Ordered by President Trump to find some bill to repeal and replace — or at least repeal — Obamacare, a group of 20-some-odd Republican senators met last night for nearly three hours, and despite optimistic talk no magic new formula emerged. And even if they do somehow come up with a bill that can attract 50 votes, it will almost certainly include features that have made every GOP plan this year increasingly unpopular.
The roster of attendees was not clear, except that several moderates and conservatives who have been on and off the reservation for various reasons were there, while the two senators most adamant in opposing a repeal-and-replace plan like the Better Care Reconciliation Act of 2017, Rand Paul and Susan Collins, were absent. They all learned in the course of the evening that another absent colleague, John McCain, has been diagnosed with brain cancer, making his return to Washington for a planned vote next week on health-care legislation more uncertain than ever.
“Hard to say [if we’re closer]. I’m fine voting next week,” said Sen. Pat Toomey (R-Pa.). McCain’s absence “does complicate things. And I just don’t know if he’s going to be back.”
Privately, senators doubted they could get the 50 votes together for a health care overhaul despite the productive meeting. There was a feeling that while a session that occasionally turned into venting was therapeutic, the challenges facing the fractious 52-member majority may be too great to bridge.
“You understand the math. It just makes things kind of more difficult,” said Sen. Bob Corker (R-Tenn.).
Trump’s apparent conviction that Republican senators just haven’t spent enough time working toward a deal on health care is colliding with the underlying reality that enough of them are fundamentally divided on the basics to make the path to 50 votes extremely difficult. In particular, conservatives are insisting on long-term Medicaid cuts and changes in Obamacare regulations. So far Mitch McConnell’s strategy, of giving conservatives what they want from a policy point of view while giving more money to the states to mitigate the consequences, has not worked. It is not clear how or why more of the same, with the added ingredient of high-profile presidential pressure, will produce a breakthrough.
At this point, McConnell’s game plan seems to be to hold a vote on a motion to proceed to consideration of some sort of bill next week. If a new repeal-and-replace plan with some promise pops up, that will be the bill McConnell offers once a motion to proceed has passed. Otherwise he will go with the 2015 bill that simply repeals Obamacare with a two-year delay in the effective date. That option signals failure. CBO’s reminder yesterday that the 2015 bill would cost 32 million Americans their heath coverage while doubling premiums in the individual market makes passage of that legislation less likely than ever. There is no reason to believe the various GOP senators who are on the record opposing a straight repeal will suddenly change their minds.
Trump added to the agony of his party’s senators by publicly demanding that they cancel their entire August recess (two weeks have already been canceled) until such time as they pass health-care legislation. The president, of course, famously doesn’t quite “get” the policy details that are dividing his party. So he’s basically asking them to walk the plank. Some politically vulnerable senators may take a look at his approval ratings and the terrible public assessments for every known GOP health-care replacement plan and decide to take a walk instead. At this point, it still just takes one more recalcitrant Republican to sink the whole exercise, and if McCain doesn’t return, it will take converting Paul or Collins to turn it all around. Optimistic talk aside, this remains the longest of long shots.