the program but it has grown topsy-turvy. We need to put the best minds on this.”

Republican lawmakers are not the only ones raising concerns about 340B oversight. The Pharmaceutical Research and Manufacturers of America, which represents drugmakers, advocates ensuring hospitals are “good stewards” of the money they gain from the program’s discounts.

Peggy Tighe, who represents hospitals in the 340B program as a principal at the D.C. law firm Powers, said “PhRMA has done a particularly good job of getting the attention of the administration …. They haven’t let up on 340B.”

The rule that Price proposed last week would cut what hospitals are paid for drugs from the Medicare Part B program, which covers outpatient drugs including those delivered through infusion.

Currently, Medicare pays hospitals an average sales price plus 6 percent for most of the Part B drugs they purchase. The administration’s proposal is to cut that to average sales price minus 22.5 percent.

340B Health, a coalition that represents hospitals, immediately responded to the proposal saying the cuts would be “devastating” to hospitals and would “lead to cuts in patient services.”

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

In Massachusetts, Proposed Medicaid Cuts Put Kids’ Health Care At Risk

The U.S Senate’s plan to replace Obamacare, now in limbo, would cut funding for Medicaid and other health insurance subsidies by more than $1 billion a year within five years. That has many lawmakers, doctors, hospitals and patients across Massachusetts in a state of alarm.

“Where in this bill is the protection for children?” asked Dr. Jonathan Davis, the chief of newborn medicine at Tufts Medical Center, as he stood in the hospital’s NICU among babies who weighed as little as 1 pound. Roughly 60 percent of babies in the Tufts NICU are covered by Medicaid.

Davis paused in front of an incubator that held a tiny girl, just a few days old, who weighed 2.5 pounds. Her little lungs pumped several times a second.

This story is part of a partnership that includes WBUR, NPR and Kaiser Health News. It can be republished for free. (details)

“The fact is, she’s in room air, so she’s breathing entirely on her own — which is great,” Davis said.

Doctors and nurses work round-the-clock to give this baby and her roommates the best possible start. But it’s unclear whether Tufts could provide this care for free if the baby or her mom didn’t qualify for Medicaid. Davis said they also need good health coverage after they leave the hospital.

“Because if those children don’t go home to get great primary care, follow-up, early intervention and support, all those gains that could potentially have been made are going to be lost,” Davis said.

That threat seems real under the Senate health care bill, said Audrey Shelto, president of the Blue Cross Blue Shield of Massachusetts Foundation.

“It is even more devastating than the House bill for low-income and vulnerable populations,” Shelto said.

That’s because as of 2025, the Senate would tie spending for each person on Medicaid to a standard inflation rate, instead of the rate of medical inflation, which is usually higher. In Massachusetts, lots of lawmakers — Democrats and Republicans — are frustrated, if not angry.

State Rep. Jeff Sánchez, House chair of the Joint Committee on Health Care Financing, reviewed the details on his way to a health care conference.

“They talked about repeal and replace,” he said. “This is more like search and destroy — because fewer people are going to get coverage that they need, and people will pay more out of pocket.”

Sánchez says Massachusetts has a longstanding practice of making kids a priority and has enhanced MassHealth to make sure kids in low-income families get the care they need.

“Nobody’s clear on what’s the future of that program,” he said. “Everything is up in the air.”

Sánchez’s co-chair, state Sen. James Welch, has called the U.S. Senate bill “class warfare” because it would take money from poor kids and their moms and give it to wealthy adults in the form of tax cuts. But Welch says the state won’t have any good options if Massachusetts has to make up $1.4 billion in federal health care cuts in the future.

“Do you raise taxes somewhere? Do you cut back on eligibilities? Do you cut back on benefits? Tough decisions are going to have to be made,” Welch said. “But health coverage that children are currently receiving — we’ll fight tooth and nail to make sure that continues.”

Eileen McAnneny, president of the Massachusetts Taxpayers Foundation, says the state should cut health care spending before any talk of raising taxes or moving people off Medicaid. But McAnneny says MassHealth, the state’s Medicaid program, is growing faster than the state can manage. About 60 cents of every new tax dollar goes to MassHealth.

“So we have to reduce the cost of the MassHealth program, or the state will deliver MassHealth services and few others because it will consume a lot of our resources,” McAnneny says.

For kids, there is one bright spot in the Senate health plan that is not in the House Obamacare replacement bill: About 20 percent of children who qualify for Medicaid because they are severely disabled would be exempt from the cuts.

Kayla Klein, of West Roxbury, is watching what Congress is doing closely. She tugs at the appliquéd dog on the front of her 2-year-old son Robbie’s T-shirt.

“Right, Robs? Where’s your port?” she asks, playfully.

