Are Senate Republicans Really Doomed on Health Care?

By the GOP’s own assessment, passing a bill to replace Obamacare is unlikely, and lawmakers just want the issue out of the way. But don’t count Mitch McConnell out quite yet.

Aaron Bernstein / Reuters

It’s no surprise to hear doom-and-gloom prognostications about the likelihood that Senate Republicans will pass legislation to replace the Affordable Care Act. Pessimism is the default mood in the Senate, a chamber that demands consensus even when none exists.

What’s notable about the latest predictions of failure, however, is that most of them were coming from the Republicans themselves.

“It’s unlikely that we will get a health care deal,” Senator Richard Burr of North Carolina told a local television station last week.

“I just don’t think we can put it together among ourselves,” Senator Lindsey Graham of South Carolina chimed in on Monday, repeating his minority view—among Republicans, at least—that the party erred by pursuing a strictly-partisan approach to health care. Several other GOP senators have voiced similar doubts in recent days, suggesting that weeks worth of closed-door discussions have yielded few breakthroughs.

Even Senator Mitch McConnell, the majority leader taking charge of the project, has been steadily lowering expectations for success. “I don’t know how we get to 50 (votes) at the moment,” he told Reuters last week.

Replacing Obamacare was always going to be a heavy lift in the Senate. Republicans have a narrower majority there than they do in the House and can suffer no more than two defections on any party-line vote. Senators a month ago were saddled with a House bill so unpopular that they announced they were ignoring it and starting from scratch (although the emerging alternative looks like it contains most of the same ingredients). And the ideological policy disagreements—over Medicaid, tax credits, and insurance regulations—that nearly scuttled the House effort are just as pronounced in the 52-member Senate GOP conference.

Taken together, the collective negativity points toward a denouement that seems increasingly likely: Republicans will either announce that they can’t agree on a bill, or McConnell will put up a measure that he knows will fail so the party will move on to tax reform and the rest of President Trump’s stalled agenda.

Yet it would be a mistake to assume the Senate will strike out. The same sense of inevitability had set in over in the House after Speaker Paul Ryan pulled the GOP bill in March. Two months and several tweaks later, he rushed the measure across the floor. In the Senate, Republicans have done away with any pretense of transparency. There won’t be hearings, and if GOP leaders do complete a bill, they will reportedly make it public just a few days before they put it up for a vote. (One senator, Charles Grassley of Iowa, arguing that the lengthy public comment period in the House was a “public relations disaster” for the party.)

Republican operatives have complained that the expanding Russia investigations and Trump’s tweets-to-distractions have set back the legislative process, but they have also allowed the Senate to negotiate in relative obscurity, without the public firestorm that followed the House process.

For all of the criticisms Republican senators have levied in the last few weeks, none have definitively said they won’t vote for the eventual bill. After Graham told reporters that conservative Senator Rand Paul’s vote was “irretrievably gone,” the Kentuckian’s spokesman tweeted that he was still keeping an open mind. And a Tuesday briefing on the emerging plan appeared to sway one of the chief critics of the GOP’s approach, Senator Bill Cassidy of Louisiana, who has demanded that any bill include stronger protections for people with preexisting conditions than the House proposal.

That dynamic is exactly what allowed Republicans to salvage their once-doomed measure in the House: Lawmakers who had drawn bright lines in opposition eventually bowed to the pressures of party unity, hailing ostensibly cosmetic amendments as game-changing improvements. In a similar vein, the Senate bill appears to be edging closer in substance to the House proposal, despite the insistence of lawmakers that they were starting over. Axios reported on Tuesday that the Senate plan would still allow states to opt out of some key insurance mandates of Obamacare, just not the one forbidding insurers from charging higher premiums to people with preexisting conditions. And the Senate bill is still expected to rely on tax credits to help people purchase coverage while calling for a slower phase-out of Obamacare’s Medicaid expansion than the House bill.

The near daily reports of insurers leaving the Obamacare exchanges—which many of them blame on instability caused by the Trump administration—might also push some fence-sitting senators to support the GOP bill. A few lawmakers, including Cassidy and Senator Ron Johnson of Wisconsin, have floated the idea of first taking action to shore up the insurance market, but that has yet to gain traction among Republican leaders.

Speaking to reporters on Tuesday, McConnell again passed up the opportunity to make any grand pronouncements or Joe Namath-like guarantees on health care—other than that Republicans would soon have a decision to make. “We’re getting close to having a proposal to whip and to take to the floor,” he said. “We’ve had seven years to talk about health care.”

Earlier in the day, the majority leader gave a speech on Obamacare in which he spent more time blaming Democrats for not joining the GOP effort (although they were not really invited) than explaining how Republicans intended to fix it. That’s ordinarily a harbinger of legislation that’s about to fail. But as the GOP demonstrated last month, predictions of a bill’s demise can often be premature.