Why Did Mitch McConnell Fail, and What’s Next for Health Care?

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McConnell. Photo: Mark Wilson/Getty Images

Senate Majority Leader Mitch McConnell’s attempt to pass Trumpcare ended in an embarrassing defeat on Monday night, after enough Republican senators withdrew their support. Opposition from his own party has killed his next attempt to pass a straight repeal of the Affordable Care Act — though it seems McConnell will forge ahead with the doomed vote.

But McConnell’s health-care failure may have come as a surprise, given his reputation as a great strategist and vote-whipper. So what made him stumble here? Adam Jentleson, former deputy chief of staff to now-retired senator Harry Reid, witnessed firsthand McConnell’s distinctive leadership. Daily Intelligencer called him up to see what he thought of the Kentucky senator’s political defeat, and whether he thought Obamacare might finally be safe.

You recently said on Twitter that this setback was a deep “humiliation” for McConnell. 
I do think this is profoundly humiliating for him. The headlines are all about how his reputation has taken a hit. I think he is very proud of his reputation. And he is desperate to redeem it and will spend a tremendous amount of time and energy trying to find a way to do that.

You also said McConnell will spend “every waking moment plotting his redemption.” What do you think that will look like?
McConnell has spent years running a certain kind of playbook against fellow Republicans who challenged him personally, or from members of his conference from the right. So far, he’s been vocally opposed to folks running against Dean Heller. But, on the other hand, he’s been doing a lot to his conference that seems punitive. Starting with making them vote on the House bill, which is a vote none of these guys are gonna want to take. It is an absolute no-win vote for them.

So if not payback, what should McConnell be doing now?
Pull the vote down, take the heat from Trump and others. There is no good way for Dean Heller or Susan Collins or Jeff Flake to vote on this. Either they’re voting against the House bill and against their president, or they’re voting for a bill that takes health care away from 22 million people and sends costs skyrocketing. To force them to walk that plank seems punitive and designed to protect McConnell at the expense of his conference.

McConnell’s reputation as a brilliant tactician seemed to fail him in a big way with Obamacare repeal. What tripped him up?
Mitch McConnell played a key role in creating this environment. He took what was a bipartisan process of crafting the Affordable Care Act, and recast it as a partisan, socialist takeover of [health care]. You can cite mistakes that were made by the Democrats in the process of crafting the Affordable Care Act, but fundamentally, it was an open, transparent, bipartisan process. Democrats genuinely reached out to people like [Senator] Chuck Grassley, [former senator] Olympia Snowe, [Senators] Susan Collins, Mike Enzi, and wanted their ideas. They considered their amendments. They included their ideas in the text of the bill.

McConnell — and he was very open about this at the time — rightly put his finger on the fact that, regardless of the substance of the bill, if a single Republican senator voted for it, it would be forever known as a bipartisan accomplishment. He wanted to avoid that at all costs. And he succeeded! McConnell scorched the earth in the middle ground that should have been available for an open and honest policy debate.

So it’s come back to haunt him?
McConnell created a dynamic for Republicans where they told their base that anything that looks like Obamacare is a socialist takeover, so there was no space for Republicans to maneuver in terms of what their replacement was. So here McConnell comes in in 2017. What is he supposed to do? There’s an incredible amount of arrogance to look at Democrats’ process that took months and years and say, “I can just do this by myself with just the small handful of my top staffers and essentially order my fellow Republicans to get in line.”

Would Harry Reid have preferred to craft legislation by himself with his closest aides and hand it out to the caucus and dictate that they vote for it? Maybe? But you have to work the process diligently because that’s how the Senate works. Letting Senator Max Baucus, one of the chief architects of the ACA, take months in the summer of 2009 to painstakingly consider Republican ideas, to reach out to Republican counterparts. You look back on it politically, that is when the bill started taking on a lot of water and it led to that awful August recess of 2009. But you had to do that to get Max Baucus into the process. Did that hurt politically? Absolutely. But it secured Max Baucus’s support and without that the bill never would have passed.

What approach should McConnell have taken?
McConnell wants someone like Susan Collins to support the bill, or even someone like Ron Johnson, or Jerry Moran, he needs to empower them to have a role in the process. And he did not do that, and the Senate is not the House. Senators, each one considers themselves to be a power center, and they are, because each one holds a lot of sway, especially when you only have two votes to spare. The leader tries to take their power away, to cut them out of the process, and they have the ability to push back. That’s what they did. I think it’s absolutely fascinating because the amount of Senate rebellion on the Republican side is dramatic. To see this six months into unified Republican rule is astounding.

