Republicans in the Senate are wavering, swaying, teetering, threatening to send the GOP health-care bill to its doom. Or are they?
There’s no doubt that the fate of this bill is uncertain, and there are votes that could still go either way. But if you want to understand how things might go, you have to sort through a whole lot of posturing to figure out where senators actually stand and what they might do. To that end, here are some things to keep in mind as we hurtle toward an expected vote this Thursday on a bill to remake the entire American health-care system:
1. Don’t believe hard-line conservatives who say they might vote no. There is a group of senators who have expressed doubts about the current version of the Senate’s bill on the grounds that it isn’t conservative enough. Last week, Rand Paul, Ron Johnson, Ted Cruz and Mike Lee said that they couldn’t support the bill as it is currently written. Today, Johnson even has an op-ed in the New York Times decrying the fact that the Senate bill is insufficiently expressive of free-market principles — why, it even claims to protect people with preexisting conditions, which Johnson opposes. He has also complained about the short time senators will have to consider the bill.
This is all a pose. If you think that Ron Johnson — who once called the Affordable Care Act the “greatest assault on freedom in our lifetime” in an interview with an organization devoted to spreading the philosophy of Ayn Rand — is going to pass up an opportunity to stick a knife in the ACA, you’re dreaming. The same is true of the other conservatives. They’ll hold out for some changes to make the bill even crueler than it is now, and then once they get something they can point to in order to argue that they made the bill better, they’ll vote for it. If they’re asked about their prior complaints about the secrecy and speed of the process, they’ll say, “It wasn’t how I would have designed it, but in the end it was the best chance we had to kill Obamacare.”
2. Don’t count on “moderates” to do the right thing. Ask yourself this: Can you recall a significant piece of legislation on which Republican moderates in the Senate, concerned that their GOP colleagues were taking an extreme position, joined with Democrats to swing the vote? It doesn’t happen. If they break with their party, it’s only when their votes aren’t decisive. When it really matters, the alleged moderates always line up with the GOP. So if you’re thinking that Susan Collins is going to make a noble, courageous stand to save millions of Americans’ health care, you’re going to be disappointed.
That doesn’t mean the vote is guaranteed, however; it just means that the moderates will break with the party only if they have plenty of cover, and not because of principle. For instance, right now Dean Heller of Nevada is probably the closest thing we have to a hard “no” vote — and that’s because he’s the most vulnerable Republican senator up for reelection next year.
3. Republican senators’ fear is the only thing that will defeat this bill — and their fear is dependent on the volume and intensity of opposition. The whole point of Senate Majority Leader Mitch McConnell’s strategy of writing the bill in secret and then quickly pushing it through is to minimize public attention and opposition. There are senators who right now are what we might consider “worried maybe” votes — they’ll vote yes if the risks don’t seem too great, but they could bail out if they can be made to fear a public backlash. Senators like Bill Cassidy of Louisiana and Shelley Moore Capito of West Virginia know that their states will be absolutely brutalized by this bill, but as of yet they haven’t been convinced that their constituents know that.
There are now 10 Republican senators who have either said they oppose the bill “in this form” — which means they could switch to support once some changes are made — or have publicly expressed their doubts about the bill without saying they oppose it. Today, Republicans released a revised bill addressing some of their concerns; it includes a provision locking people out of coverage for six months if they go without insurance temporarily, which is supposed to accomplish the same goal as the individual mandate. But the bill’s essence remains the same. Only if media attention to the bill’s horrors increases, and if the calls pour in to their offices, will they decide that the risks to themselves are too great.
4. There could be a tipping point at which Republicans start abandoning the bill en masse — but we aren’t nearly there. With a 52-48 majority, McConnell can lose only two votes on this bill, and he has probably already granted one to Heller, giving him permission to vote “no” in order to save his own skin. But if pressure increases and two more senators look like hard “no” votes, then you’ll probably see lots of senators abandon it, not wanting to be associated with something that not only was so substantively awful but also carries the stench of defeat. That will only happen, though, if they’re sure that the bill is headed for defeat. And that, in turn, depends on activists and constituents raising the stakes high enough to make supporting the bill seem incredibly dangerous.
It’s possible that the release of the Congressional Budget Office score of the bill — which could come as early as this afternoon — will be the event that focuses everyone’s attention on the bill’s consequences and elevates the volume of the debate to the point where senators can’t avoid the consequences of their decision. But that will only happen if those consequences are made undeniably clear to them.
5. This right here — the next three days — is the endgame. For a time, it was assumed that even if the Senate passed a bill, it would be less harsh than the House’s bill, and then there would be a dilemma for the conference committee charged with reconciling the two versions: Write a compromise bill that was too vicious and it might not hold Senate moderates, but write a bill that wasn’t vicious enough and House conservatives would vote no.
As of now, though, there’s little chance that there will actually be a conference committee, because that just allows more time for the public to understand what they’re doing and risks more members of Congress fleeing. So if it passes, Paul Ryan will probably just take the Senate’s bill and put it up for a vote in the House. Members of the Freedom Caucus will decide that while they’d prefer if it would throw even more people off their coverage and make life even more miserable for the poor and the sick, they’ll take what they can get, because this is their only chance. It will pass, President Trump will sign it, and the results for Americans’ health care and economic security will be catastrophic.
What that means is that everything depends on this week. Republicans don’t want to defend their bill publicly, they’re lying about it desperately and they’re hoping they can wrap up the whole thing before the public realizes what’s happening. They can be stopped — but only if they’re feeling heat from the public.