Senate Republicans never wanted their health care bill that no one likes exposed to scrutiny for any longer than necessary. That’s why Senate Majority Leader Mitch McConnell negotiated and drafted it in private, and that’s also why he wanted a vote prior to last week’s July Fourth recess. He was forced to delay though, when it became clear that he had nowhere near 50 votes and no immediate path to obtaining them. And so home the senators went.
The “an extra week of constituents yelling at their senators will kill this thing!” school of thought has always been a little overrated. Senators did not need to hear from a few more riled up people at a Fourth of July parade to recognize that voting for a bill that cuts health care spending by a trillion bucks would have lasting political repercussions. But that extra week hasn’t helped! Rather than give senators a quiet time to work private back channels and move toward an agreement, it only appears to have entrenched them in their positions. What, if anything, can be done?
Maine Sen. Susan Collins, for example, appears to sense that opposing the Better Care Reconciliation Act is not just the right political position, but a legacy-defining one. After participating in a Fourth of July parade last week, she gloated to the press about the fanfare with which her position was received.
“I heard, over and over again, encouragement for my stand against the current version of the Senate and House health care bills,” she said. “People were thanking me, over and over again. ‘Thank you, Susan!’ ‘Stay strong, Susan!’ ”
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Collins is enjoying herself, and there is no reason for her to support this or any adjusted version of the BCRA going forward. She is probably gone. Kentucky Sen. Rand Paul is also probably gone. So McConnell needs every other Republican senator onboard to pass his bill. Unfortunately, all of those other senators hate the bill too.
West Virginia Sen. Shelley Moore Capito, in an interview with Politico, said that she is prepared to be the third “no” vote that kills the bill. North Dakota Sen. John Hoeven, the sort of rank-and-file member that McConnell does not need to be having problems with right now, also came out as a “no” on the current bill. He, like Kansas Sen. Jerry Moran, represents a state with a large rural population. The Better Care Reconciliation Act is not good for states with large rural populations.
The Better Care Reconciliation Act is not good for Alaska. Over recess, Sen. Lisa Murkowski continued lobbing salty, passive-aggressive responses to questions about the process. “It may be that there is another discussion draft,” she told constituents. “If there is, I can’t tell you what’s in it. That’s what happens when you don’t have an open process.” It is hard to see what could be offered to Murkowski to get her to vote for this bill. Same goes for Nevada Sen. Dean Heller, or Ohio Sen. Rob Portman.
We do know what it would take to win over Texas Sen. Ted Cruz, Utah Sen. Mike Lee, and perhaps Wisconsin Sen. Ron Johnson: Cruz’s consumer choice amendment, which would allow states to sell plans that don’t comply with the Affordable Care Act’s regulations so long as they also sell one that does. Since that amendment would undermine affordability for those with pre-existing conditions, though, its adoption would infuriate the moderates and rank and file further. We are six months into this reform process, and Cruz’s rhetoric about how Everyone Wins With More Choices! isn’t fooling his fellow senators.
“There’s a real feeling that [the amendment is] subterfuge to get around pre-existing conditions," Iowa Sen. Chuck Grassley told Iowa Public Radio over the recess. “If it is subterfuge and it has the effect of annihilating the pre-existing condition requirement that we have in the existing bill, then obviously I would object to that."
A GOP aide told the Hill last week that “if we voted on the Cruz proposal, it would be in the neighborhood of 37 to 15 against, 37 no votes and 15 yeses, and that’s probably generous.” Still, McConnell has placed Cruz in charge of selling it to the conference. Since Cruz enjoys such favor with his colleagues, it should be a cinch.
It’s too early to call this process dead, even though that’s precisely what Arizona Sen. John McCain is calling it. If there is an agreement, it will revolve around conservatives getting some tweaked version of the Cruz amendment while the Medicaid cuts are softened and individual market subsidies are boosted. This is what I’ve been saying since the bill was first revealed, and it remains true. What’s new since the latest time Congress was in session is that, because so many senators have trash-talked the bill already, they will have to pretend in their messaging that these adjustments constitute an entirely new bill that is leaps and bounds better than that garbage they saw a couple of weeks ago. It’s going to be difficult, though, when the Congressional Budget Office releases a score of the new bill that’s still mostly crappy.
If this miraculous feat doesn’t come together, though, it won’t be because senators had to spend an extra week at home getting hollered at by constituents. It will be because the bill was always bad and no one ever liked it.