Senate Majority Leader Mitch McConnel (R-Ky.) announced the passage of the vote to proceed to debate on the GOP's health-care bill on July 25 as "the first step" toward repealing Obamacare. (The Washington Post)

Republicans’ desperation to pass something, anything, that they can call “Obamacare repeal” and their total lack of concern for the health-care insurance that millions of Americans depend upon have never been more vivid. All Republicans but Sens. Lisa Murkowski (Alaska) and Susan Collins (Maine) voted to advance a bill — some kind of bill — that, from what we have seen, would dump millions off the Medicaid rolls, raise insurance premiums and out-of-pocket costs for many of President Trump’s voters and return millions in tax cuts to the rich. But we don’t know, and neither does any senator know, where this is going or what consequences might flow. The greatest deliberative body now looks like a bunch of teenagers out for a joy ride. (The reason? They said they’d wreck the family car and they’ll look foolish if they renege.)

The vote delayed the huge embarrassment that will await them when the Senate in all likelihood will fail to repeal and replace Obamacare. The excuse that senators were just voting to begin debate didn’t fit well with the promise made by Sen. Shelley Moore Capito (R-W.Va.). She had said she “did not come to Washington to hurt people” and would only vote to advance a bill that would help her constituents. She wound up voting for something that may very well result in huge pain and suffering for the thousands of her constituents who are on Medicaid and/or need opioid addiction treatment. She either lied or changed her mind.

Republicans’ defense that this was just a vote to begin debate will do Sens. Dean Heller (R-Nev.), Jeff Flake (R-Ariz.) and others up for reelection in 2018 little good when the ads start flying. They voted for uncertainty and confusion, to endanger health care of the most vulnerable with no clue how they would replace it. They cannot escape blame for whatever happens.

In the first major vote after the motion to proceed, the Senate emphatically rejected (43-57) a measure that would have combined the Senate Better Care Reconciliation Act with an amendment from Sen. Ted Cruz (R-Tex.) to allow insurers to offer an unregulated plan along with Obamacare-compliant plans and a separate amendment from Sen. Rob Portman (R-Ohio) to add funds back to help those the GOP bill threw off Medicaid. There will be more votes on more versions of Trumpcare in the next day or so.

Rather than repeal and replace Obamacare, Senate Republicans at some point may vote to disable Obamacare and do nothing about the consequences. That, in a nutshell, is what the so-called skinny repeal bill is all about.

It’s not a repeal bill at all. The Post reports: “The ‘skinny repeal’ option would repeal the ACA’s mandates that both individuals buy plans and that employers with 50 or more employees provide coverage, according to lobbyists and Senate aides, as well as eliminate the law’s tax on medical device manufacturers.” That, of course, would further destabilize the exchanges, accelerating the death spiral, and would put at risk millions covered by employer insurance. It does nothing about any problem that Republicans have identified (e.g. premiums too high, deductibles too high, insurers abandoning the exchanges). When the Congressional Budget Office previously scored repeal of the individual mandate, it found: “About 2 million fewer people would have employment-based coverage, about 6 million fewer people would obtain nongroup policies (insurance people can purchase directly either in the marketplaces or from insurers outside the marketplaces), and about 7 million fewer people would have coverage under Medicaid. All together, the agencies estimate, 43 million people would be uninsured in 2026.” In addition, the left-leaning think tank Center for American Progress found that if the individual mandate were repealed, a “20 percent increase in individual market premiums next year [would occur and] would mean that the average premium in insurance marketplace would be about $1,238 higher than it would otherwise be under current law.”

No wonder the GOP is not predicting that this will pass. Perhaps it should provide a score, a hearing or two and a rationalization for this latest gambit. (It would be fun, however, to watch GOP hard-liners vote to keep the vast majority of Obamacare provisions, including Medicaid expansion, on the books.)

Never have we seen such a chaotic, rash legislative process on such a serious matter. Republicans throw around one idea after another with no systematic analysis or input from doctors, insurers, governors, etc. But look on the bright side:

  • Libertarian and right-wing Republican senators such as Rand Paul of Kentucky, Mike Lee of Utah and Ron Johnson of Wisconsin who fancy themselves as defenders of constitutional process and “principle,” who decry Democrats for lack of transparency, have been revealed as hypocrites.
  • Together with his decision to toss the filibuster for Supreme Court nominees, this destruction of Senate process and responsible legislation makes very clear that Senate Majority Leader Mitch McConnell (R-Ky.), far from being a Senate traditionalist, is a legislative nihilist. He has done more to undermine the deliberative process of the Senate than any other living senator.
  • Every Republican, save the two “no” votes, is the 50th vote to move along Trumpcare, just as every Democrat was the 60th vote to pass Obamacare. That means each and every Republican can be tagged for whatever ills result from a bill that passes. They could have stopped it.
  • Sen. John McCain (R-Ariz.) made rather clear he’ll be a “no” vote on the merits on something akin to this bill. With McCain, Collins and Murkowski (and others who will get cold feet) holding out, passage of anything that looks like Obamacare repeal remains unlikely. That reminds us of all the House Republicans who took a miserable vote — for nothing, if Obamacare repeal ultimately fails. That makes them easy targets in 2018.

In sum, the consolation for a meltdown in legislative order, rationality and responsible government is that we now know just how incapable the GOP is of governing. Years of antagonism toward government have made them cavalier about the harm they can do to ordinary citizens in their quest to avoid blame. What a shabby group they are. Let’s hope they don’t do real damage before they lose their majority.