Robbie’s T-shirt hides a central line port through which he gets medicine every day that he needs to stay healthy; he has the blood-clotting disorder hemophilia.

Robbie makes his mom and dad, Joel Klein, laugh a lot. But they’re also very worried. Hemophilia medications can be terribly expensive, and the Kleins are both school teachers, without hefty salaries. Robbie has private insurance through his parents to cover most of the cost, and Medicaid fills in the gaps, for now.

The Kleins want to make sure members of Congress understand the decisions they’re making are really important.

“Our futures and our livelihood are hanging in the balance,” Joel Klein says.

“It makes you feel very fragile. It makes you feel like you aren’t empowered when your child’s life is at stake,” Kayla Klein adds.

Senate leaders say they expect to vote on their health care bill before their August recess. It’s not clear whether the bill has the votes to pass.

This story is part of a partnership that includes WBUR, NPR and Kaiser Health News.

5 Ways GOP Reforms Could Change Your Health Plan Options

One of the fiercest complaints about the Affordable Care Act is that it imposed a government mandate on consumers to purchase coverage with a broad and specific set of benefits — including maternity care, mental health treatment and limits on out-of-pocket costs — whether they wanted those benefits or not.

More choice is always better, critics argued. But what if choice trumps protection?

The latest Senate bill — drafted solely by Republicans — fell apart late Monday as two more senators said they would not vote for it. The political tumult was spurred in part by the potential changes for consumers.

“I think choice is great when it comes to buying cell phones or pizza slices,” said Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute. “It’s a very different thing in insurance. None of us is immune from someday becoming one of those sick people. Insurance is supposed to protect us from unpredictable risk.”

One bill provision, dubbed the “Cruz amendment,” for backer Texas Sen. Ted Cruz, would have allowed insurers to offer plans stripped of most of the ACA’s requirements so long as they also offer some policies that do meet those rules.

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The provision aimed to win support from conservatives who want lower premiums, which would be achieved with the more limited benefit package. But it’s not so simple. Consumers would have to weigh the tradeoffs between price and their somewhat unpredictable future needs.

“This is the fundamental divide,” said Christopher Condeluci, an attorney and former counsel to the Senate Finance Committee.

“You are taking a risk in purchasing a less comprehensive plan because you never know what’s going to happen. But, if you feel this is the right type of plan, then you should have ability to make that economic and risk decision.”

ACA supporters, though, see high value in the strong consumer safeguards.

The ACA, they say, rescued consumers left wanting by some of the choices on the individual market. Before the ACA, some policies had very limited coverage, not covering hospitalization, for example, or paying only small amounts toward doctor visits, tests or drugs.

Sometimes consumers were misled by insurers or agents about the breadth of coverage. Sometimes they were just confused and didn’t realize the limits until after the medical problem occurred — their most vulnerable point — leaving some on the hook for hefty medical costs.

The ACA’s comprehensive benefit rules, supporters say, may add to premium costs, but protect consumers from making bad choices — deliberately or inadvertently — that could result in tens of thousands in unpaid medical bills or no treatment altogether.

The next steps in the Senate’s consideration of the GOP health plan are now uncertain as Sen. John McCain (R-Ariz), a key GOP vote, recovers from surgery and the intra-party fissures emerge.

McCain issued a statement urging that the chamber return to “regular order, hold hearings, receive input from members of both parties” to produce the legislation. But Majority Leader Mitch McConnell (R-Ky.) signaled his intent to hold a vote to repeal the health law with a two year delay. As the discussion continues from this point, here are five things you should know about how this marketplace provision could play out:

1. Premiums would be lower, but maybe not for you.

Because they would cover less, premiums on such policies would be lower for healthy people. That’s how the market was before the ACA passed, when insurers could reject people with preexisting medical conditions in most states.

The ACA barred that practice, so insurers generally raised everyone’s rates to cover those who were ill. Premium increases were softened for consumers who received subsidies to purchase ACA coverage, but really hit people with incomes of more than $48,000 and who are not eligible for subsidies.

Still, the Cruz plan might not lower premiums for everyone.

Insurers could use a person’s health — including their claims history and genetic profile — to set rates, a move barred in ACA plans. They could also outright reject people deemed too risky or sick. People with medical conditions — or those that develop them while covered — could be charged far more than those without. And the Senate bill doesn’t offer consumers help in buying the plans. Federal subsidies cannot be used to purchase the Cruz amendment plans.

2. Coverage would be less generous.

Because the plans would not have to include the ACA’s ten “essential health benefits” — hospital care and prescription drugs among them — consumers could end up paying those expenses themselves.

Those costs could be high, as insurers could also forego the ACA’s annual out-of-pocket caps, which this year are $7,150 for individual coverage and $14,300 for family plans.