Going off that, I thought it was notable that the three senators who have seemingly sunk McConnell’s repeal-and-delay strategy on Tuesday were all female and were all excluded from the drafting of the bill.
Right. There is an undercurrent in the Senate Republican conference that you don’t have to scratch the surface very hard to get female leaders feeling like they are not taken completely seriously. They are not given major leadership roles. And I think a lot of that is directed personally toward McConnell. It’s hard to put your finger on it because it comes through in a lot of subtle ways, but they have a deep bench of female senators over there, but the depths of talent is completely out of whack with the responsibility or leadership that they are engaged [in].

The release of a horrific CBO score also stymied McConnell. How much do senators personally weigh what the CBO says?
Senators take the CBO extremely seriously. Regardless of what they might say in public. They get that the CBO is a reference point for every news outlet and commentator in the country. So they understand whatever it says there will be a consensus that will be extremely difficult to shake moving forward on the policy debate. You can criticize its methods, we certainly did that when we disagreed with the CBO, but that always feels halfhearted because, fundamentally, you know that whatever the CBO says is the baseline everybody can operate off of for the debate.

So beyond the obvious policy implications, the CBO score was, I think, the turning point where the Republican conference started to lose faith in McConnell because his crack team was unable to get a score that was significantly different from the House’s score. It was very smart of McConnell, the day after the House passed their bill, to come out and say, “The Senate is going to write its own bill.” I think that went over very well with his conference. But to have the CBO score come and say, “Yeah, it’s basically the same bill” completely wiped away the sense that the Senate had contributed something new and different. McConnell has always had this mythos around himself and his staff. The CBO score just blew that away.

Following the bill’s collapse in the Senate, Senator Alexander announced a hearing to see how the ACA can be maintained. People are at least talking about bipartisan discussions. What might that look like in the Senate?
I think that a smart play for Republicans is to work with Democrats to fix the most glaring problems of Obamacare and run in 2018 as bipartisan problem solvers who are able to make changes that have escaped leaders for years. The big problem for them there is their base. Will their base let them do that? Will their president let them do that? And, fundamentally, how do Republican voters feel having Obamacare more firmly [entrenched] and unlikely to be going anywhere?

That is a smart play for the GOP, it’s just not clear they are operating in a rational world. I also think you can easily see a package of small- to mid-scale bipartisan fixes breezing its way through the Senate. Part of the huge frustration over the past few years was, any sort of policy on the scale of Obamacare is going to have problems when it’s implemented. Normally, you have the luxury of being able to tweak it as you go and pass technical fixes or moderate policy. We have not been able to pass those things. In the past seven years you had Republicans aggressively taking shots to make it fail — like Marco Rubio’s bill to eliminate the risk corridors. That was a huge blow to the ACA and had a lot to do with the current instability in some of the markets.

What’s the biggest hurdle for a bipartisan Obamacare fix?
The next phase of this is a freight train that is speeding down the rails headed straight for Paul Ryan. You could probably pass a bipartisan package fix in the Senate. Then, it lands in Paul Ryan’s lap, and he’s in the exact same position as John Boehner: Do you bring up a bill that probably doesn’t have a majority — it could pass with a strong bipartisan consensus — but does not have the support of a majority of Republicans? I don’t even know if a bipartisan fix of Obamacare could get the majority of Republicans in the Senate. It almost certainly won’t get a majority of Republicans in the House. If I’m Paul Ryan, that’s what’s keeping me up at night because that is the next phase of this debate.

But it seems like it would be difficult for McConnell to pass a bipartisan bill where most of his caucus votes against it.
It’s been done before. One of the things we made note of in 2015 and 2016 was that a lot of Republicans were running around bragging about all the bills they were passing through the Senate once they took over the majority. If you look, a lot of those bills were passed with 90 to 100 percent of support from Democrats and 50 percent or less from Republicans. There’s a bit of a muscle memory there for Republicans. The way they sort of logged a lot of bipartisan achievements was to lean heavily on Democrats to support and bring along just enough Republicans to pass it. A big X factor now is whether Trump comes out loudly opposed to it or whether he supports it. If he supports it you could definitely make it work, and if he supports it you could see it even getting a majority of Republicans in the House — although I’m a little skeptical.

What would be the best-case scenario for Democrats?
Schumer has very quietly played his hand masterfully on this issue and deserves a tremendous amount of credit, and I think [compromising with Republicans] is a line he will walk very carefully.

Fundamentally, Democrats have to be able to say they preserved Obamacare. As long as they can say to the base, “We preserved Obamacare,” the base will be very supportive. I think that’s achievable. Frankly, I think it could be a very strong positive for Democrats going into 2018 to say, “At the outset of the Trump administration, nobody thought it was possible for Democrats to save Obamacare. Everybody thought it was a given that it was going to be repealed within the first few weeks of the Trump administration.” So for Democrats to be able to go into 2018 saying, “We saved Obamacare, even if we had to make a few tweaks,” I think that’s a very strong place for them to be in.

This interview has been condensed and edited.

Why Did Mitch McConnell Fail & What’s Next for Health Care?