Mitch McConnell
Credit: Gage Skidmore/Flickr

With announcements last night from Senators Mike Lee (R-UT) and Jerry Moran (R-KS) that they will not support the Republican bill to repeal and replace Obamacare, Majority Leader Mitch McConnell was forced to concede that he doesn’t have the 50 votes to pass it.

Senate GOP leaders gave up their effort to dismantle and simultaneously replace much of the Affordable Care Act, after the defections of two more Republican senators left the party short of the votes needed to pass President Donald Trump’s top legislative priority of his first seven months in office.

But they’re not done yet.

What McConnell is saying is that they will instead revive a bill that Republicans passed in 2015 to repeal Obamacare, but was vetoed by President Obama. Since that bill delayed implementation of the repeal for two years, we’re back to the idea put forward by some Republicans at the beginning of this process to “repeal and delay.” The rationale was that the prospect of a collapse of Obamacare would force Democrats to work with Republicans on a replacement. In other words, it is a renewed form of the hostage-taking we saw from Republicans repeatedly during the Obama presidency.

Most people are assuming that a repeal and delay vote will never pass the Senate. This revival of that strategy is merely a way for McConnell to give Republicans a way to tell their constituents that they voted “yes” on the bill to repeal Obamacare. But it also puts tremendous pressure on so-called “moderate Republicans” who would have to go on record voting “no” for a dangerous bluff from McConnell.

Because the 2015 bill’s revival would once again be subject to the rules of the budget reconciliation process in the Senate, it wouldn’t necessarily repeal all of Obamacare. Instead it would:

  • eliminate the exchanges,
  • phase out subsidies,
  • phase out Medicaid expansion
  • eliminate taxes that funded Obamacare
  • defund Planned Parenthood immediately

What wouldn’t be included are all of the regulations on health insurers that are part of Obamacare. They would stay in place. That includes things like the protections for people with pre-existing conditions, coverage for the list of essential benefits and what is known as “community rating,” which prevents health insurers from varying premiums within a geographic area based on age, gender, health status or other factors.

Kevin Drum points out that eliminating the funding mechanism while keeping the regulations in place would destroy not just Obamacare, but the entire individual insurance market. I suspect it would even go beyond that. The regulations that would stay in place affect all health insurance—even what is provided by employers. So the damage could extend beyond the individual market.

The brutality and cynicism of this play by McConnell is two-fold: (1) he’s counting on the probability that this repeal and delay bill won’t pass, and (2) even if it does, the prospect of this kind of havoc in health care would force Democrats to concede.

To recap, here are the steps McConnell has taken in this effort to repeal Obamacare:

  1. Set up the process via reconciliation so that it would only need 51 votes,
  2. Crafted the bill behind closed doors,
  3. Refused to allow committee hearings or public debate,
  4. Refused any input from Democrats,
  5. When that failed to secure 51 votes, switched to repeal and delay, in an attempt to hold health care hostage and blame Democrats for their failure to concede.

This is exactly the kind of power play we’ve seen from McConnell over and over since he became the Republican leader in the Senate. His aim has never been to govern for the benefit of the people, but to defeat Democrats and maintain power. That is precisely why Democrats should do to him what Republicans have consistently done to Nancy Pelosi…make Republicans running for the Senate a referendum of this kind of leadership (or lack thereof).

Nancy LeTourneau

Follow Nancy on Twitter @Smartypants60.