Senate Republicans’ successful vote Tuesday to move forward with a yet-to-be determined Obamacare repeal effort may have kept the GOP’s long-held dream of dismantling the Affordable Care Act alive.
But their willingness to jump into a politically chaotic and tenuous abyss, where there is no guarantee of a final replacement bill or even a comprehensive repeal measure, reflects that they are still well short of delivering the consensus alternative they for seven years promised would come once a Republican was in the White House.
To get to this moment, Senate Republicans had to backtrack on promises — some years-old, some fairly recent— that they would not vote to repeal Obamacare without a replacement. They are several steps into this legislative process, and there is no “terrific”replacement that will provide “insurance for everybody,” as President Trump had previously promised.
Even their goal of reducing premiums, which has been the GOP lodestar as Obamacare replacement negotiations faltered, will be unfulfilled, if a narrow “repeal only” measure ends up being the final bill the Senate votes on, the end-game currently being floated.
In the seven years of promising to repeal Obamacare, Republicans failed to offer a consensus replacement plan. In the nine months of negotiations around repeal since Trump won the election, Republicans failed to deliver a replacement that could win 50 votes in the Senate. And now they argue that a late-night, high-stakes amendment process — where lawmakers will consider proposals that have been barely vetted and McConnell will get ultimate say on what the final bill looks like — will somehow solve the deep disagreements dividing the conference’s vision for health care reform.
“We don’t really know what the end game, at least between now and whenever this wraps up Friday morning at some point, at the end of the vote-a-rama,” Sen. John Thune told reporters. “There will be discussions that occur prior to that, I’m sure with our members to determine what are things that pull all 50 — or at least all 50 Republicans together.”
While many Senate Republicans are hoping they can still revive their replacement bill, there’s an acknowledgement that they’re willing to pass whatever it takes to get the issue out of the upper chamber, where it will have to be conferenced with the House-passed legislation.
“It’s a way to get into conference and maybe have a more extended conversation,” Sen. Bob Corker (R-TN) told reporters after Tuesday’s vote.
In the House’s defense, Republicans there did manage to narrowly pass a replacement bill there. But more than a few moderate House Republicans voted for it believing that the Senate would make it better.
Senate Republicans meanwhile pooh–poohed the House legislation, which the Congressional Budget Office said would result in 23 million fewer people with coverage by the end of the next decade. The best they could do was a replacement, the Better Care Reconciliation Act, that would result in 22 million fewer people with coverage, and as of last week they did not have the votes for that bill to pass.
On Tuesday, Senate Republicans who voted to advance a bill that will remain a mystery until they’ve made it through the full amendments process were still posturing about what they would like to see in the final legislation.
But already, there are signs that previous no votes aren’t about to get what they’ve be wanting. Sen. Rob Portman (R-OH), who led Republicans hesitant about the replacement’s cuts to Medicaid, and Sen. Ted Cruz (R-TX), who offered a controversial proposal to win over conservatives, will get votes on their amendments.
But those proposals will need 60 votes to pass, due to the rules constricting the process Republicans are using to push repeal, so it is likely they will ultimately fail and bring down with them the entire Senate replacement plan, which has other provisions found to be afoul of Senate rules.
Senate Republicans will at some point also have to vote on a delayed-repeal bill modeled on 2015 legislation that then-President Obama vetoed. Ironically, if the legislation became law, premiums would skyrocket, insurers would leave the exchanges and 32 million fewer people will have coverage by the end of the decade.
Just a week ago, crucial Republican holdouts said this bill was unacceptable to proceed on.
MORE: I will only vote to proceed to repeal legislation if I am confident there is a replacement plan that addresses my concerns.
— Shelley Moore Capito (@SenCapito) July 18, 2017
Republicans also had the chance to vote on this legislation, when it was McConnell’s initial plan back in January—but many rejected it then as well.
There’s plenty of rhetoric now coming from Republicans with hopes that a magical replacement is still out there for them to uncover. The amendment process they’ll be going through over the next two days will be a series of political show votes, some offered by Democrats to embarrass Republicans. Many of the amendments offered by Republicans will be of substance, but because they’re unscored by the CBO, won’t pass without 60 votes.
At the end of it all, McConnell is expected to put forward a repeal bill even narrower than the 2015 legislation, perhaps one that repeals only Obamacare’s mandates and some of its taxes.
“At the end, you end up with a situation you vote on the lowest common dominator for passage,” Corker said.
Republicans did not campaign on repeal-and-replace with the lowest common denominator. Yet that’s the best the Senate may be able to do, before turning it back over to the House.