As Senate Republicans deal with the complex process of trying to get to 50 “yea” votes for their version of Trumpcare, the prevailing calculus is about how to keep restive conservatives onboard while throwing money at the concerns of “moderates.” That is why yesterday’s CBO “score” of the bill, bad as it was, provided some glimmer of hope for Mitch McConnell. CBO showed individual market insurance premiums going down in a few years (mainly because the benefits such premiums would cover would shrink), addressing a key demand of conservatives. The score also showed $321 billion in deficit reduction — which in theory gives McConnell a golden slush bucket of $100 billion in free money to give party moderates for concessions like opioid-treatment programs, risk-pool funding, and perhaps a slower phase-out of Obamacare’s Medicaid expansion. It won’t be easy. With Rand Paul and Dean Heller looking un-buyable, McConnell has no margin for error at all. But it’s not beyond the realm of possibility.
There is another GOP faction, however, that absolutely must be placated for this legislation to pass, and nobody much is talking about it: the anti-abortion lobby. Indeed, here and there you read that McConnell might be able to get Susan Collins and Lisa Murkowski onboard by tossing out language “defunding” Planned Parenthood for a year.
That is not happening. Right-to-life advocates, who have veto power over the votes of multiple senators and probably even more House members, are making militant noises not just about the Planned Parenthood language —which, after all, was included in the 2015 “trial run” Obamacare repeal legislation over the objections of Collins and Murkowski — but about an additional provision added in the House that prohibits use of health-care tax credits to obtain private insurance that provides abortion services. Just yesterday Marjorie Dannenfelser of the Susan B. Anthony List and Tony Perkins of the Family Research Council conveyed their demands via Breitbart:
The expectations of the pro-life movement have been very clear: The health care bill must not indefinitely subsidize abortion and must re-direct abortion giant Planned Parenthood’s taxpayer funding to community health centers. The Senate discussion draft includes these pro-life priorities, but we remain very concerned that either of these priorities could be removed from the bill for procedural or political reasons. We are working closely with our pro-life allies in the Senate to prevent this from happening as it could result in our opposition.
The reference to “procedural” problems is an allusion to widespread reports that the Senate parliamentarian has ruled the language restricting use of tax credits as non-germane to the budget, which might mean it must be taken out of the bill lest it lose its status as a “budget reconciliation” measure that needs only 51 votes to pass. As the Breitbart piece goes on to explain, the RTLers want the Senate to overrule the parliamentarian on this point —which it can, but at the risk of opening the floodgates to other non-germane amendments, like the changes in Obamacare regulations so many conservatives want. Eventually, pushing aside the special Senate rules for consideration of the budget could amount to a backdoor abolition of the legislative filibuster, as senators seek to push every controversial piece of legislation imaginable into budget bills that cannot be filibustered. That is a precedent Mitch McConnell would be reluctant to set.
Perhaps Republicans can find a way to reframe the ban on use of tax credits for abortion services in a way that will keep it in the bill without undermining the parliamentarian. But make no mistake, they will ultimately have to obey the right-to-life lobby or find some other massive favor to bestow on it to avoid open opposition to the health-care bill. Had Supreme Court Justice Anthony Kennedy retired yesterday as some thought he might, anti-abortion advocates would have been so focused on replacing him with a sure fifth vote to overturn Roe v. Wade that they might not have cared as much about proving their clout in shaping Trumpcare. As it is, whips will crack as the Senate moves toward a vote.
