In order for Senate Majority Leader Mitch McConnell to pass his health care bill, he must first clear a procedural hurdle on a motion to proceed to consideration of the bill. To accomplish this, he’ll only need fifty votes rather than the typical sixty because this is a budget reconciliation bill that can bypass all filibusters. Yet, according to the Washington Post’s whip count there are already three Republicans (Susan Collins of Maine, Rand Paul of Kentucky, and John McCain of Arizona) who are hard “nays” on affirming the motion to proceed. If this doesn’t change, the bill is dead because the GOP caucus only has 52 members and so can only afford to lose two votes.
I think we all know better than to rely on John McCain to back up his words with action, but the list of potential ‘no’ votes is quite a bit longer. There are twenty Republican senators from states that expanded Medicaid, and only a handful of them are truly indifferent to the devastation the McConnell bill would do their states. Not only would millions upon millions lose their access to health care but rural hospitals would go out of business and state budgets would be gutted.
McConnell has tried to address some concerns by increasing the amount of money set aside to deal with opioid treatment, but it’s still a horrible deal for states that will lose Medicaid funding. McConnell left some of the taxes in place to address concerns from folks like Sen. Bob Corker of Tennessee that the optics would be too difficult if they were taking away people’s lives in order to pay for higher take-home executive pay at insurance companies. But this wasn’t really at the core of the optical problem with the bill. McConnell has so far gone along with a plan hatched by Sen. Ted Cruz of Texas to allow insurance companies to sell super-cheap health care plans that don’t cover anything and will be virtually useless the moment that you want to use them, but even the insurance companies don’t want to sell that crap because it would just turn their regular plans in profit-losing high-risk pools for very sick people. In fact, it’s unclear if there is any constituency that wants Cruz’s idea to pass. As best as I can tell, Cruz wants it so the Republicans can claim that they’ve made premiums more affordable even if what your premium is paying for is a letter that declines your treatment.
The size and nature of the Medicaid cuts still seem to be unacceptable to several Republican senators, including Lisa Murkowski of Alaska, Shelly Moore-Capito of West Virginia and Rob Portman of Ohio. There are doubtless others, like Cory Gardner of Colorado and even Tom Cotton and John Boozman of Arkansas who don’t want to say anything but will be quite pleased if the Medicaid cuts never go into effect.
Were McConnell to jettison or massively scale back the Medicaid cuts, he’d probably lose Sen. Mike Lee of Utah (who is currently noncommittal even with them) and Ted Cruz, plus they’d lose a bunch of votes from the Freedom Caucus in the House.
McConnell can certainly tinker around the margins, but the Medicaid issue is the one that he can’t seem to solve. Sens. Collins and Murkowski explicitly want the cuts taken off the table, but they’re currently in the bill because they need to be in the bill.
There’s another incentive for Republican senators to oppose a motion to proceed, and that is that if the bill is taken up on the Senate floor there will be a vote-a-rama on dozens of proposed amendments. And the Democrats are prepared to drive wedge after wedge into the divisions that already exist within the Republican caucus. The whole thing will fall apart if the Senate starts passing Democratic amendments so the GOP members will be whipped relentlessly to say no to virtually all of them. This they will not want to do, especially because some of them actually will agree with those amendments. They won’t want to vote against things they support, particularly if they don’t think the bill will ever became a law. The best way to avoid that nightmare is to kill the bill in its crib.
If the bill is going to fail, the next step is shift around the blame. Most Republicans can hide behind the few courageous ones and say that they voted to take up the bill. This is why many senators won’t say they support the bill but also won’t say that they’ll oppose it. They’ll try to blame the Democrats for refusing to cooperate, but the Democrats are actually powerless to stop this bill. They haven’t even been asked to support it and none of their ideas have been solicited or incorporated. The whole idea was the pass a bill with no compromises.
Moderate Republicans will validly point out that the bill is incredibly unpopular and was written behind closed doors with no hearings or expert testimony. Conservatives will be able to identify the people who voted against taking the bill up at all.
The president and his administration will be blamed for lackluster leadership but they’ll turn around and blame congressional Republicans for missing a lay-up.
There’s still a possibility that McConnell will succeed in getting the bill through the procedural hurdle, and then through the minefield of Democratic amendments, but even if he somehow does what looks close to impossible right now, the House will still have to pass the bill exactly as it is worded or the whole thing starts up all over again. If the House can’t pass the exact Senate version then they’ll have to start writing a new draft which will have to pass and go back over to the Senate. There isn’t enough time left to do all that and still pass a new budget and get started on tax reform.
Given the long odds, what we’re witnessing right now is mainly theater. McConnell has to try, so he’s trying. But he also has to get this off his plate so he can move on to other things. If he fails to repeal Obamacare, he’ll have trouble coming up with the money for tax reform, and the whole year’s legislative agenda will be at risk of annihilation.
It’s this risk that keeps a faint pulse of hope alive for the few folks who genuinely want McConnell’s bill to pass. The consequences of failure are going to be so great that no one wants to be held responsible for causing the failure.
Substantively, though, the bill is so bad and, as a result, so unpopular that passing it would be as big of a disaster as failing to pass it. In fact, failing to pass it would be painful in the short-term but a better bet politically in the medium to long term.
Plus, the sooner the Republicans realize that they can’t get anything done, like tax reform or infrastructure without Democratic support, the sooner they’ll start acting like a governing party instead of some kind of pirate raiding party of bandits.