The next few days are going to be pretty frantic in the Senate. The Congressional Budget Office just released its scoring of the Republican “repeal and replace” health care bill, and the numbers are almost as dismal as the House version’s. But will it matter? At this point, it’s impossible to really predict, as the entire political world waits to see what senators like Susan Collins and Lisa Murkowski have to say about it.
My best guess is that one of two things will happen. Either the bill fails because at least five or six Republicans declare their opposition, or the entire thing will pass with blinding speed and be signed by Donald Trump, probably on Independence Day.
Let’s take a look at the first scenario. As of this writing, five Republican senators have indicated they will not vote for the bill in its current form. Mitch McConnell has already thrown one change into the mix, penalizing people who don’t buy insurance for six months, in an effort to prohibit people waiting until they get sick to buy health insurance. McConnell is likely going to be open to other minor changes to woo fence-sitting members of his own caucus.
Of the five professed “no” votes, I personally only believe one of them is solid. Or maybe one-and-a-half. McConnell can afford to lose two votes, so this means the bill might just have enough support to pass by Thursday. The solid “no” is Dean Heller, who is coincidentally the most vulnerable Republican in the entire Senate. He’s up for re-election next year, his state is a purple state, and Nevada’s well-liked Republican governor is strongly against the bill because he knows how many Nevadans will be thrown off the Medicaid expansion the state accepted. So Heller’s stance is one designed to save his own political skin, and it’s doubtful any tweak accepted by McConnell is going to be able to sway him.
The other four GOP senators against the bill are quite likely just posturing. Ted Cruz is one of them, and his love for such posturing is well-known. These four are on the Tea Party side of the Republican Party, and their complaint is that the bill is not Draconian enough. For them, 22 million people losing their insurance simply does not go far enough. But of the four, only one of them has any real record of voting his libertarian political conscience in the face of overwhelming Republican pressure: Rand Paul. And from comments he made over the weekend, even he seems to be wavering. So that’s one solid and one possible “no” vote. If Paul holds firm, this means that McConnell cannot lose any other votes to pass the bill.
The pressure being brought to bear by McConnell and the rest of the party upon the fence-sitters is simple to define: “This is going to be our only shot at repealing Obamacare, so even if you don’t like parts of it, we are going to paint you as a traitor to every promise Republicans have made to get elected for the past eight years if you vote against it.” If McConnell only manages to get 49 votes for the bill, then what that means is that the entire well-funded weight of Republicans who sincerely want Obamacare repealed will fall upon those three senators. This will be a multimillion-dollar campaign, and all three will likely face right-wing primary challenges in their next election. They will, in a word, be demonized ― by their own party.
This is why I doubt the bill will fail with only three Republicans voting against it. I think it’s much more likely it either passes or fails with more GOP defections ― perhaps as high as a dozen. In this scenario, we may not even ever know for sure how many were going to vote no, if McConnell pulls the bill from the floor at the last minute. If he knows he’s going to lose big, he may spare his members from having to go on the record ― no matter what he says to the contrary, right up to the point he pulls the bill.
I say all of this because of the concept of safety in numbers. If there are more than just three defections, then any one of them can’t be personally painted as “the vote which killed the bill.” If it becomes obvious within their caucus that the bill is doomed, then voting against it becomes less costly, politically, for each individual senator. The hard-liners can vote no and campaign on: “It wasn’t a full repeal.” The compassionate senators can campaign on: “It was bad for our state.” So if the bill does fail this week, I expect there to be (at the very least) four or five votes against it. We may soon see an indication of this, if the moderates begin weighing in after today’s brutal C.B.O. report.
The C.B.O. report can be summed up in one word, thanks to Donald Trump: mean. This is a very mean bill. Both versions of repeal-and-replace will kick over 20 million Americans off health insurance. Tens of thousands will die prematurely, through lack of this access. This is all being done solely to provide massive tax breaks to the wealthiest of the wealthy. There’s simply no way to spin this. The bill is so mean, even the Grinch would smile in approval. Poor people die so rich people can get a big tax break. What’s not for Mr. Grinch to love?
