The last thing one would normally think might happen in the balance of 2018 is yet another GOP effort to enact legislation repealing and replacing Obamacare. After all, Republicans failed spectacularly in that project last year, twice (or three times if you count the first aborted effort to enact legislation in the House last spring).
There’s no particular reason to think the odds of a Trumpcare bill passing have gone up (indeed, the GOP margin in the Senate has nearly vanished with Doug Jones’s special election win in Alabama and John McCain’s long absences for brain-cancer treatment). GOP leaders have all but packed it in for this Congress, believing the 2017 tax bill and confirmation of Trump appointees is a sufficient legacy to carry into the midterms. And the Trump administration is doing its best to undermine Obamacare via regulatory “reforms” and waivers, without further agony in Congress. Additionally, Congress does not plan to enact a budget resolution this year, the condition precedent for crafting a budget reconciliation bill that can pass the Senate with a mere majority.
Nonetheless, there are periodic reports of conservative plotting to make one more push before the midterms, like this quote from conservative health-care think tank chief Grace-Marie Turner:
“Congress is going to have to come back to a full repeal-and-replace measure, and we have been working every week since October to refine this legislation at the behest of the Senate. (Former) Sen. Rick Santorum has really been the energy behind this effort,” said Turner, who also explained the other players in the effort.
“Heritage Foundation, Ethics and Public Policy Center, the American Enterprise Institute, a lot of state-based think tanks and a lot of experts from around the country have been putting together a proposal that we believe cannot only get majority support in the Congress but majority support of the American people to fix this for good,” Turner said.
As you may recall, Santorum was given a lot of credit (or blame) for talking his former colleagues in the Senate into taking a second bite at the Obamacare repeal apple last all, using the state-focused Graham-Cassidy bill as a template. That didn’t work, but the sweater-vested conservative kept trying to design the perfect harpoon to bring down the Great White Whale. According to conservative journalist Quin Hillyer, the new/old legislative blueprint may be revealed “within weeks,” and will be greeted by lusty cheers from the usual suspects:
When they unveil it, expect a host of such [conservative] groups to make a concerted effort to rally grassroots support and give courage to House and Senate members to pass it. This is an amazing, even unprecedented project, truly growing up from activists and thinkers rather than being the usual top-down, elected-official-led exercise in sausage-making.
But there’s a major player in Washington that is already involved:
The White House has been quietly but constructively supportive of the project, I am told, and should provide strategic and communications support this time that is well planned, rather than the more seat-of-the-pants effort we all saw last year. Pence, in particular, has been personally engaged.
It would be typical of this White House to insist on a strategy that its own party’s congressional leadership hates with an abiding passion but cannot publicly denounce because it involves Obamacare. But what’s the political theory behind reversing the stand-pat posture of the GOP heading toward the midterms? If you guessed “base mobilization,” you get a gold star on your calendar. Here’s Hillyer:
Politically, the now-defunct assessment had been that passing a health-policy overhaul would scare too much of the public in an election year, making it a nonstarter. The growing understanding, though, is that Republicans are already at risk of losing to a “blue wave” this fall anyway, and that bold action to energize conservative grassroots might be the only way to stop the wave.
But as Cody Fenwick notes, there is another, perhaps more compelling, rationale for a 2018 Obamacare repeal effort which Republicans, understandably, may not want to talk about publicly:
Santorum and others may think that there will be a “blue wave” in 2018 no matter what, so this may be the last time the GOP has the opportunity to get rid of Obamacare. And that might make Republicans desperate enough to try again.
The idea that the House might be a lost cause this November, and that the trifecta Republicans have enjoyed since the beginning of 2017 may not appear again for a good while, could motivate Republicans to do as much damage to the hated welfare state as possible before giving up power. After all, a parallel motive helped convince Democrats to finish the job of enacting Obamacare in 2010 despite growing signs of a powerful public opinion backlash and a midterm GOP “wave.”
Everyone would agree that another failed run at Obamacare this year would not only depress “base” enthusiasm but would cap the record of this Congress in a self-humiliating way. So the biggest question is what Santorum & Co. have up their sleeves that would change the equation in the Senate without losing too many House votes. That’s unclear, but it sounds like the time-honored strategy of buying votes could represent the first and last recourse, according to Hillyer:
Under the original Graham-Cassidy bill, the formula for the block grants was seen by some as disfavoring states that already expanded Medicaid coverage under Obamacare. The new formula phases in the grants in a way that ensures those particular states will not see what amounts to short-term cuts in federal funding.
This might make the new plan slightly more expensive in the short run, but still well within budgetary parameters, and still better than deficit-neutral.
According to health-care expert Andy Slavitt, big bags of money may also be prepared for the states of Susan Collins and Lisa Murkowski, who helped deep-six Obamacare repeal last year.
There are significant corollary advantages, in other words, to the GOP’s abandonment of the fiction that it really cares about fiscal discipline. If their Obamacare repeal legislation looks a little porky, they can always schedule another Balanced Budget Amendment vote.
In the end conservatives will probably be unable to convince enough Republicans that this is a good idea in time to set into motion all the things that would have to happen (most notably that budget resolution) to make Santorum’s dream a reality. But if the president’s Twitter account gets behind it, anything could happen.