In the first five years after its passing in March 2010, the Affordable Care Act (or Obamacare) was targeted for repeal by House Republicans no fewer than 54 times. The attempts varied from direct head-on assaults to cunning gambits to the occasional “oh also if you’d just sign this without reading it” under-the-radar attempt. Repeal of Obamacare was an important campaigning point for Republican presidential candidates in 2012, and a key talking point in 2016.
So that’s been fun for them.
Almost seven months into the Trump administration’s All Republicans All The Time version of Washington, the signature goal of not just Trump himself but also Paul Ryan, Mitch McConnell, and countless other right-wing Congresspeople continues to run up against the cold hard truth that people don’t want to be abandoned to the cruel vagaries of the American medical system. To say that the products of GOP attempts to have their cake and eat it too have been cartoonish is a dramatic understatement.
First there was the House bill, Trump’s signature legislative “achievement,” which was later derided by himself as “mean.” The Senate refused to take it up, instead deciding to concoct their own version in secret, hoping they could convince Senators to vote on it all but blindly before the July 4th recess. McConnell feared, of course, that having to go back among their constituents would scare some Senators out of line. Guess how well this one worked.
Having been unable to schedule a vote before the break, McConnell tried twisting arms on the return. The Better Care Reconciliation Act, as his version was dubbed, was postponed for a vote until John McCain could return to support him, since McConnell was already walking a razor’s edge and would need a tie plus Mike Pence to succeed. That gap created the time needed for not only the moderate opposition of Sen. Susan Collins (R-ME), but also for even harder-right opposition to manifest from Sens. Mike Lee (R-UT), Jerry Moran (R-KS) and Rand Paul (R-KY).
Trump, displaying his traditional level of compassion, had long advocated for straight repeal and the resultant suffering of Americans to apply leverage to Democrats. As one does. With the Republican “repeal and replace” having failed, he and McConnell pushed for straight repeal, passing a procedural vote to open debate on such a bill by a 51-50 margin. While Trump went on a tirade against Sen. Lisa Murkowski (R-AK) for opposing this plan, the Senate immediately moved on a version of the previous bill amended to include an additional $100 billion for Medicaid and a plan by Ted Cruz (R-TX) to permit insurers to offer the most bare-bones of insurance plans.
That failed too.
After a vote of 43-57, a fairly substantial rebuke to McConnell’s goals, the gloves came off. Wednesday saw the new plan lined up: straight repeal, and figure it all out afterwards (if at all). It should be noted that an identical bill, two years ago, passed the GOP-controlled House and Senate and went to President Obama’s desk. What prompted seven Republican Senators to defect this time, when the White House was sure to sign the legislation? What could have motivated them to defeat this measure, 45-55?
Therein lies the rub: Trump has announced that he will sign any health care bill that appears in front of him. When they sent the legislation to Obama, it was a political exercise, all part of the classic Washington dance. We get things done, they expressed with their votes; it’s the President who is obstructing the will of the American people. Now, however, there is no political cover left for America’s representatives from the Grand Old Party. Whatever bill they approve will be signed into law, and they will wear the consequences back home at the polling booth, a color made famous by one Lady Macbeth.
The most recent attempt came last night in the wee hours of the morning, with the House having issued special permission for McConnell to pull a literal fly-by-night stunt. This one was quite possibly the silliest of them all, with GOP Senators asking their House colleagues to promise that if the Senate approved the so-called “skinny repeal,” the House would reject it. That’s right: “I’ll vote for this to become law, but only if you promise that it won’t.” Most of us would reason that if one doesn’t want something to become law, one votes against that measure. Instead, as above, it’s part of a dance: one in which the House and Senate produce an agreement that there will be “repeal,” but require a conference committee to build on top of that. In fairness, it’s not a totally unreasonable position, though it does require a firm commitment from the House not to simply take the skinny repeal and run away with it.
Who runs the House again? Oh that’s right. Paul “Let ‘Er Fall” Ryan. Guess what he wouldn’t promise not to do.
What is a “skinny repeal,” anyway? Well, in short, it claws back the provisions of the Affordable Care Act that provide employer and individual coverage mandates, resulting in a law that exposes insurers to the highest-risk individuals without any enforceable provision to help counterbalance those risks. In short, it’s repeal by way of catastrophic collapse – an estimated 16 million would lose coverage, and projections suggest a 20% increase in health insurance premiums, a spike that would surely chase healthy buyers out of the market. While the subsidies and expansion of coverage would remain in place, the key to making the teetering stool that is the ACA work will have been thrown out. What do you call a two-legged stool? Scrap wood.
Let’s get back to last night: the “skinny repeal,” which few desire but many elected to vote for nonetheless, under the premise (as exemplified by Sens. Ron Johnson (R-WI) and Mike Rounds (R-SD), cited above) that the House would play nice – hopefully – and let a conference committee do its job. I wonder just how dreadful the sound of Paul Ryan salivating at 1 AM is. I’m sure it echoed down Constitution Ave, rattling windows and making small children wish for something less horrible, like the boogeyman. McConnell had chased down his defectors and gotten all his ducks in a row, expecting Murkowski and Collins to defect, ready to proceed 51-50 once more. Victory was within his snakelike grasp.
That’s when it all went off the rails.
It turns out that if you invite John McCain back to help you proceed, he’s also back when you don’t want him. With McCain a crucial presence in the Senate chamber, Sen. Schumer (D-NY) had a last-minute conversation with the onetime presidential candidate about his recent speech on bipartisan cooperation. Schumer came away smiling, McConnell’s face found its frowny groove once more, and what had looked like a sure thing became the closest defeat yet: 49-51, game, set, match.
After 40 minutes of strongarming from McConnell, from Pence, and even apparently a phone call from The Donald himself, McCain took a stand that he should have taken earlier in the week. He watched as the colleagues who had shared his concerns fell in line despite their misgivings. He torpedoed the skinny repeal. Why? Two very simple reasons, as he explained: first, that Paul Ryan hadn’t promised not to Paul Ryan things; and second, that the “skinny repeal” wasn’t what Republicans had been promising. The line, McCain asserted, was “repeal and replace,” and without a replacement plan in the bill, he declared that he wouldn’t support a flat repeal. It may be one of the last votes McCain ever casts, as he is scheduled to begin treatment for his aggressive glioblastoma.
So here we are on Friday, in the wake of the defeat of a bill it seems almost nobody actually supported. What comes next, besides the obligatory fury of a thwarted short-sighted narcissist down on Pennsylvania Ave? In the short-term, it would appear that the Senate will back off, though we shouldn’t hold our breath that the House won’t feel that the ball is back in their court. McConnell, for the moment, has declared that it’s time to “move on.” “What are their ideas?” he asked regarding the Democrats. “It’ll be interesting to see what they have in mind.” Perhaps we’ll get a breather before the dance begins again. Perhaps Republicans have familiarized themselves with Einstein’s definition of insanity. Perhaps the carnival of unforced errors this past week has sucked the enthusiasm and vigor out of Republicans for taking any more shots at a flawed but necessary health care law.
We’ll just have to see what next week brings.