Senate GOP to Reform Health-Care System on the Fly, in a Blindfold

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“Let’s just do it and be legends, man.” Photo: The Washington Post/The Washington Post/Getty Images

Last week, Senate Republicans took Trumpcare off its respirator. After weeks of emergency surgery, the disfigured, bedridden legislation was simply beyond saving. Conservatives had realized that they had little interest in backing a bill that both retained Obamacare’s basic structure — and also radically increased premiums and deductibles for much of the GOP base. Republican moderates, meanwhile, decided that they didn’t actually want to throw millions of people off their insurance to sate Donald Trump’s ego. And once those two wings had defected, rank-and-file Republicans were free to vent their frustration at the opaque, partisan process that had brought Obamacare repeal to such an untimely end.

“One of the major problems with Obamacare was that it was written on a strict party-line basis and driven through Congress without a single Republican vote,” John McCain said in a statement eight days ago. “The Congress must now return to regular order, hold hearings, receive input from members of both parties, and heed the recommendations of our nation’s governors so that we can produce a bill that finally provides Americans with access to quality and affordable health care.”

Since McCain issued that statement, the Senate parliamentarian ruled that crucial pieces of the GOP’s replacement bill had violated the rules of budget reconciliation: Politically essential anti-abortion measures, Ted Cruz’s amendment gutting Obamacare’s regulations, and the six-month waiting period for people who lapse in health insurance coverage — the bill’s substitute for the individual mandate — all could not be enacted without 60 Senate votes.

On Tuesday, the Senate GOP plans to vote to proceed to debate with their bill, anyway — even though it now lacks a CBO score; and some Republicans are only voting to proceed so they can vote on a full repeal bill that cannot pass; and none of the dissenters’ policy complaints have been addressed, let alone their procedural ones.

Now, a cancer-stricken John McCain, in what will likely be one of his last major acts as a public servant, is flying in from Arizona to help his party avoid a return to regular order; neglect to hold hearings on the likely effects of their plan to gut a half-century-old program on which 70 million Americans rely; ignore input from members of the other party; and run roughshod over the recommendations of our nation’s governors, so that they can produce a bill that denies more than 20 million Americans access to quality and affordable health care.

It is difficult to explain what triggered this turn of events — and even more difficult to say where, precisely, events are turning to. Axios reports that the Senate leadership’s plan is to vote to proceed to debate, and then, assuming that passes, vote on the party’s freshly gutted replacement plan, the Better Care Reconciliation Act. From there, things get murky:

Sen. Rob Portman has struck a deal that would add $100 billion to the bill’s stabilization fund. It would pair with Sen. Cruz’s consumer-freedom amendment, which allows insurers selling ACA-compliant plans to also sell non-compliant plans. But a vote on that agreement would be subject to a 60-vote threshold because it hasn’t been analyzed by the Congressional Budget Office. That means it’ll fail.


Then would come the vote on an updated version of 2015 straight-repeal bill. This is also expected to fail. (The way leadership is structuring the vote procedurally, this would technically be the first amendment voted on — likely as a nod to Sen. Rand Paul — even though BCRA would be on the table first.)


If votes on the 2015 bill and BCRA both fail, all votes are to amend the House bill. It’s unclear what these votes will be, but Democrats are sure to make Republicans take some painful ones.

One Senate aide offered a more concise summary of the plan: “The ultimate goal is to get to conference where there would be more time to work out some of the issues and get scores on these items.”

NBC News’ Vaughn Hillyard reports that Republicans believe they can “get to conference” by passing a “skinny repeal” — abolishing the individual mandate, employer mandate, and medical device tax.

Regardless, the Senate is relying on the same rationale that got this effort through the House: Pass it, and let our future selves sort it out. From a policy perspective, this strategy is incoherent. The problems that Republican dissenters have with this bill are fundamental and contradictory. But in political terms, the move makes some sense.

“There is a contingent of GOP senators who refuse to accommodate their concerns in negotiations in the hopes of avoiding a vote altogether,” one senior GOP strategist told Politico. “The only way to change that dynamic is to hold a vote that provides the opportunity to put every senator on record as to whether they are willing to debate Obamacare … if some Republicans are more comfortable dealing President Trump a loss than debating Obamacare, this vote will provide the opportunity to make that clear to their constituents.”

The gambit here is dictated by the same logic that would lead a lovestruck co-worker to stop rehearsing the right words, down the vodka, and drunk-dial Kevin from marketing; or, more appropriately, that would lead a first-time hit man to stop weighing the pros and cons of what he’s about to do, finish the whiskey, and head up the driveway. The point is to make a beeline for the point of no return.

Only, in this instance, when the irrevocable’s been done, there won’t be awkward eye contact by the water cooler, or a single life cut short, but a haphazardly restructured health-care system, 20 million more people without insurance, a gaping new hole in the Great Society, tens of thousands of Americans lost to preventable deaths — and a bit more budgetary space for passing giant tax cuts for the rich.

GOP to Reform Health-Care System on the Fly, in a Blindfold