For Republicans, Obamacare was always the great unifier. In a fractious party, everyone agreed that the Affordable Care Act was the wrong solution to what ailed the nation’s health-care system, with too much government and too little freedom for consumers.
Replacing Obamacare has become the party’s albatross, a sprawling objective still in search of a solution. The effort to make good on a seven-year promise has cost the Trump administration precious months of its first year in office, with tax restructuring backed up somewhere in the legislative pipeline, infrastructure idling somewhere no one can see it and budget deadlines looming.
Republicans have been here before on health care, on the brink and scratching for votes. The House eventually found a way through this political and substantive maze. Now it’s left to Senate Majority Leader Mitch McConnell (R-Ky.) to find the puzzle pieces and President Trump, perhaps, to supply some muscle, lest the GOP be forced to admit failure on the party’s top legislative priority.
Was it only Monday that Majority Whip John Cornyn (R-Tex.) boldly declared there would be no turning back this week, that the Senate health-care bill would be put to a vote before lawmakers leave for the July 4 recess? “I am closing the door,” he tweeted. “We need to do it this week.” So much for that.
If it was a bluff by the leaders, other Republican senators called it. McConnell, a shrewd legislative poker player, quickly folded Tuesday. Instead of moving forward, the bill is now on ice. The original Senate leadership plan called for negotiations in secret by a small group, springing the results on the other members and forcing a quick vote before outside opponents could mobilize. Instead, the calculation that time was of the essence crashed into the reality of vote counting. The new calculus is that delay is better than defeat.
But will more time help to melt away the opposition? It did in the House, after the sudden and spectacular collapse of the leadership’s bill hours before a scheduled vote in late March. By early May, after weeks of negotiations between Freedom Caucus conservatives and members of the less-conservative Tuesday Group, the House approved a bill. The president was so hungry for even a partial victory that he held a ceremony of celebration with House members in the Rose Garden. Later, he privately and then publicly called that House bill “mean,” and it was left to the Senate to make amends.
In a worst-of-all-worlds environment, Republicans continue to struggle with what they’re selling, beyond the stated goal of repealing or revising the Affordable Care Act. Whatever overarching arguments they hope to make on behalf of their legislation have been lost in a welter of competing claims and demands among senators with different priorities and dissimilar ideological viewpoints.
The Republicans’ major selling point is that Obamacare is collapsing. Even Democrats acknowledge weaknesses with the current law, though some Democrats have accused Trump and Republicans of deliberately trying to make those problems worse. McConnell said Tuesday that a Republican solution will be superior to the status quo. Exactly how, Senate Republicans haven’t been able to say. But in terms of corralling the votes, McConnell should not be underestimated.
On Monday, the Congressional Budget Office (CBO) put a dagger in the Senate GOP’s efforts. The CBO analysis said the Senate bill would result in 22 million more Americans without health care than under current law, just 1 million fewer than the House bill. Reductions in Medicaid spending pose another obstacle, particularly to GOP senators from states that expanded Medicaid under Obamacare.
The CBO report wasn’t all bad news for the senators. The Senate bill would save significantly more money than the House bill, giving McConnell and company funds to use to ease the opposition of some senators. But money alone won’t resolve all the differences, particularly among those who want to see the Affordable Care Act largely dismantled. It will be a tedious, though not impossible, process to find the votes.
McConnell was always prepared to tweak the first product that emerged from weeks of closed-door discussions. He was willing to make immediate adjustments to woo and win over the holdouts. He was prepared to do that before the bill hit the floor this week. He was ready to see it changed further through amendments on the floor.
But the timetable proved to be too ambitious, perhaps too highhanded. The resisters wanted changes — and several demanded more time. That was a toxic combination that McConnell could not overcome. Echoing Trump, McConnell acknowledged the complexity of the task. “It’s a very complicated subject,” he told reporters at the Capitol. Such legislation often takes longer to put together than people think, he added. That was a game way of saying he’s on to Plan B, with no guarantees of success.
Health care has highlighted the divisions within the party. After the House vote, Rep. Tom MacArthur (R-N.J.) resigned as co-chair of the Tuesday Group due to unhappiness with the deal he made with conservatives. On Friday, Sen. Dean Heller (R-Nev.), a vulnerable incumbent facing reelection next year, announced that he could not vote for the Senate bill in its current form. Trump’s political action committee announced that it would mount an advertising assault on him, which began Tuesday. That kind of intraparty hardball could only make Heller weaker.
The health-care fight has left the president frustrated and at times looking helpless. He is torn between his desire for the ultimate victory and the many things he said about the subject during his campaign and even since, such as that he wants coverage for everyone. He has reduced all that to saying he wants something with heart. Does a bill that reduces coverage as significantly as the CBO says the GOP bills would do meet that definition?
The Republican Party’s health-care objectives haven’t changed, nor have the principles upon which Republicans want to create the new health-care system. It’s the details that they haven’t mastered. House leaders had one advantage over McConnell and the Senate: a larger margin for error. McConnell can’t afford to lose more than two Republicans. The road ahead will test him as perhaps never before.
If successful, Republican lawmakers will have a second test, which will be to sell their alternative to the public. The Affordable Care Act split the country, with supporters and opponents in hardened camps through most of the Obama administration. Today, Obamacare has become more popular, according to recent polls. In contrast, early measures of the Republicans’ plans show minimal support and sizable opposition.
What are the party’s options? Fail and be held accountable by a conservative base that for years has been promised that Obamacare would be gone once the GOP held power. Pass something that looks like either the House or Senate bills and be left with the potential political consequences of being accused of eliminating coverage for 20 million more Americans.