It’s Looking Bad for Trumpcare, But Expect One More Big Push

Maybe Senate health-care legislation is dead or dying, but McConnell could have one more trick up his sleeve. Photo: Jabin Botsford/The Washington Post/Getty Images

It is now pretty clear why Majority Leader Mitch McConnell really wanted a vote on the Senate’s version of Trumpcare before the July 4 recess: Republicans have returned to Washington in a state of more visible disarray on this legislation than ever before. At least ten Republican senators are thought to be “no” votes on the Better Care Reconciliation Act of 2017, and the number could rise after the lawmakers reflect on the sour public assessments of the bill they heard back home and read about in the media over the recess. Senators John McCain of Arizona and Bill Cassidy of Louisiana offered negative assessments of BCRA’s chances of enactment on Sunday shows. Senators Chuck Grassley and Ted Cruz — of Iowa and Texas — are sniping at each other over the latter’s proposed amendment to let insurers offer cheaper health plans with less coverage and its impact on people with preexisting conditions.

Worse yet from a morale point of view, Republicans are now openly sparring over what to do if BCRA fails. As the Hill reports:

[GOP] Lawmakers are largely splitting into two camps: those who want to work with Democrats on a fix to the healthcare law, and those who want to simply pass a straight repeal of the law and work on a replacement later.

While conservatives are mainly behind the second option, Senate Majority Leader Mitch McConnell (R-Ky.) made waves on Thursday by saying that his party could work with Democrats to stabilize ObamaCare markets if the repeal bill fails. 

So is it time to declare BCRA — and perhaps with it, the whole Trumpcare effort to repeal and partially replace Obamacare — dead or at death’s door?

Maybe not. McConnell won’t yank the bill at least until the Congressional Budget Office “score” of two revised versions of BCRA — one with “sweeteners” for moderates (including opioid-treatment dollars, and a lot more money for states to ameliorate some of the bill’s effects), and the other with Cruz’s amendment — comes back, which could be late this week or perhaps next week. It is possible the “bad” CBO numbers for the original BCRA — especially the estimate that 22 million Americans would lose health insurance — will come back improved enough that the GOP can begin a whole new PR campaign to suggest they’ve “fixed” their damaged policy goods.

Moreover, the fractious debate over what to do if BCRA fails could represent tactical maneuvering as much as differences of opinion. In calling for a simple Obamacare repeal vote, conservatives are reminding Senate Republicans that all but one of them (Senator Susan Collins was the exception, along with Senator Mark Kirk, who was defeated in 2016) voted for such a measure in 2015. In pointing to the possibility of bipartisan legislation to shore up Obamacare, McConnell is almost certainly threatening conservatives to get on board or potentially miss their only opportunity to claim they repealed the hated Democratic initiative.

Unless CBO comes back with a new “score” that’s as bad as or worse than the original, you can probably expect one more big push to get BCRA across the line, with lots of noise about the concessions various senators have managed to wring from McConnell. Time pressures will add to the sense of urgency: In the midst of a tweetstorm on many other subjects today, the president issued this challenge:

“Fully approved and ready to go” suggests Senate passage of BCRA and then a quick rubber-stamping by the House — all by July 29, when Congress is due to go on recess until after Labor Day.

That seems very unlikely at the moment, but don’t count out McConnell just yet. His game all along has been to keep everyone focused on positive comparisons of the bill finally voted on with earlier versions of the legislation. So from his point of view the current negativity could just represent that final darkness before the dawn. If both moderates and conservatives in the Senate GOP find just enough in the revisions and the CBO score to justify a claim that they’ve “won” various demands, Trumpcare could yet become law this year.

It’s Looking Bad for Trumpcare, But Expect One More Big Push