After weeks of secretive talks, Senate Majority Leader Mitch McConnell finally unveiled his proposal to dramatically reshape the health-care industry knowing full well that — as currently written — it lacks the votes to win approval.
Republican senators now face a put-up-or-shut-up moment: For seven years, they have been promising that, if they controlled all the levers of power in Washington, they would repeal the law they have derisively labeled “Obamacare.” In early May, the House approved its own very unpopular version of the legislation. Since then, McConnell has been reworking the measure in backroom negotiations in the GOP leader’s office just off the Senate floor. Many GOP senators complained bitterly about the secretive process, while privately breathing a sigh of relief that they didn’t yet have to take a position on the emerging legislation.
On Thursday, McConnell laid his cards on the table. Now his conference faces a final choice.
“After seven or eight years, it just causes people to focus by saying, you’re going to have to vote on it, and people are going to have to make decisions,” McConnell’s top lieutenant, Majority Whip John Cornyn (R-Tex.), said Thursday, explaining why the draft was released.
Republicans now head into five or six days of intense negotiations aimed at getting 50 senators to agree to support the measure. Most of these talks, too, will be conducted behind closed doors.
Some conservatives are demanding changes that would lower insurance premiums overall by gutting the ACA’s guarantee of coverage for people with critical health problems known as preexisting conditions. Some moderates do not approve of the measure’s proposal to cut Medicaid funding to Planned Parenthood.
And a pair of Midwestern Republicans wants tens of billions of dollars in fresh funding to battle the nation’s opioid epidemic, which is killing thousands of people each year in the region.
McConnell faces a difficult task in threading the legislative needle. Every move to appease one of those constituencies could drive away support from the others.
But the decision to forge ahead reflects the reality that the longer these disputes fester, the further Republicans may get from resolving them.
McConnell has made a final calculus that he does not want to spend all of July in negotiations, tinkering with each element of the complex 142-page bill. That would set up the prospect of finishing the health-care effort just as Congress headed out for its traditional August break, creating a quandary similar to the one Democrats faced eight years ago, when angry constituents crowded town hall meetings across the nation to complain about the legislation that ultimately became the ACA.
“We don’t have a final product, but we had to release something to get started,” Cornyn said.
Some think McConnell secretly would like his bill to fail. According to the nonpartisan Congressional Budget Office, the House legislation would lead to 23 million fewer Americans having health insurance by 2026. Polls show the bill at one point had the approval of fewer than 20 percent of American voters.
Some Democrats are betting that McConnell privately believes that overhauling the health-care system on a party-line vote would repeat the mistake Democrats made in 2010, when they approved the ACA without Republican support. Their advisers spent the day Thursday circulating to the media passages from McConnell’s 2015 memoir, “The Long Game,” in which he identified his effort to force Democrats to pass the ACA without Republican votes as one of his biggest political victories.
“It had to be very obvious to the voters which party was responsible for this terrible policy,” he wrote then.
But McConnell, a devout college football fan who favors the University of Louisville, is a firm believer in the notion that each first down helps produce another first down, that touchdowns beget touchdowns, and that losses often lead to more defeats. So he knows that if Republicans fail to repeal Obamacare, it would be a dramatic disappointment in President Trump’s already unproductive first year in office.
That’s why victory is essential, and that’s why Republican leaders have begun the final whip process to try to lock down the votes to pass the legislation.
McConnell can afford to lose only two of his 52 Republicans. That would set up a scenario in which Vice President Pence casts the tiebreaking vote. Then negotiations would begin with House Speaker Paul D. Ryan (R-Wis.) to resolve differences between the two bills.
Sen. Susan Collins (R-Maine) told reporters Thursday that she and Sen. Lisa Murkowski (R-Alaska) would try to amend the Planned Parenthood restrictions during next week’s “vote-a-rama,” a period when senators can offer unlimited amendments to the health-care measure. GOP insiders expect Sens. Rob Portman (R-Ohio) and Shelley Moore Capito (R-W.Va.), who oppose the bill’s deep cuts to Medicaid, to be mollified by more cash to combat the opioid epidemic.
If McConnell gets those four aboard, the Senate’s conservative bloc — including two of Trump’s highest-profile opponents in the 2016 Republican primaries, Sens. Ted Cruz (R-Tex.) and Rand Paul (R-Ky.) — would present the final hurdle.
On Thursday, Cruz and Paul joined Sens. Ron Johnson (R-Wis.) and Mike Lee (R-Utah) in issuing a midday declaration that they cannot “currently” support the legislation “as written.”
“We are not ready to vote for this bill,” the four senators said in a written statement, “but we are open to negotiation.”
The fate of the bill could ultimately lie with Cruz, the man Trump labeled “Lyin’ Ted” during the 2016 campaign. Cornyn said he has spoken with his Texas colleague, who on Thursday was carrying a memo in his jacket pocket that contained a list of demands that mark the “path to yes.”
By the end of next week, it will be clear whether he got there.
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