Trumpcare As We Know It Is Dead

Photo: Alex Wong/Getty Images

Hours after senators Mike Lee and Jerry Moran announced their opposition to the Republican health-care bill, leaving Senate Majority Leader Mitch McConnell two votes short of the number needed to begin debate on the Better Care Reconciliation Act, McConnell finally admitted defeat. “Regretfully, it is now apparent that the effort to repeal and immediately replace the failure of Obamacare will not be successful,” he said in a statement issued late on Monday night.

McConnell isn’t just dropping the Republicans’ seven-year battle against the Affordable Care Act. He’s going to give the GOP’s original “repeal and delay” tactic one more try by holding a vote in the coming days on a straight repeal of Obamacare, with a two-year delay in implementation.

This approach involves using the version of the GOP health plan passed by the House in May, the American Health Care Act, as the vehicle for a Senate vote on the repeal-only measure. The amendment McConnell is talking about wouldn’t fully repeal Obamacare, as that would require 60 votes, and there are only 52 Republican senators. Instead, as the Hill explains, it would damage Obamacare as much as possible under the reconciliation process, which only takes 50 votes:

The measure guts the law by repealing authority for the federal government to run healthcare exchanges, and scrapping subsidies to help people afford plans bought through those exchanges. It zeros out the penalties on individuals who do not buy insurance and employers who do not offer health insurance.

The idea is that once Republicans start the clock on turning Obamacare into an actual “failure” (which, conveniently, will take place after the midterms), they can force a few Democrats to go along with the amazing GOP replacement plan (which they haven’t come up with yet).

As McConnell notes, Republicans already used this process to pass an Obamacare repeal bill, and only two GOP senators — Susan Collins and Mark Kirk — were opposed. However, that was back in 2015, when Republicans knew Obama would just use his veto to save his signature health law.

Now that the GOP is using real bullets the calculus is very, very different. “Repeal and delay” was all the rage among Republicans in November and December, when they were still giddy about Trump’s win. But that approach collapsed in January when President Trump and Senator Rand Paul agreed that Obamacare should be repealed and replaced simultaneously.

Weirdly, at the end of June, Trump and Paul started promoting “repeal and delay” as a novel strategy to solve the GOP health-care push. But in the past six months, at least nine senators have promised not to repeal Obamacare without a replacement plan.

There is almost no chance that the repeal-only measure will pass, especially because it already has a Congressional Budget Office score, and it’s even more horrific than the estimates for various versions of the failed GOP replacement plan.

As the New York Times explains, despite the delay in implementation, an Obamacare repeal vote would have immediate, possibly catastrophic consequences:

Obamacare’s insurance markets depend on the voluntary participation of private insurance companies, and most of them see those markets as difficult long-term investments. Many of them might choose to retreat to safer lines of business in the uncertain “zombie” period between the passage of such a repeal bill and its ultimate enactment.

The result might be chaos for consumers unable to find affordable plans — or even any plans, in some parts of the country. Lawmakers may not be able to control the timing of Obamacare’s demise with such a strategy.

But by holding the vote, McConnell is giving conservative senators the straight-repeal vote they’ve been calling for, and putting those who killed BCRA on the record. He’s also giving Trump just what he asked for after Moran and Lee came out against the bill:

Trying Trump’s strategy of blowing up Obamacare may tie him more closely to the bill that bears his name. His actions on Monday only underscored the idea that he’s been largely absent from one of his administration’s defining policy fights. He spent part of the day posing in a fire truck:

Then he had dinner with several Republicans to discuss the strategy for Obamacare repeal — but they were the wrong lawmakers. Lee and Moran weren’t invited, and Politico reports that the White House was “blindsided” by their announcement:

At a dinner with GOP senators on Monday evening, Trump said the party would look like “dopes” if they couldn’t pass the bill after passing a repeal bill in 2015.

“If the Republicans have the House, Senate and the presidency and they can’t pass this health care bill they are going to look weak,” Trump said, according to a source familiar with the meeting. “How can we not do this after promising it for years?”

Trump had no idea defections were coming tonight, according to another White House official with knowledge of the meeting. “Why would we have a dinner like that if we knew people were going to drop out?” the official said.

Democrats were celebrating a hard-fought victory on Monday night, but activists warned that the fight isn’t over, and Indivisible said it would move forward with plans for a day of health-care action on Tuesday. As Politico reported, Trump may not be engaged in the Obamcare repeal process, but he does care about winning — which means the danger still hasn’t passed.

To Trump, the Obamacare fight has always been about scoring a win. He doesn’t care nearly as much about the specifics, people close to him say, and hasn’t understood why legislators just won’t make deals and bring something, anything to his desk.

… Along the way, Trump has weighed various options, from not paying cost-sharing subsidies and letting the law implode to repealing it without a replacement – which he veered back to on Twitter Monday night.

“He told us months ago, we could just let it blow up and blame the Democrats,” said one activist who met with Trump at the White House.

This post has been updated throughout.

Trumpcare As We Know It Is Dead