Two No Votes On Obamacare Repeal That Were Months In The Making

Sen. John McCain’s  (R-AZ) surprise, dramatic no vote that officially sunk the long-struggling Senate effort to dismantle the Affordable Care Act was a fitting finale to a tumultuous and unpredictable legislative push. But the continued resistance of Sens. Susan Collins (R-ME) and Lisa Murkowski (R-AK) illuminated the deep distrust that accrued over the Senate leadership’s secretive process, as well as the major substantive issues in the Republican health care bill that GOP never was fully ready to engage on.

From Day 1 the two veteran senators made clear what their top concerns were. They were shut out from a private group said to be working on a closed-door health care deal that was only the start of multiple norms busted and a unprecedented lack of transparency. And rather than meet their demands on the substance, Republicans attempted to cut side deals or even bully them, until they were just written off completely.

While McCain’s vote had up until the very last second felt up in the air, Murkowski’s and Collin’s opposition was months in the making.

Though they are often aligned in votes, and they sit next to each other in the chamber, Murkowski and Collins have different styles and occupy distinct roles in the Capitol Hill ecosystem.

Collins has for a long time reveled in her position as a perpetual thorn in leadership’s side. She’s a regular on the Sunday shows, and is friendly with the congressional press stalking the Capitol, who in the last few months followed her in hordes.

She speaks carefully and often dives into technical details when discussing her positions, but also knows how to throw a good quip. After a hot mic caught her calling a male House member — who more-or-less challenged her to a duel over here Obamacare repeal opposition — “so unattractive, it’s unbelievable,” Collins offered a mea culpa that said “Neither weapons nor inappropriate words are the right way to resolve legislative disputes.”

Murkowski, for the most part, tends to operate more under-the-radar. While she and Collins were both uncomfortable with a 2015 bill to repeal Obamacare due to its defunding of Planned Parenthood, she ultimately voted for it, leaving Collins as the lone GOP defector still in the Senate today.

That’s not to say Murkowski, who won a write-in campaign in 2010 after being defeated in the GOP primary, doesn’t have an independent streak of her own, as she’s taken other votes this year in opposition to the Trump administration.

But as the weeks of health care negotiations went on, Murkowski always appeared less comfortable in her role as a potential opponent of the effort. Her tactics to dodge reporters in the Senate basement were the stuff of legend.

One time, she avoided a reporter’s question by pulling up photos on her phone of what she called a “grow tower” – stacks of Home Depot buckets from which lettuce and herbs grew.

“We’re going to change health care with healthy eating,” she said, instead of discussing the Medicaid expansion phaseout about which she’d been asked.

On another occasion, she responded to a TPM question by signaling she was talking to someone else, even though the other senator had moved along in the hallway. When TPM tried again, Murkowski raised her finger in front of her face and scolded, “Hang on, PLEASE,” even though she was no longer talking to anyone else.

Her favorite technique, when asked about the Senate’s health bill, was to shoot back “What bill?” with enough freshness in her voice to tell you she wasn’t happy with the opaque process.

Collins, meanwhile, never hid her concerns, even though — with discipline — she withheld her official opposition until the Congressional Budget Office score of the first version of the legislation.

Both lawmakers were left out of Senate leadership’s initial health care working group. Collins’ absence could be explained if you thought of her as a vote the GOP was never going to  get. But the snub to Murkowski — along with Sen. Shelley Moore Capito (R-WV)   — was more notable, not just for the bad optics of an all-male group, but that two key moderate voices whose votes the GOP would very likely need were being sidelined from the process.

The GOP’s challenges with those two lawmakers went far beyond the process. Collins balked at using Obamacare repeal to do a massive Medicaid overhaul, and in general, opposed any measure that would result in tens of millions losing coverage. Murkowski’s qualms were more state-specific, though rooted in similar underlying issues.

Alaska was hit on multiple angles by the overarching GOP plan: The state’s Medicaid expansion was on the chopping block, the large Medicaid cuts threatened the rural hospitals on which Alaska depends, and the way the tax credits were reworked put a disproportionate burden on Alaskans, who pay the highest insurance premiums in the nation.

Despite both senators’ consistent concerns about the Medicaid cuts, Senate Republicans never backed down from their plan to use Obamacare repeal as a vehicle to gut the program — and to impose more draconian cuts than the House legislation.

Collins reveled in being the Senate GOP health care agitator — making herself a regular on cable news and joining far-right Republican Sen. Rand Paul (R-KY) in continually torching the GOP approach.

Murkowski held her cards closer to the chest, as there were signs Republican leaders and the Trump administration were trying to win over. She was a regular presence at Senate huddles with top HHS officials, who tried to sell a questionable argument that they could mitigate the Medicaid cuts. President Trump’s Interior Secretary Ryan Zinke called her to threaten administration partnership with Alaska on energy policies, a Murkowski pet issue, over her opposition to the Obamacare repeal vote, a threat that by all appearances has backfired.

A carve-out aimed specifically at Alaska appeared in a revised version of the bill, but Murkowski — in a huddle two weeks ago that marked a turning point in her willingness to publicly criticize the repeal effort— argued that it was just a band-aid on the bill’s deeper problems.

“Look at what the impact, the cost impact to Alaska would have been under this proposal, as it impacted Medicaid. This is something, you can’t look at one little piece of it and say, ‘a ha,'” she said.

After weeks of keeping her answers terse, Murkowski held court for nearly 10 minutes criticizing the state of Republican affairs on health care (though only after subjecting the dozens of health care journalists gathered around her to an extended back-and-forth with an energy reporter about “critical minerals.”)

From then on, she seemed more comfortable in her firmly “no” position, even if she wasn’t always so loquacious.

If there was any doubt, it was cleared up in Tuesday’s vote that let Republicans keep going on their repeal gambit. Murkowski and Collins both cast no votes, signs they would also be no’s at the end of the line. Trump tried one more time to put the pressure on Murkowski with a tweet earlier this week.