Maybe There’s No Light at the End the Tunnel for the GOP Health Bill After All

Mitch McConnell’s tactical brilliance in dealing with health-care legislation doesn’t mean he has a strategy for actual success. Photo: Drew Angerer/Getty Images

As the Senate lurches towards some sort of final vote on health-care legislation, probably tomorrow, political observers are in a frenzy trying to figure out what GOP leader Mitch McConnell is really planning. He is reportedly going to unveil a “skinny repeal” bill. With four GOP senator making their support for it conditional on it not becoming law, it now seems safe to regard it purely as means to kick the legislative can down the road to a House-Senate conference where the “real” Trumpcare bill can be hastily assembled. But nobody knows exactly what McConnell’s got up his sleeve; Senate Democrats went so far as to boycott the amendment process until such time the “skinny repeal” bill is made public.

With the endgame approaching, it’s time to explore another possibility: that Mitch McConnell has nothing up his sleeve, and is instead just winging it in a desperate effort to avoid failure for as long as possible.

This is hard for people to accept, with good reason. McConnell has a long-standing reputation as a legislative wizard who rarely makes mistakes. Even the whole “skinny repeal” gambit itself seems like a fresh illustration of his tactical brilliance. Literally no one outside the Senate (and probably within it) had ever heard of it until it suddenly emerged as the light at the end of the tunnel for a Senate health-care debate that most experts had written off as a failure.

But the more you look at “skinny repeal,” the less it looks like any kind of “solution” and the more it resembles something to put out there when everything else you’ve tried has not worked. As a “minimalist” policy that Republicans will consider better than nothing, it’s losing altitude by the minute, particularly in the House, which would have to rubber-stamp it before it becomes law.  Why would Republicans enact a bill that would cost 16 million Americans their health insurance and boost premiums on the individual market without achieving any of the conservative policy goals they’ve set for themselves, from repeal of Obamacare’s insurance regulations to curtailing Medicaid spending to rolling back high-end taxes?

Unfortunately, the other possibility stipulated for the “skinny repeal” bill is looking equally problematic. Yes, passing something could get Republicans to a House-Senate conference that could adopt some earlier version of Trumpcare or come up with something entirely new. But the deep and abiding policy and political differences Republicans have had in finding a consensus repeal-and-replace bill are not going away. And worse yet, the Senate parliamentarian has created a real obstacle course for any comprehensive bill, declaring a long series of politically and substantively critical provisions violations of the Byrd Rule, which means waiving them will require 60 votes. Indeed, the bad news from the parliamentarian just keeps coming: Most recently, as my colleague Eric Levitz points out, the idea of letting states waive key Obamacare regulations, without which health-care legislation would have never made it out of the House, is now out-of-bounds without 60 votes.

All of these parliamentary objections will apply to a House-Senate conference committee’s report when it returns to the Senate. Yes, perhaps some can be avoided by clever draftmanship, but all of them? Probably not. And if so, that leaves the ultimate “nuclear option” of overruling the parliamentarian and probably killing the legislative filibuster once and for all, which (a) McConnell has strongly opposed in the past, and (b) might cost him votes he can’t afford.

So at this point all passage of a “skinny repeal” bill might do is to delay failure a bit longer. That would be consistent with the entire congressional process over health care this year. Now and then the ever-impending death of GOP legislation has been postponed by exceptional tactics, from the “Buffalo bribe” and the state waivers and loose change for “high-risk pools” that lubricated the House bill, to all of McConnell’s many shenanigans.

But the small-bore tactics have distracted attention from an underlying strategic paucity. Republicans are trying to do something (repealing Obamacare) that is politically unpopular and substantively damaging without having a consensus plan to replace it. That problem is not going to be solved with the raw materials McConnell, Paul Ryan, and the Trump administration have at hand. On one level, failure is inevitable. Postponing it will only do so much. And Mitch McConnell cannot find some miracle to square every circle — or create light at the end of this long, dark, legislative tunnel.

Maybe GOP Health-Care Bill Heading Nowhere But the Boneyard