But this doesn’t mean the bill’s chances are dead. This could be the law of the land very soon. Because if the bill does pass, it’s going to sprout wings and fly so fast it’ll make your head spin.
Wavering GOP senators may be talked into deluding themselves, to put it bluntly. The House Republicans had a convenient fallback position when they voted: Senate Republicans would fix any possible problems with the bill, so it was OK to go ahead and vote for it, comfortable in the knowledge that Mitch McConnell would fix everything. This is quite likely the argument that will be used behind closed doors within the Republican Senate caucus in the next two or three days: “Don’t worry, the worst problems will be fixed in the conference committee with the House, after we pass this version.” This ignores the fact that the House version is worse, but whatever. It may prove to be a soothing enough delusion for people like Susan Collins to get on board.
What all of this ignores is that this particular section of the Schoolhouse Rock “I’m Just A Bill” process may not actually happen. Instead, once the Senate passes their bill, Paul Ryan may just offer it up on the floor of the House, untouched. If the House votes for the exact same bill the Senate passed, then no conference committee will be necessary to hammer out the differences, because there will be no differences. McConnellcare will become Trumpcare when it gets sent to his desk and signed into law. Which could happen with blinding speed. If the Senate passes the bill on Thursday, Paul Ryan may hold the House in session until Friday (or even Saturday) to force the bill to a quick vote before they all leave for the upcoming holiday. Trump, in this particular scenario, will quite likely sign the bill on Independence Day, for the obvious symbolism. “America is now free from Obamacare,” he will state, as he puts pen to paper.
The House Republicans will be motivated by the same argument used all along: “This is the only train leaving the station. This is the only bill you get to vote on to repeal Obamacare. You may not like parts of it, but if you don’t vote for it, you’ll have to explain to your Republican base voters why you voted against repealing Obamacare after promising you’d do precisely that for so many years.” As we’ve already seen with the initial Ryancare House vote, this is a powerful argument within the Republican caucus.
Nobody has any idea, at this point, which of these scenarios is more likely. But out of all the possibilities, I think these are the two most probable outcomes. I say this because there is one dynamic which isn’t likely to change. The more the American people find out about the Republican plans, the more they dislike them. In other words, as time goes on, public support dwindles. What this means is that a conference committee could be politically devastating for Republicans. It would take weeks (at the very least ― months is much more likely) for such a committee to come to agreement. If the conference committee didn’t come up with some compromise by August, then there’d be a whole month for the implications to sink in (and, as a side result, Republican townhall meetings would become an extinct species). The only news about the bill during this time would be Republicans bickering about how mean they really want to make it. Public support ― already incredibly low ― would sink even further.
This dynamic also works against the Senate deciding not to vote this week and spend a little more time on it, which would again push the whole debate into July. Remember, the first time the House tried to pass their bill it failed. But then a few weeks later, they jammed it through. This is a possibility in the Senate, but that C.B.O. report is not going to substantially change even if the bill is tweaked here or there in an effort to corral the final votes. Tens of millions would still lose insurance. The only thing delay would accomplish would be to give Democrats and other opponents of the bill more time to make their case to the public. Since they’ve got a pretty strong case to make, this wouldn’t really help wavering Republicans get to a “yes” vote.
This could be the week that either Obamacare dies or the Republican effort to repeal it dies, at least for the rest of this calendar year. Whichever happens, it will likely ― by design ― happen with blinding speed. Until the so-called “Republican moderates” weigh in, it’s impossible to say which is more likely. But now that the C.B.O. has released its report, the meanness of the effort is part of the public record. Obamacare’s fate hangs in the balance of whether a handful of Republican senators can accept tens of millions of citizens losing health insurance in order to provide an almost trillion-dollar tax cut to the wealthiest Americans. By doing so, they’ll incidentally be unifying the Democratic Party and providing an unavoidable and central focus to next year’s midterms. The Democratic ads will all but write themselves, now that the C.B.O. has provided the numbers to use. That clip of Trump admitting he called the House bill mean will figure prominently, as well.
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