As the Senate GOP efforts to repeal the Affordable Care Act reaches its supposed apex this week, a remarkable amount remains unknown – even to Republican senators. But what is close to a given is that whatever happens, the effort will likely fail.
Majority Leader Mitch McConnell (R-KY) last week indicated that he was sticking to his plans to hold a vote Tuesday to open the debate on a health care bill. But neither of the two repeal proposals he has floated — a repeal-and-delay bill and the Obamacare replacement legislation the GOP has been negotiating — has enough support to pass.
Senate Republicans left town Thursday unclear which of the proposals would serve as the base for the final vote, which would likely come a couple of days after Tuesday’s initial procedural vote.
“I don’t think that’s a good approach to facing legislation that affects millions of people and one sixth of our economy,” Sen. Susan Collins (R-ME), an opponent of both delayed repeal and the current Obamacare replacement, said Sunday on CBS’ Face The Nation.
Sen. John Thune (R-SD), the No 3. in Senate GOP leadership, said on Fox News Sunday that which bill they go forward with is a decision that “Senator McConnell will make at some point this week before the vote, depending on how these discussions go.”
Republicans’ path to passage is complicated by Sen. John McCain’s (R-AZ) recent brain cancer diagnosis, which is keeping him in Arizona for treatment for an unknown amount of time. If Collins is joined by a second GOP senator in opposing the procedural vote Tuesday, repeal would be dead in its tracks due to McCain’s absence.
Those on the right skeptical of the repeal efforts have signaled they would vote to open the debate Tuesday if they were later allowed to vote on the repeal-and-delay bill.
“I have told them I will vote for a motion to proceed if we’re proceeding to the clean repeal vote,” Sen. Rand Paul (R-KY) said on CNN Sunday.
The problem for leaders with that plan is that just as many Republicans oppose repeal-and-delay. When McConnell first announced last week the prospect of voting on that bill instead of the replacement legislation, three senators — Collins, and Sens. Lisa Murkowksi (R-AK) and Shelley Moore Capito (R-WV) — quickly came out in opposition to that plan, making it also dead on arrival.
“I don’t think that it’s a responsible way to repeal something, have everything fall off a cliff … and have no plan in front of us,” Capito said on a local radio show last week. “I don’t think the U.S. Congress does too well with deadlines. I don’t think that’s when good policy comes forward.”
Another wrench was thrown in the Republicans’ effort last week with the “guidance” the Senate parliamentarian handed down Friday suggesting that key pieces of the legislation would need Democratic votes to pass. From a policy level, the biggest setback was her singling out of the continuous coverage requirement Republicans have in their replacement bill; if Republicans can’t rework it to comply with Senate rules, the individual market would not function under their replacement plan. Politically, her rulings against anti-abortion provisions put conservative support in jeopardy, while her ruling against a New York-specific measure spells trouble for GOP leaders trying to win over hesitant senators with state-specific carveouts in their bill.
The only real shot GOP leaders have for winning final passage is complicated. First, they must win Tuesday’s procedural vote. Then that could buy them the opportunity to shore up support for the replacement legislation, the Better Care Reconciliation Act, either through amendments or more assurances to skittish senators.
McConnell, in remarks after Senate GOP lunch with President Trump last week, stressed his desire for Republicans at least to get through this initial vote.
President Trump’s top officials at the Health and Human Services Department — Secretary Tom Price and Centers for Medicare and Medicaid Administrator Seema Verma — have hosted extensive meetings with a number of Republicans to convince them the bill’s steep Medicaid cuts could be mitigated through administrative action.
Regardless, if McConnell can run the table on the wavering moderates — besides Collins, who did not even attend a high profile meeting with Price and Verma last week — he would still need the votes of Paul and Sen. Mike Lee (R-UT) to pass the replacement bill, assuming McCain is not back from his treatment to vote.
Lee told Politico last week he was willing to be the decisive vote to tank the replacement bill for not going far enough to repeal Obamacare. A Lee spokesman told TPM Monday that he had not received any indication from Senate leaders that the change to the bill Lee requested has been made.
Paul, on Sunday, called the replacement bill a “monstrosity.”
Notably, top Senate Republicans have already begun to spin a potential major loss on health care by swearing that a defeat this week won’t end their repeal efforts.
“We’ll go back to the drawing board and we’ll get a bill up. We are going to vote to repeal and replace Obamacare,” Thune said Sunday. “The question is not — it’s not a question of if, it’s a question of when.”
Just as notably, however, other key Republicans have begun preparations for a more narrow, short-term Obamacare fix if this week’s votes fall short.
“However the votes come out on the health care bill, the Senate health committee has a responsibility during the next few weeks to hold hearings to continue exploring how to stabilize the individual market,” Senate Health, Education, Labor and Pensions Committee Chair Lamar Alexander (R-TN) said in a statement last week. “I will consult with Senate leadership and then I will set those hearings after the Senate votes on the health care bill.”