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| Saul Loeb/AFP/Getty Images |
Repealing Obamacare, which unified Republicans for six years, has now become the party’s albatross.
- Senate Majority Leader Mitch McConnell is having a rough week. Late yesterday, he announced the procedural vote on the Senate health care bill would be pushed back to an undetermined time after Congress’s Fourth of July recess as it failed to garner enough support among members of his own party. [NPR / Arnie Seipel]
The Senate majority leader believed that the blowback for keeping his health-care bill secret would be less than the blowback for negotiating it in public....But the Kentuckian misread the degree to which members of his own conference wanted a seat at the table. With little margin for error, he also had too much confidence in his ability to hammer out a compromise that could win over both hardliners who want full repeal and moderates who want to protect Medicaid expansion.
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- However, the bill isn’t completely doomed yet, because the draft legislation contains $200 billion that McConnell could theoretically add to appease moderates. He could also potentially get rid of more of Obamacare mandates that conservatives are looking for. [Vox / Dylan Scott]
- But striking that balance between moderate and far-right Republicans is going to be tricky, and McConnell can only afford to lose two votes.
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Last week, [McConnell] flippantly dismissed complaints about bypassing the committee process. “No transparency would be added by having hearings in which Democrats offered endless single-payer system amendments,” the leader said at a press conference. “That is not what this Republican Senate was sent here to do.”
Many of his members felt otherwise. There was technically a working group of senators that came up with the bill, but McConnell was in the driver’s seat. Republican senators who were invited to closed-door “listening sessions” say they were sounded out about what they could and couldn’t support. But several grumbled that they couldn’t get any information out of leadership about what was and wasn’t on the table. Others said privately that the meetings felt less substantive and more like a box-checking exercise.
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| Senator Susan Collins, Republican of Maine, on Capitol Hill on Tuesday, was an early opponent of the Senate health care bill. Stephen Crowley/The New York Times |
- Throughout the process, McConnell made some tactical errors of his own, such as excluding Republican senators including Collins and Louisiana’s Bill Cassidy — both known for their health care knowledge — from the early working group that drafted the bill. [NYT / Jennifer Steinhauer]
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Another consequence of the secretive process is that almost no Republican senators have been out there trying to sell the bill – to the public or to each other. Dozens of GOP lawmakers who privately planned to vote for the motion to proceed today made a public show of saying that they were undecided and still studying the proposal. They avoided local reporters and put out opaque statements that gave themselves plenty of wiggle room, as they waited to see how things shook out.... That ensured one-sided coverage in the press, which in turn made it even harder for members to justify supporting the bill.
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Sarah Binder, a professor of political science at George Washington University and a senior fellow at the Brookings Institution: “First, most closed-door bargaining in the Senate is bipartisan. … Second, when leaders close the doors, it’s often because the legislative process has ground to a halt. … Third, McConnell’s tactics are particularly unusual because Republicans are trying to legislate on one of the nation’s most complicated policy issues. Health care affects one-sixth of the economy … Usually, issues that demand secret negotiations are must-pass measures about to hit a nonnegotiable deadline, such as failing to raise the debt ceiling or to fund the government on time.”
Don Ritchie, the historian emeritus of the Senate, said that the chamber has not taken such a partisan, closed-door approach to major legislation since in the years before World War I. A century ago, Senate Democrats, at the urging of President Woodrow Wilson, drew up major tariff reforms while shutting out Republicans. But when Democratic leaders tried that again when they had large majorities during the Great Depression, rank-and-file senators revolted. It hasn’t happened since, he told the Los Angeles Times.
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| Gov. John R. Kasich of Ohio, a Republican, at the White House in November. Kevin Lamarque/Reuters |
One majorly under-covered angle in the press coverage of why the Senate has punted is the widespread opposition of GOP governors. “More than half a dozen Republican governors, including several from states with Republican senators, expressed either grave reservations or outright opposition to the bill,” Alex Burns reports on A17 of the New York Times: Two examples:
- Nevada Gov. Brian Sandoval (R) rejected the Senate proposal so forcefully that he helped sway his state’s Republican senator, Dean Heller, to oppose the measure.
- Ohio Gov. John Kasich (R) had a press conference in D.C. yesterday to call the Senate bill “unacceptable,” saying it would victimize the poor and mentally ill, and redirect tax money “to people who are already very wealthy.”
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| President Trump spoke in the Cabinet Room of the White House before having lunch with Republican senators on Tuesday. Al Drago/The New York Times |
Trump’s inability to twist the arms of wavering Senate Republicans, despite his best efforts, makes him looks impotent. ...Even in private, Trump is unfamiliar with what the bill he has endorsed would actually do: The president convened Republican senators in the East Room yesterday afternoon so that members could air their grievances. “A senator who supports the bill left the meeting at the White House with a sense that the president did not have a grasp of some basic elements of the Senate plan — and seemed especially confused when a moderate Republican complained that opponents of the bill would cast it as a massive tax break for the wealthy,” Glenn Thrush and Jonathan Martin report in the Times. “Trump said he planned to tackle tax reform later, ignoring the repeal’s tax implications.”
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If Senate Republicans manage to pass a health-care bill, it's safe to say the legislation will have come back from the dead... A new Quinnipiac University poll shows just 18 percent of Republicans strongly approve of the bill. The all-important political bloc of independents really dislike it too: 72% disapprove.
The bill, as is, makes nobody happy. It cuts Medicaid deeply and scales back Obamacare’s financial aid for people who buy private coverage. It’s projected to reduce premiums in the long term, but only because people would see higher out-of-pocket costs. But then it also keeps some of the health care law’s major insurance regulations, a cardinal sin for conservatives.
On the other end of the ideological spectrum, more moderate senators have been saying for weeks that they want to soften the Medicaid cuts and want additional funding for the opioid crisis.
In its current form, the Senate bill gradually ends the general federal funding for Obamacare’s Medicaid expansion, which covered millions of poor Americans, in 2024. It also places a federal spending cap on the entire program for the first time. The result, according to the CBO, would be a $772 billion cut, versus current law, and 15 million fewer people enrolled in Medicaid a decade from now than under Obamacare.
The bottom line is that CBO estimates 22 million fewer Americans would have health insurance under the plan 10 years from now. “His problem is that the policy is just really bad,” a Republican health care lobbyist said.