The fate of the American health care system is going to be decided in the next two weeks. Whether tens of millions of people lose their coverage, whether we transform Medicaid (which now serves 70 million Americans) into something smaller and stingier, whether we all lose the measure of security we just got a few years ago, it’s all on the line.
Today, Democrats in Congress say they are prepared to try new tactics in order to stop the bill that Mitch McConnell and the Republicans are determined to pass through the Senate. According to a senior Democratic aide, they’ll be doing the following:
- Slow all action on the Senate floor to a crawl by objecting to “unanimous consent” requests (which are required to move anything forward), with the possible exception of some honorary resolutions.
- Make multiple requests to move the health care bill that passed the House into the Senate committee process, as a way of highlighting the secrecy with which the Senate version is being crafted.
- Make parliamentary inquiries (which can further slow things down) on the secrecy of the GOP bill.
- Hold a talkathon starting today and stretching until at least midnight tonight, wherein Democratic senators will rail against the bill on the Senate floor.
“These are merely the first steps we’re prepared to take in order to shine a light on this shameful Trumpcare bill and reveal to the public the GOP’s true intentions: to give the uber-wealthy a tax break while making middle class Americans pay more for less health care coverage,” Senate Minority Leader Chuck Schumer said in a statement. “If Republicans won’t relent and debate their health care bill in the open for the American people to see, then they shouldn’t expect business as usual in the Senate.”
Will it work? They might succeed, but it won’t be easy — and it will depend on everyone involved understanding that there’s only one real path to victory.
Something extraordinary and unprecedented is happening right now. A group of 13 Republican senators is writing a bill in secret that will remake the entire health care system. There will be no hearings and no expert testimony. No committee will consider the bill. Even Republican senators outside that small group don’t know exactly what’s in it. And they want to pass it in the next two weeks, in the obvious hope that it will all be done before the public even notices let alone understands how much the bill would hurt them. And even though the details are still opaque, we already know that the bill will be impossibly cruel; today we learned that the Senate may be making even deeper cuts to Medicaid than the odious House bill.
So how do Democrats stop it? As I’ve been arguing, whether it looks like the Democrats are “fighting” is less important than whether their specific tactics are likely to achieve their goal. Today, we found out what those tactics in the Senate are going to be.
Now, none of these actions will actually stop the Senate bill — at least not yet — in part because as of now there is no bill. At times like this one can fall into the trap of confusing means and ends, seeing a tactic that gets a lot of media coverage as a successful achievement of the goal. Media coverage is critical, but it’s important to keep in mind that there is one — and only one — mechanism by which this bill can be defeated. For every parliamentary maneuver Democrats employ to slow things down, there’s another maneuver McConnell can come up with to move the bill forward. Eventually, there will be a vote if McConnell wants one.
The only way Democrats win in the end is if three or more Republican senators decide to vote No. Any strategy has to work backward from that outcome.
Republicans have a 52-48 majority in the Senate. If three of them object, the bill is dead. There are only about a half-dozen senators who might pull their support — a couple of moderates like Susan Collins of Maine and Lisa Murkowski of Alaska, and a few senators from states where the citizenry has benefited hugely from the ACA, particularly its expansion of Medicaid. Those include Shelley Moore Capito of West Virginia, Jeff Flake of Arizona, and a couple others. Democratic groups are already running TV ads targeted at those senators.
But there is a very specific series of events that would have to occur for the Senate Democrats’ strategy to be successful. Here’s how it has to work:
- Democrats shut down all or part of Senate business in protest of the secrecy and speed with which the GOP bill is moving through.
- The shutdown generates lots of media coverage.
- That coverage is seen by the folks back home.
- With the bill becoming more controversial, the CBO releases a brutal score of the bill, which gets yet more press coverage.
- Just as it did with the House bill, the attention increases opposition to the bill.
- Citizens in the home states of the persuadable senators take action — holding protests, calling the senators’ offices — in significantly larger numbers than they are right now.
- The senators decide that the bill is too toxic to support and back away from it.
We have to be clear that like most incumbent politicians, Senate Republicans truly fear only one thing: the displeasure of their constituents. That’s why numbers 5 and 6 are the most critical links in this chain. If the senators aren’t feeling pressure from their constituents, they’ll think they can get away with passing this bill and they won’t be punished for it. So the delaying tactics Democrats employ are useful only insofar as they generate attention and opposition among the public.
The good news for Democrats is that like the House bill, the Senate bill will be an abomination. That’s why Republicans are working so hard to keep it secret and vote on it as fast as possible: they know that if the public gets a good look at it, they’ll be horrified. If Democrats can force it into the light, they have a chance to defeat it. But it will all come down to the question of how threatened a few Republican senators feel.