The policies cannot set annual or lifetime dollar limits on care, but under the Cruz amendment, insurers could use deductibles or other out-of-pocket costs to achieve a similar goal: shifting more costs to consumers. For example, chemotherapy might have unlimited annual coverage, but only after a huge deductible — say $10,000 or $20,000 — is met.

3. It would create essentially two different markets.

Insurers could offer Cruz amendment plans, so long as they also offered at least one gold level, one silver level and one “benchmark” plan that meets the ACA rules. But there’s nothing saying they would have to actively market those plans.

Most policy experts fear the result would be market segmentation — a siphoning off of the healthiest people into Cruz plans. “The attempt here is to turn what we know as Obamacare today into a high-risk pool,” said Robert Laszewski, an insurance industry consultant.

Then what would happen? Premium costs could rise rapidly for people in the ACA plans and, at the same time, subsidies for consumers purchasing those plans would become less generous for many, particularly older people.

Even the insurers’ trade lobby has sounded alarm about the Cruz approach, sending a letter last week to Senate Majority Leader Mitch McConnell (R-Ky.) and Democratic Leader Chuck Schumer (D-N.Y.) that called it “simply unworkable in any form.”

4. You might be temporarily barred from broader coverage.

Because the plans won’t be considered “creditable coverage,” consumers who buy one and then decide to switch to a plan that is consistent with ACA rules might face a penalty of having to wait six months for that coverage to begin. That lockout period aims to keep people from jumping in and out of comprehensive coverage.

Here’s how that would work: Someone with a stripped down plan gets cancer and wants to switch to coverage that is more generous. Under the current proposal, that person might have to wait six months, which could complicate if not threaten their cancer treatment.

Some experts read the proposal as appearing to offer a small exception to that six-month lockout — but only if consumers don’t have a single-day gap between the day their Cruz amendment policy expires and the new ACA-compliant plan kicks in.

“People would have the freedom to choose, but the difference between the choices and the consequences of those choices are extraordinary,” said Laszewski, a longtime critic of the ACA who has blasted the proposed Senate replacement. “Do they roll the dice with their health and hope they never get sick?”

5. They are different from “catastrophic plans.”

The bill would also expand eligibility for coverage known as catastrophic plans. These are not the same as the Cruz amendment plans. Catastrophic plans include the broader array of ACA benefits. They also allow three doctor visits annually exempt from the deductible.

At the same time, however, their deductibles are higher than any of the other types of ACA plans sold, equal to those previously mentioned annual out-of-pocket limits. So far, they haven’t been terribly popular. They are currently limited to people age 30 and younger, with a few other exceptions. The Senate bill would make them available to all ages — and allow subsidies to be used to purchase them.

Unpaid Premiums? Switching Plans? What Changes Are Coming For 2018 Coverage

People are anxious about what’s going to happen with marketplace coverage next year. Even as Republicans contemplate their next move in the effort to undo the Affordable Care Act after the Senate GOP plan unraveled Monday night, the marketplaces are still likely offer plans this fall for 2018 coverage. Below I explain some of the important changes that are in the works that could affect consumers’ enrollment and coverage next year.

Q: I stopped paying for my marketplace plan at the end of June because I couldn’t afford the premiums. Will I have trouble this fall when I try to sign up for a new plan?

You could run into roadblocks. The Trump administration is giving insurers leeway next year to demand payment for unpaid premiums during the previous 12 months before allowing consumers to enroll (see page 18349) in one of the insurer’s plans again.

The Affordable Care Act gives consumers who are receiving premium tax credits a “grace period” of three months to catch up if they fall behind on premiums. Under current regulations, if they don’t make up the payments in three months, insurers can cut off consumers’ coverage after the first month and aren’t responsible for paying any claims that are pending after that.

Insuring Your Health

KHN contributing columnist Michelle Andrews writes the series Insuring Your Health, which explores health care coverage and costs.

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But insurers complained that the rules encouraged consumers to game the system by halting their premium payments late in the year, hoping that they wouldn’t need care. Then they’d re-enroll the following year, thus saving up to two month’s worth of premiums without any penalty for the months that they didn’t pay.

There are many reasons why people might drop coverage during the year, including the one you describe – that they’re unable to afford it. According to a McKinsey & Company study, roughly 1 in 5 people who bought a marketplace plan in 2015 stopped paying it at some point during the year. Forty-nine percent of those people repurchased the same plan in 2016.

Insurers aren’t required to adopt the administration’s new approach and states can prohibit them from doing so if they wish.

The new rule for paying back premiums only applies if you want to buy a plan from the same insurer. If you switch insurers you can’t be denied a new plan because you owe premiums to another company.

