As the clock ticks down toward his self-imposed July 4 deadline to vote on the Senate version of a bill to replace the Affordable Care Act, Majority Leader Mitch McConnell is coming under pressure to produce the bill that he’s plainly anxious to keep secret as long as practically possible.
Nearly six months in, the 115th Congress has precious little to show for itself in terms of legislative accomplishments because lawmakers have dedicated months to produce a bill to replace the ACA, first in the House and now in the Senate. The House bill only barely scored a majority of votes when it finally came to the floor last month, and there was widespread agreement at the time that it couldn’t pass the Senate in the same form.
Related: As Costs Mount, States Warily Eye Changes to Medicaid in GOP Health Plan
McConnell drafted an all-male panel of 13 Republicans to produce an alternative to the House version. But the group has largely worked in secret, and most members of the Senate haven’t seen their proposal yet. However, it’s becoming more difficult with every passing day for McConnell to shield their deliberations from the public and his own party.
A vote before July 4 would require a Congressional Budget Office Score of a bill that apparently is not yet finished. Conservative hardliners in the House of Representatives are waving McConnell off any changes to the bill that would make it, in their view, less conservative.
Joseph Antos, a health care expert with the conservative-leaning American Enterprise Institute, says the situation “looks pretty grim” for McConnell and the Senate Republicans. “Clearly, Mitch McConnell would like to get this moving in some direction or another because time is wasting,” he said, and if the Republicans also hope to address tax reform through budget reconciliation this year, they must clear the decks of health care reform before the summer recess.
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“The questions for [McConnell]: does he put maximum effort into trying to get the 50 votes he needs to pass health care – does he work out special deals with what would turn out to be an awful lot of people? One of the risks that he runs is the more time Republicans in the Senate have to talk about things and hear from their friends in the House, the more difficult it will be to make a deal,” Antos said.
Even for McConnell, a man long accustomed to navigating the conflicting currents of the US Senate, the next two weeks are going to be treacherous. Here are some of the biggest hazards he’s facing.
Angry Rank-and-File Senate Republicans
McConnell’s determination to hash out the details of the bill in secret and spring it on rank and file Republicans and the public just days before a final floor vote may be a shrewd tactic to try to pass a politically radioactive bill, but it is wearing thin on many Republicans who will be asked to risk their careers in supporting the measure without having had any real input in the process.
McConnell’s decision to create a 13-member working group on health care comprised of ardent foes of the Affordable Care Act has miffed an array of more moderate Republicans who resent being left out of the critical negotiations. Even worse, most Republicans are totally in the dark about the legislation and are incapable of having an informed conversation with constituents or reporters about the consequences of the evolving legislation.
Senators including Bob Corker of Tennessee, Susan Collins of Maine, Lisa Murkowski of Alaska and Bill Cassidy of Louisiana who have voiced strong objections to the direction the legislation is taking – especially on issues regarding Medicaid, pre-existing medical conditions -- could end up opposing the final version.
Related: Senate Republicans Are Getting Closer to Rolling Back Medicaid Expansion
It only would take three Republican defections in a chamber where the GOP holds a narrow 52 to 48 seat majority to torpedo the legislation.
When asked last week if she was confident Senate leaders could produce a bill she can vote for, Collins replied dryly: “I have no idea. This really is a work in progress, and until I see the bill and the [Congressional Budget Office] assessment of the bill, I’m not going to feel comfortable taking a position.”
Corker said, “The process is better if you do it in public, and that people get buy-in along the way and understand what’s going on. Obviously, that’s not the route that is being taken.”
Wary House Conservatives
The House version of the bill barely scored a majority of that body, even though the GOP had a substantial numerical advantage over Democrats. One big problem was that many of the House’s more conservative Republican members didn’t believe the bill was conservative enough.
In a letter to McConnell on Monday, the House’s influential Republican Study Committee warned him that they would not support a bill that weakened any of four key elements of the American Health Care Act as passed by the lower chamber.
Related: How the GOP Health Care Disaster Is Opening the Door to Medicaid for All
The RSC demanded that the Senate bill immediate block more states from adopting expanded Medicaid under the ACA, and that states that did expand it have that program eliminated by 2020. They also want states to be allowed to waive the “Essential Health Benefits” enumerated by the ACA, to abolish all ACA-related tax increases, and to prevent any money from the government from funding abortion, a move that would also defund Planned Parenthood.
He Needs a CBO Score
Senate Republicans want to pass a health care reform bill through the chamber’s reconciliation process, which allows them to avoid a Democratic filibuster but also places restrictions on what the legislation can do. A major limit is that the legislation can’t add to the deficit outside the current 10-year budget window.
To prove that the bill won’t drive up the national debt in the years outside the budget window, Senate rules require McConnell to have the legislation scored by the Congressional Budget Office. Under normal circumstances, that wouldn’t be a problem, but McConnell is currently missing two key things: a bill for CBO to score, and time for its analysts to do their work.
Even if McConnell’s working group produces a bill this week, the majority leader will be cutting it close with CBO if he’s going to insist on a pre-July 4 vote. The healthcare industry accounts for something like one-sixth of the entire US economy and measuring the impact of a bill that reshuffles that entire sector is no small task.
Related: House GOP’s Health Plan Isn’t Much Better the Third Time Around, CBO Says
It is possible that the job could be eased somewhat if McConnell has been providing CBO with elements of the bill in advance, even if the final product isn’t complete yet. It’s also possible that analysts might need less time than expected if the Senate adopts large portions of the House bill, which it has already scored.
The Democrats Aren’t Going to Help: McConnell was never going to get any votes from Democrats to repeal the Affordable Care Act, which is why he has been so focused on finding a way to pass the bill through the reconciliation process. However, angered by the majority leader’s refusal to allow public scrutiny of the Senate version of the repeal bill, Democrats are now moving toward active obstruction.
While they can’t completely shut down the Senate, Democrats have said that beginning on Monday they will clog up the body to the greatest extent possible by objecting to requests for unanimous consent. That will force the GOP to jump through myriad tedious procedural hoops to advance almost anything through the body.
The GOP Health Plan Is Politically Toxic: GOP uncertainty and growing unease over the direction that Congress and the Trump administration are taking on the Obamacare repeal and replace legislation have also begun to spill over into the special elections this year and the 2018 congressional mid-term elections.
Related: The GOP Is Playing Chicken With Millions of Americans’ Health Insurance
The highly anticipated House special election in Georgia’s 6th congressional district on Tuesday to fill the seat vacated by Republican Health and Human Services Secretary Tom Price is being viewed by many as a referendum on Trump and the Republicans’ health care reform plan. If Democrat Jon Ossoff manages to beat Republican Karen Handel in the heavily Republican suburban Atlanta district, Democrats will be energized throughout the country in their bid to reclaim control of the House next year.
Moreover, the House-passed version of the GOP American Health Care Act has been overwhelmingly rejected by Americans in recent polls, and moderate Republicans may find it difficult to defend a vote in favor of a Senate plan that may come close to embracing key elements of the House plan.
The Community Catalyst Action Fund, a group opposed to the Republican efforts to replace Obamacare, today launched a $1.5 million TV ad campaign urging Collins and four other moderate Republicans to vote against whatever plan emerges in the Senate. The others are Lisa Murkowski of Alaska, Jeff Flake of Arizona, Dean Heller of Nevada and Shelley Moore Capito of West Virginia.
