Following the unveiling of the House Republican plan to shrink Obamacare dramatically, two surprising things happened. The first is that the conservative-movement apparatus has lined up rapidly against the bill. The major right-wing pressure groups — FreedomWorks, the Club for Growth, Americans for Prosperity, and Heritage Action for America — all announced opposition, and were quickly echoed by the most right-wing members of Congress, like House Freedom Caucus chair Jim Jordan and Senator Rand Paul. The second surprising thing is that Senate Majority Leader Mitch McConnell announced his intention to jam the House bill through the Senate quickly. Rather than develop its own bills through committees and the normal debate process, McConnell declared he plans to bring it directly to the Senate floor. Neither of these decisions makes a great deal of sense on their own, and they make even less sense in conjunction with each other.
The grounds for the right’s opposition is that the House bill would replace Obamacare with a “new entitlement,” albeit one funded almost entirely through cuts to an old entitlement (Medicaid) and which would provide such meager benefits as to be useless to large numbers of its purported beneficiaries.
What makes this revolt so confounding to the party leadership is that the House bill, while too liberal for the party’s right flank, is also almost certainly too conservative to pass the Senate. Senators Lisa Murkowski, Cory Gardner, Rob Portman, and Shelly Moore Capito signed a letter yesterday opposing the bill’s repeal of the Medicaid expansion. A fifth, Dean Heller, has raised concerns about protecting Medicaid. Susan Collins and Bill Cassidy have proposed a much more moderate replacement bill, which has also been co-sponsored by Capito and Johnny Isakson. Additionally, Lamar Alexander, Jeff Flake, and Lindsey Graham have urged caution and deliberation — all of which run counter to the leadership’s strategy of ramming a bill through as quickly as possible in order to enable the passage of a big tax cut later in the year.
That makes 11 Republican senators who have, in some form or fashion, expressed reservations about the party leadership’s preferred health care strategy. Even assuming the three senators who object to the law from the right — Ted Cruz, Rand Paul, and Mike Lee — can be corralled, Trumpcare seems to be very far from corralling the necessary 50 Senate votes. And this is before the Congressional Budget Office produces its score, which will probably show millions and millions of people losing coverage, and may possibly also show the deficit blowing up.
While McConnell’s plan might be necessary in order to keep the party’s legislative strategy on track, it is highly and even delusionally optimistic, given the state of his vote count. It also runs counter to the Senate’s institutional culture. Senators cherish their power to shape and control legislation. A strategy of photocopying the House bill and ramming it through seems almost designed to violate the Senatorial ego.
This raises a question: Is it designed to violate the Senatorial ego? And thus to fail? Neither the conservative revolt nor McConnell’s plan make a lot of sense if you view them as strategies designed to yield the most right-wing health-care policy that is attainable. They do make sense as a strategy designed to insulate Republicans from failure.
Republicans have made two promises that can’t be reconciled. They promised to repeal Obamacare, and to replace it with a terrific law that would take care of everybody. As the House Republican ad put it, they promised, “more choices and better care, at lower costs. … peace of mind to people with preexisting conditions … without disrupting existing coverage.” Those things cannot be reconciled. If Republicans repeal Obamacare, they will put in place something that not only fails to provide the better, cheaper care they have promised the country, but does not meet even the minimal threshold of access to basic care for people who currently receive it.
From that standpoint, the winning play for the GOP might be to try to repeal and replace Obamacare but fail. If they are seen trying and failing to repeal the law, it might upset the base, but most Republican lawmakers will have their opposition to Obamacare on the record. And if it is to fail, it should fail quickly, so they can move on to cutting taxes.
This may all be wrong. It is never safe to assume rational thought on the part of public actors, especially in the reality-distortion field of Trump’s Washington. Maybe ultra-conservatives think they are using their leverage to push the bill to the right. Or maybe McConnell believes he can whip his caucus into line. Whatever the explanation, the strategy behind the bill is almost as incompetent as the bill itself.