Insurers have to notify consumers of their policy in enrollment applications and nonpayment notices. But, even so, consumer advocates expect changes to cause confusion among consumers. Further, there’s no mechanism in the new rule for consumers like you to contest a bill from an insurer for unpaid premiums that you don’t believe you owe.

“Insurers are certainly going to try to collect everything they can,” said Timothy Jost, an emeritus professor of law at Washington and Lee University who’s an expert on the health law.

To avoid problems next year, make sure to call your insurer and cancel your current coverage before your 90-day grace period ends at the end of September, consumer advocates say.

Q: What happens if I sign up for a marketplace plan this fall and find out in January when I start using it that it’s not a good plan for me? Can I switch?

Probably not. Unless you get married, have a baby or experience some other event that qualifies you for a special enrollment period, you’ll have to stick with the same plan you chose during the open enrollment period, which will run for six weeks this fall from Nov. 1 – Dec. 15.

Last year, people had more wiggle room to switch plans in January and February, since the open enrollment period ran for three months, from Nov. 1 until Jan. 31.

Consumer advocates are concerned that consumers, many of whom wait to sign up for coverage until the end of the open enrollment period, might miss their window of opportunity this year.

In previous years when computer or other glitches slowed down the open enrollment process, the

Obama administration allowed people more time to sign up, said Sarah Lueck, senior policy analyst at the Center on Budget and Policy Priorities.

“The administration should be prepared to extend the open enrollment period” this year as well, Lueck said. But don’t count on it.

Q: With all the uncertainty in the marketplaces, why not just buy a short-term plan that covers me up to $1 million? I know they’re not as comprehensive as exchange plans but they’re a lot cheaper.

The low premium may be tempting, but be careful what you wish for, say experts. If you have a pre-existing medical condition like high blood pressure or diabetes, insurers may simply decline to sell you a policy at all, or sell you one that doesn’t cover any medical expenses related to that condition.

Once you have the plan, chances are you won’t be able to renew it if you actually get sick, because unlike regular coverage short-term plans aren’t guaranteed renewable.

Then there’s the fine print. “A lot of the plans have hidden exclusions or caps on specific services that may come back and bite you,” said Sabrina Corlette, research professor at Georgetown University’s Center on Health Insurance Reforms. “When you read it through, it may say it will cover an appendectomy up to $2,500, or it will cover each day in the hospital up to $300.”

Since short-term plans don’t count as “minimum essential coverage” under the Affordable Care Act, you could owe a penalty for not having health insurance. For all the talk of repeal, that’s still the law of the land.

Please visit to send comments or ideas for future topics for the Insuring Your Health column.

Postcard From Capitol Hill: When Health Care Takes a Breather

As one senator’s health care emergency upended what was supposed to be an action-packed week for the Senate health care bill, Capitol Hill’s denizens began rebooking Monday.

Like T.J. Petrizzo, a lobbyist whose clients include children’s hospitals and cancer centers. On Monday afternoon, he was sitting alone in a nearly deserted Senate cafeteria looking at his phone.

“I cleared my calendar this week to do health care, health care, health care,” he said. “The intensity level has let off, but I’m still doing health care this week.”

The absence of Sen. John McCain (R-Ariz.), who is recovering at home from emergency blood clot surgery in his brain on Friday, has jammed the Senate’s plans. Without McCain, and with at least two senators opposed to the current bill, Senate Majority Leader Mitch McConnell doesn’t have the 50 votes he needs to move the measure.

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Thursday’s expected vote on advancing the bill to a floor vote won’t happen now. The Congressional Budget Office didn’t release its analysis of the Senate’s revised bill on Monday as expected either. The online news service Axios reported that a senior Capitol Hill aide, who was unnamed, said it’s “highly unlikely” there will be a CBO report this week.

Uncertainty about the course ahead mounted with reports Monday that McCain’s recovery might take more than a week, leaving less time for action before the Senate’s scheduled recess starting Aug. 17.

“I didn’t think we’d still be talking about health care in the middle of July,” said one Democratic staffer.

“It seems like the vote is always ‘next week,’” said another.

The opposition party is seizing on the delay to mobilize resistance to the bill and keep up pressure for changes.

Sen. Dick Durbin (D-Ill.) tweeted Monday morning: “Here’s a radical idea @SenateGOP: use the time that Sen. McCain is gone to hold a public hearing on your latest health care repeal bill.”

When the Senate convened in the late afternoon, health care reform — the No. 1 issue on voters’ minds, according to a Bloomberg poll out Monday — was not on the agenda.

Instead, senators took up a matter that may be well under the public’s radar: the nomination of Patrick Shanahan for deputy secretary of defense. He was confirmed, 88-6.