The latest twist in the poorly scripted movie that is the current U.S. political system: The future of a bill that could take health insurance from millions of Americans may be decided by how quickly one senator recovers from an unexpected health problem.
Late on Saturday night, Senate Majority Leader Mitch McConnell announced that he would delay the vote on the Better Care Reconciliation Act once again because Senator John McCain required “minimally invasive craniotomy with an eyebrow incision,” which involves opening the skull to remove a blood clot above his left eye. McCain is at home recovering in Arizona, and a statement released by his office suggested that he may only be out for a week.
On Sunday the New York Times kicked off a new wave of speculation about the bill’s fate when it noted that his condition “may be more serious than initial descriptions have implied, and it may delay his return to Washington by at least a week or two.” The paper did not speak to any of McCain’s doctors, but other medical experts said the recovery time for such procedures can be several weeks. They also discussed how McCain’s history of melanoma might complicate matters:
Dr. Philip E. Stieg, the chairman of neurological surgery at Weill Cornell Medicine and the neurosurgeon in chief at NewYork-Presbyterian, said it seemed a good sign that Mr. McCain was able to go home so quickly.
“I think the one possibility that’s of concern is that melanomas are known to go to the brain and they can bleed,” Dr. Stieg said. “They’ll have to wait for the pathology to come back. The good news is that five centimeters is a sizable blood clot, but in the frontal lobe, it should be well tolerated and hopefully he won’t have any neurologic deficits.”
Obviously even doctors who are actually treating McCain can’t say precisely how long his recovery will take, or what complications may arise. What we can say is that McCain’s situation makes the bill’s future even more doubtful.
The Senate’s version of the Republican effort to end the scourge of Obamacare — or rather give to the rich and take from the sick and poor — was originally supposed to get a vote before the July 4 recess, but it was pulled because McConnell didn’t have the votes. The latest version was unveiled last Thursday, and GOP leaders said they planned to hold at least a procedural vote to advance the bill this week.
With 52 Republican senators, the GOP can only afford to lose two votes, and senators Susan Collins and Rand Paul have already said they’re hard “no”s. Sunday on ABC, Collins trashed the bill again, and estimated that another eight to ten GOP senators have “serious concerns,” though they aren’t as outspoken as she is. “At the end of the day, I don’t know whether it will pass,” she said.
Several Republican senators had already admitted that if people spend some time getting to know BCRA, they’re going to like it even less. Last month, Senator John Cornyn said passing the bill is “not going to get any easier” with time, and Senator Lindsey Graham has said the bill “is not like fine wine; it doesn’t get better with age.”
While few think they’d actually oppose BCRA, both McCain and Arizona’s junior Republican senator, Jeff Flake, are officially undecided, and have expressed disappointment in the current bill. “Arizona has been nationally recognized for running one of the most efficient and cost-effective Medicaid programs in the country,” McCain said last week. “This legislation should reward states like Arizona that are responsibly managing their health-care services and controlling costs — not penalize them.”
Axios reports that the White House considers every day without a third Senate defection a victory. “If at [the] end of the weekend nobody else has jumped out of the box, that’s a win,” said a senior administration official.
But there are new hurdles on the horizon. The scandal over Donald Trump Jr.’s Russia emails took some of the focus off health care, but groups opposed to the bill now have more time to demonstrate (Indivisible is planning national protests to #KillTheBill on Tuesday). The delay also gives the nonpartisan Congressional Budget Office more time to assess the bill’s impact. A previous assessment said 22 million people would lose their insurance by 2026, and a new score is expected on Tuesday or later this week.
The White House has been working to discredit the CBO in recent days, and according to Axios, McConnell has been telling senators that they just need to advance the bill, and then they can change it yet again:
McConnell is privately telling senators, per our sources, that they if they vote against the motion to proceed they’re effectively arguing that there’s nothing wrong with the health care system and the Affordable Care Act markets are just fine. He’s telling them they’ll have virtually unlimited opportunities to amend the bill.
But Republicans can’t keep tweaking what is technically the fiscal year 2017 reconciliation bill forever. Issues like the 2018 budget-reconciliation bill, a debt limit increase, and a defense policy bill are looming, so if McConnell can’t get McCain back in a timely fashion and keep every other Republican senator in line, he may lose his chance to further damage the U.S. health-care system.