Mitch McConnell has been reportedly promising vulnerable Republican senators that they needn’t worry about the bill’s deep cuts to Medicaid, since they will never take effect anyway. But not everybody in his caucus is happy to hear this. “I am concerned about Leader McConnell’s comments to apparently some of my Republican colleagues — ‘Don’t worry about some of the Medicaid reforms, those are scheduled so far in the future they’ll never take effect,’” Senator Ron Johnson (R-WI) complains. “I think those comments are going to really put the motion to proceed in jeopardy, whether it’s on my part or others.”
The danger this raises for McConnell is not that Johnson will block his plan. A committed right-wing ideologue who plans to retire at the end of his term, Johnson has no reason to fear the repercussions of throwing his constituencies off their insurance. Johnson also doesn’t have much leverage to stop it — if he votes no because the Medicaid cuts are too uncertain, he’ll get the certainty of no Medicaid cuts. But his objection illustrates the risk McConnell faces by the delay of the vote caused by John McCain’s hospitalization.
McConnell has tried to overcome divisions within his caucus by selling his plan as different things to different people. He can tell archconservatives that the Ted Cruz amendment, which lets insurers sell plans that discriminate against sick people, will lead to a deregulated individual market where healthy people and sick people are split into different risk pools. And he can tell his mainstream flank the opposite. He can sell the right-wing on the deep Medicaid cuts his plan imposes — not only rolling back Obamacare’s expansion of Medicaid, but then cutting the Medicaid budget after that, beginning in 2025. And he can tell the purple-staters that the Medicaid cuts will be reversed before they ever take effect. There are almost certainly not 50 votes for any particular plan. But, by keeping the details vague and telling everybody what they want to hear, he can possibly find 50 votes for different, hazy ideas of what the bill would do.
If McConnell is forced to reassure Johnson that the Medicaid cuts are solid, then other senators who oppose those cuts might jump ship. The longer the discussion goes on, though, the higher the risk that McConnell’s double game collapses.