Mitch McConnell’s Health Care Gambit: What We Don’t Know

WASHINGTON ― The GOP health care bill is not dead ― at least not officially.

Just hours before a promised Tuesday vote on a motion to proceed, Majority Leader Mitch McConnell (R-Ky.) was still working behind the scenes to win the support he needs to begin debating a Republican health care bill.

“Republican health care bill” is all we know. After years of complaints about the process Democrats used to pass Obamacare, Republican senators intend to open debate without a single hearing, without a single markup, and without clear knowledge of what they’ll be voting on.

Republicans spent time Monday night defending that process. GOP leadership member John Barrasso (R-Wyo.) said it was “absolutely” appropriate for Republicans to proceed, even without knowing the effects of a key part of their bill and whether it will take 60 votes to pass. When HuffPost asked Sen. Bob Corker (R-Tenn.) if the process was really better than that used by Democrats to pass Obamacare, Corker said: “We’ll see.” And Sen. Chuck Grassley (R-Iowa), answering the same question, said he would just like to see a bill passed.

The plan was for Republicans to vote Tuesday afternoon on a motion to proceed to the House-passed legislation. If that motion passes, Republicans could then put up amendments to replace that measure entirely. A repeal-only bill, a revised replacement bill, and legislation to give states the power to decide Obamacare all were expected to get a vote.

It wasn’t clear, however, what the text of those bills would look like, whether the provisions would survive the Senate’s Byrd rule, and ― the biggest question of all ― whether McConnell has the votes for passage.

Amazingly, the GOP plan just might work at winning Republican support ― an accomplishment for McConnell at this point.

The biggest news Monday night was that Sen. John McCain (R-Ariz.) would return to the Capitol on Tuesday for the motion to proceed. It’s hard to imagine GOP leadership bringing McCain back after last week’s surgery if they didn’t think his vote would be decisive, though McConnell may be trying to rally Republicans by using McCain’s presence. (Who wants to be the GOP senator who made McCain risk his health to fly across the country to cast an irrelevant vote?)

If McConnell can pull off this feat of beginning debate, no one should count out the Senate leader in getting a bill back to the House. But even if he gets 50 votes for the motion to proceed, McConnell will still face trouble passing a bill. Every previous version has had strong opposition from at least three GOP senators ― enough to sink the bill.

McConnell still has roughly $200 billion to dole out to win over reluctant Republicans. And if the Senate begins an amendment process, it wouldn’t be far-fetched to see lawmakers negotiating until they craft something that could get 50 votes (with Vice President Mike Pence breaking the tie).

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For weeks now, Republicans have been working on a Medicaid “wraparound” amendment, which would give some states additional money to soften the blow of Medicaid cuts in the Better Care Reconciliation Act. That amendment could be key to getting undecided moderates on-board, like Sen. Dean Heller (R-Nev.), Shelley Moore Capito (R-W.Va.), Rob Portman (R-Ohio), even Lisa Murkowski (R-Alaska).

Murkowski has looked like one of the toughest Republican holdouts. She has outright said she would not support a motion to proceed for the repeal-only bill, saying it would be devastating for her Alaska constituents, and she has raised concerns about the Better Care Reconciliation Act.

But as of Monday night, Murkowski said she was undecided on the motion to proceed to the House legislation. Asked if she knew what Republicans would be voting on after the motion to proceed, Murkowski said she didn’t.

“I’m told we’re going to be finding that out, which will be very important,” she said.

McCain’s presence could put additional pressure on Murkowski, in addition to Heller, Portman, and Capito.

One aspect to this gambit is the order of the legislation on which Republicans will vote. Sen. Rand Paul (R-Ky.), who plans to vote against the Better Care Reconciliation Act, but would vote for the repeal-only bill, has suggested he might oppose the motion to proceed if the repeal measure is not the first amendment after debate is opened.

“I can vote for a motion to proceed if we’ll proceed to a clean repeal,” Paul said. “Let’s see how we do on that one. If it doesn’t pass, they can put up their monstrosity insurance bailout bill.”

“I’m not for them saying, ‘Oh, we’re not sure what we’re going to,’” Paul added.

But asked point-blank if his vote for the motion to proceed was contingent on the repeal bill getting the first vote, Paul evaded a straight answer, saying Republicans promised people they would repeal Obamacare and he thinks they “ought to do it upfront.”

One vote GOP leaders seem to be counting out is Sen. Susan Collins (R-Maine). Collins said she would be a no on the repeal bill, a no on the Republican replacement bill, and a no on the House bill. But Collins said she couldn’t say where she would be on a new bill, and would vote yes on a motion to proceed to a resolution instructing committees to come up with a bill.

Collins said Monday that leadership had not contacted her in days ― a sign that even McConnell may have given up on her vote.

Senators may go along with opening debate, however, just to soften attacks against them for not repealing and replacing Obamacare, especially if they can park a vote on one of the alternative proposals ― all of which look destined to fail.

For Paul, and Sen. Mike Lee (R-Utah), who have said they won’t support the Better Care Reconciliation Act because it preserves too much of Obamacare, voting for the repeal-only bill is a good way to show their priorities and shift the blame onto moderates. For moderates, voting for the Better Care Reconciliation Act, but not the repeal bill, may be a way of blaming conservatives, as long as the legislation never comes back to life.

Collins, Murkowski, and Capito have said they will oppose the repeal-only bill, meaning it stands little chance of passing. And Collins, Paul, Lee, and Jerry Moran (R-Kan.) have all said they will oppose the Better Care Reconciliation Act, with a handful of moderates remaining cagey about where they stand.

If all the bills are going down, it isn’t exactly clear why McConnell would want to go through the exercise of opening debate, unless he actually thinks he can get the bill over the finish line. If senators like Heller, who said he would vote against the motion to proceed for an earlier version, are just going to vote against the repeal-only bill and the Better Care Reconciliation Act, it might look odd if he supports the motion to proceed, though Republicans could always say they thought it was appropriate for the Senate to begin debate.

But GOP leadership and President Donald Trump seem to be treating the motion to proceed as if it were support of the legislation itself. Maybe there’s something else we don’t know.

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