Senate Republicans May Have Found Their Health-Care Compromise

Rand Paul, pragmatic deal-maker? Photo: Bill Clark/CQ-Roll Call,Inc.

Late last week, Donald Trump revived “repeal and delay” — the GOP’s short-lived plan to kill Obamacare first, and draft a replacement second. GOP senators Mike Lee, Rand Paul, and Ben Sasse promptly endorsed this way out of their party’s health-care quagmire.

Most observers saw these developments as threatening Mitch McConnell’s fragile hopes of bridging his caucus’s divide on health-care policy. Politico declared, “Trump further disrupts Obamacare repeal efforts.”

But it now looks like the opposite may prove true: The reemergence of the strategy of repealing Obamacare in one bill, and replacing it in another, might just lay the foundation for the Senate GOP’s grand bargain over health care. Observe how Rand Paul described his vision for “clean repeal” on Fox News Sunday:

Let’s do clean repeal like we promised, and, I think, you can get 52 Republicans for clean repeal. You can have a simultaneous bill — or a concurrent bill — that they can call replace, and that I think, perhaps, if it’s big spending, they could probably get Democrats to go along with big spending. I’m not for that, but I’m saying, I want repeal to work, and the way you do it is you separate into two bills and you do it concurrently.

In other words, Paul is asking leadership to give conservatives one more chance to register their symbolic opposition to Obamacare, for old time’s sake — and then, immediately pass a “big spending” bipartisan bill that props up the existing law, with moderate Republican and Democratic votes.

It’s hard to imagine a better way for an arch-libertarian — who represents Kentucky — to have his ideological purity and keep his state’s rural hospitals running, too.

But Paul wasn’t the only one endorsing this sort of scheme.

“I’d like to say let’s do the repeal and then let’s try to get 60 out of 100 senators,” Sasse told CNN. The Nebraska senator suggested that, unlike Paul, he would favor an extended period of legislative deliberation between Obamacare’s repeal and its replacement. But, nonetheless, his suggestion that the bill pass with 60 votes is a tacit endorsement of a legislative process that ends with technocratic fixes to the existing law (which Trump could then rebrand as his own).

It’s possible that Sasse’s insistence on 60 votes has less to do with an attraction to bipartisanship than frustration with the limits of reconciliation — the legislative process that allows the Senate to pass bills with a simple majority. Right now, Senate conservatives have their hearts set on rolling back Obamacare’s regulatory protections for people with preexisting conditions. But under the rules of reconciliation, the Senate can only pass measures that have a direct impact on the budget, and it’s unlikely that regulatory reforms would meet that standard.

Still, whatever Sasse’s motivation, a modest bill fortifying the private market is the only thing that could get eight Democratic votes.

And, over the weekend, White House Director for Legislative Affairs Marc Short endorsed such a legislative endgame.

“If the replacement part is too difficult for Republicans to come together, then lets go back and take care of the first step and repeal,” Short told Fox News Sunday. “And then at that point, if you’ve repealed it, you can come back with a replacement effort that could be more bipartisan.”

Maine senator Susan Collins has long favored a bipartisan bill. Kansas’s Jerry Moran expressed a similar sentiment this week.

And on Thursday, even McConnell seemed to signal that a bipartisan bill may be nigh, saying, “If my side is unable to agree on an adequate replacement, then some kind of action with regard to private-health-insurance markets must occur.”

Republican senators appear to have irreconcilable disagreements about health-care policy. But that’s only true to the extent that they actually care about health-care policy. It seems possible that what the conservatives really care about is performing rituals of ideological purity — while the moderates just want to avoid throwing hundreds of thousands of their constituents off health insurance for the sake of affirming some lies they sold voters about Obamacare.

If that’s the case, then “pseudo-repeal and bipartisan replace” might be the grand bargain they’ve been searching for.

Senate GOP May Have Found Its Health-Care Compromise