When Paul Ryan first introduced Trumpcare to the House, his caucus’s far-right and (relatively) moderate factions both balked. Conservatives hated that the bill retained much of Obamacare’s basic structure — including oppressive, big-government regulations that prevent non-affluent diabetics from being priced out of the insurance market. Moderates, meanwhile, observed that throwing 24 million people off their health insurance — so as to fund a tax cut for the rich — probably wouldn’t cure what ails the American health-care system.
The House GOP leadership proceeded to: revise the bill so that it undermined protections for people with preexisting conditions; keep virtually everything else the same; and pass the legislation with the overwhelming support of the so-called moderates.
So, when the Senate’s iteration of Trumpcare divided Mitch McConnell’s caucus along similar lines, most expected we’d see an encore: The Majority Leader would push the bill further right to appease Ted Cruz and Mike Lee, and then Susan Collins, Dean Heller, and Lisa Murkowski would misplace their spines and go with the flow.
But we seem to be watching a very different show. Bloomberg’s dispatch on McConnell’s latest attempts to salvage Trumpcare suggests the “moderates” have already pocketed several gains, while the conservatives have gone empty-handed:
McConnell is planning to add $45 billion in spending to address the opioid epidemic, according to the aide, a top demand of moderate Republicans, including Senator Rob Portman of Ohio and Shelley Moore Capito of West Virginia.
Senator John Cornyn of Texas, the No. 2 Republican leader, said Thursday that the revised bill could be altered to keep Obamacare’s 3.8 percent tax on net investment income to bolster subsidies for low-income people in the law’s exchanges. Such a move would leave intact a revenue stream of $172 billion over a decade that could be used to boost health expenditures in the bill, including more-generous subsidies for those buying insurance on Obamacare’s exchanges.
Senator Bob Corker, a Tennessee Republican, said that based on a meeting he had with McConnell late Wednesday, he expects the party’s Senate leaders will scrap their effort to repeal that tax.
So: Major opioid-treatment funding and more generous subsidies are in — the capital gains tax cut is out.
Bloomberg notes that the leadership is “considering” Ted Cruz’s proposal to allow health insurers to sell plans that don’t abide by Obamacare’s regulations in all 50 states — so long as they also offer one plan compliant with those restrictions. But the outlet suggests that leaders are skeptical it would pass muster with the moderates.
And even if it did, conservatives would still likely walk away empty-handed. At this point, Cruz’s own pitch is that he’ll trade moderates more money for fewer regulations. But while Senate Republicans have unambiguous authority to adjust funding levels, the regulatory changes that Cruz seeks would probably be vetoed by the parliamentarian for violating the rules that govern reconciliation bills.
All of which is to say: McConnell appears to be making the opposite calculation of his counterpart in the House — he’s assuming the moderates are stalwart in their opposition and need to be appeased, while the conservatives are merely posturing.
This is a tad surprising given that before the bill was pulled, only two moderates had declared their opposition — Collins and Heller — while four conservatives had rallied against it. Since McConnell can afford to lose exactly two votes, one might have thought he’d worry more about his right flank.
But the fact of the matter is that the initial bill was already a historically reactionary piece of legislation — one that’s to the right of GOP voters’ wishes, let alone to those of the electorate at large. And while few were willing to express the courage of their policy convictions (or else their political cowardice) before McConnell delayed the vote, it appears that a whole lot of Republican senators feel squeamish about throwing millions of people off their health insurance to pad the passive income of plutocrats.
It’s still far from clear that McConnell has any path to passing this thing. But if one exists, it doesn’t lie to the right of where this bill stood a few days ago.
