Now McConnell is simply urging his members to vote for the motion to proceed on the grounds that they will have a virtually unlimited opportunity to amend whatever bill he brings up. What he’s really doing is trying to buy more time for a compromise to emerge, or for mounting pressure on wavering senators to flip “no” votes to “yes.”
Yet the hurdles for the Senate plan have only multiplied over the last week. First, Senator John McCain’s brain-cancer diagnosis left Republicans at least temporarily with one fewer vote to spare. Republicans were expecting he would miss Tuesday’s vote, but on Monday night his office announced he would be flying back to Washington to participate in the debate. His dramatic return could buoy the GOP, but even McCain has voiced concerns about the Senate bill and has not committed to vote for its final passage.
Then on Thursday, the Congressional Budget Office found that revisions to McConnell’s earlier plan had yielded virtually no improvement in its projected impact on insurance coverage or premiums. The CBO said that 22 million more people would still be uninsured as a result of the bill and that average premiums would first rise and then fall over time. Because Republicans retained more of Obamacare’s taxes on high earners in the latest version, it made a deeper reduction in the deficit. But the CBO also found that deductibles would shoot up in many plans, increasing overall costs for consumers.
On Friday, the bill took an even more serious hit when the Senate parliamentarian issued a preliminary ruling that several important provisions did not comply with budget rules allowing Republicans to pass the measure on a party-line, simple-majority vote. Those included anti-abortion policies prized by conservatives, state-based carve-outs used to garner votes in the House, and key changes to insurance regulations.
Yet another obstacle is still looming for McConnell, even if he can scrounge up 50 votes to begin debate: Neither the CBO nor the parliamentarian has weighed in on an amendment demanded by Senator Ted Cruz of Texas that would allow insurers to sell cheaper plans that do not adhere to Obamacare standards alongside ones that do. Insurers have warned that the proposal is “unworkable in any form,” and an aide said Monday that based on the parliamentarian’s first set of rulings, it was expected that the Cruz amendment would be thrown out. Cruz and Senator Mike Lee of Utah, however, have demanded some version of the plan be included in the bill.
Those challenges come on top of a bill that was already short of votes to begin with. A group of Republican senators from states that expanded Medicaid—Capito, Rob Portman of Ohio, and Dean Heller of Nevada—were already withholding their votes and pushing for more money to be restored. Heller is facing pressure to oppose the bill from his state’s GOP governor, Brian Sandoval, and Portman is facing the same from Governor John Kasich of Ohio, who on Monday said it was “a mistake for senators to proceed with a vote” and urged lawmakers to oppose the motion to proceed.
Leading GOP senators have suggested that if the motion fails on Tuesday, the party could try again later, either once McCain returns or if they eventually strike a deal encompassing 50 of their members. But after so many fits and starts, and so much time and political capital expended, it may be that the procedural vote is, as Trump said, the Republican Party’s last chance to make good on a fading health-care promise.