Following his stunning failure with the first announced plan to repeal and replace the Affordable Care Act, shot down by both moderates and conservatives in the Republican Party, McConnell is coming back to the table to give this one more try. He is postponing the August recess so that Republicans have more time to work on the bill, the full text of which
was released on Thursday, and to avoid the raucous town hall meetings and constituent events where unhappy voters express how they feel about the plan.
The odds remain slim that this new version of the bill will be any more successful. Over the Fourth of July break, McConnell's vote count deteriorated as more Republicans expressed their reservations or opposition to the bill. At this juncture, he cannot claim that he has the 50 votes that he needs from his 52-person majority, and a number of Republicans have made no bones about their dissent. Kentucky Sen. Rand Paul has made clear his opposition to the new bill, and Republicans Lindsey Graham and Bill Cassidy are teaming up
, as they announced Thursday, to work on an alternative approach.
McConnell seems to be hoping that the symbolic benefit of repealing the ACA is greater than the enormous pain that the legislation will inevitably cause in constituencies throughout the nation. Without any serious help from the President, and given the current paralysis of the White House, this is basically all that McConnell can count on.
Perhaps McConnell is hoping that enough Republicans on Capitol Hill, desperate to have some positive news coverage for their party, will vote yes.
Or perhaps the senator's strategy is to send his colleagues a bill that nobody likes in the hopes that the thrill of a major legislative victory will overcome their distaste for the legislative sausage they are about to hand out to the country.
Conservative Senate Republicans, as well as the Freedom Caucus in the House, won't be happy about that the revised bill McConnell has put forward walks back a major GOP promise
: it will not eliminate the Obamacare-era taxes on the wealthier Americans that conservatives have been clamoring about for some time.
To pass the bill, Republicans would have to vote to continue with taxes that they have been telling constituents are devastating to the economy -- and hope that Congress could pass separate tax cuts for the wealthy (a high-risk bet, given the laggard pace of Washington these days).
The major sweetener to conservatives is Sen. Ted Cruz's amendment -- the so-called Consumer Freedom amendment -- that allows insurance companies to provide cheaper policies that are unregulated, although it is not clear that will have the votes to pass either. Also of note are the inclusion of health savings accounts and tax credits for catastrophic health plans.
For many on the right, though, this replacement bill still contains too many regulations and too many taxes, a far cry from the clean repeal that they have been promising for years.
Conservatives, however, have more to celebrate than the moderate Republicans, who have been hiding from their constituents and dodging reporters. The new bil
l, like earlier versions, would impose draconian cuts on Medicaid. It will end Medicaid
as an open-ended entitlement program and convert it into a system of fixed payments to states. To be sure, the revised legislation does contain some changes aimed to appeal to constituents. It adds $45 billion in opioid treatment, offers about $70 billion more in funds to hold down the costs of premiums and stipulates that under public health emergencies, Medicaid spending in a particular part of a state would not count toward spending limits.
Even so, senators have been hearing from hospitals and doctors, as well as other powerful officials from the medical industry, who are warning about the detrimental impact of these cuts. Politico reported
that at a recent closed-door meeting, many Republicans were unhappy. "No breakthroughs. We remain in the same camp," said Dean Heller of Nevada who has been a big problem for McConnell. "No," said
Sen. Rob Portman when he was questioned about whether his opposition to the proposed reductions in Medicaid had changed.
With 20 Republican senators coming from states that expanded Medicaid under the ACA, this is
a bitter pill to swallow.
McConnell is surely hoping that one of the two Congressional Budget Office estimates of the likely impact of the bill (in terms of how many people are covered and at what cost) scheduled for next week (one with the Cruz amendment and one without) won't be quite as bad as the last go around, which produced devastating results
. But if the Cruz amendment survives and the individual mandate is gone, the legislation would surely produce higher premiums for the most vulnerable Americans: the elderly and those who are sicker. For many of them, quality health care would once again be out of reach.
Voting yes on the bill will be a vote to take away health care coverage for millions of Americans. It would also be a vote to impose steep cuts to hospitals in the rural areas that were crucial to Trump's and much of the Republican coalition's victories.
All of the changes to the legislation still need to survive the reconciliation process (which governs debate on budget-related bills not subject to filibuster in the Senate) where they will likely be challenged. To be included, each measure must be evaluated by the Parliamentarian, who plays the determining role in what provisions make the cut. And even if after all that, if the bill were to pass the Senate, a House and Senate conference committee would have to come to agreement on a revised bill before it could become law. Given how excited some GOP House members were about the undelivered tax cuts, that seems like a hard sell.
Meanwhile, Trump warned senators that "I will be very angry" if Congress doesn't send him a bill. The threat won't mean much to McConnell or Speaker Paul Ryan, who likely feel that the President and his administration have been one of the biggest obstacles to -- and distractions from -- legislation that should have been a slam dunk. Indeed, right as the Senate Republicans announced the revised bill, news alerts were popping up on smartphones nationwide, announcing that the Senate Judiciary Committee is requesting Donald Trump Jr.'s testimony about his meeting with a Russian lawyer and the related emails. Congressional Republicans' only chance is to pass this legislation in spite of the President.
And no matter what, that's going to be incredibly difficult for McConnell to pull off, because the essence of the bill is unappealing to so many Republicans. The legislation does not really deliver any major benefit. It does not satisfy the concerns of most on the right, and it is so harsh that it makes it difficult for a large number of Republicans to support. The secretive process in which the bill came to be is not really the problem -- the bill itself is the problem.
The challenge facing Sen. McConnell right now is whether there are enough Republicans who are willing to turn aside the torrent of criticism and the potential for dire ramifications on our health care system, just to finally have a taste of legislative victory.