What about the Senate?
In the event that the House of Representatives ends up passing the American Health Care Act Friday, Senate Republicans’ stated plan is to bring the bill to the floor next week. On its face, this makes almost no sense. Four Senate Republicans have already voiced loud, clear objections to the House bill’s Medicaid cuts. Two more say they won’t vote to defund Planned Parenthood. Bill Cassidy, John McCain, and Dean Heller have also voiced lower-key objections to the Medicaid cuts. And at least three senators — Ted Cruz, Mike Lee, and Rand Paul — have dissented on the grounds that the bill isn’t full repeal. Meanwhile, Johnny Isakson is at home in Georgia recovering from surgery, meaning Mitch McConnell can only afford one defection from his caucus.
Clearly, then, in order to pass, the bill would need to change. And while under McConnell’s plan the bill can be amended via the express “vote-a-rama” process on the floor, this is a very poorly designed mechanism for working out a compromise and building consensus. In fact, it would leave the bill prey to “poison pill” amendments in which 48 Democrats would join with a handful of Republicans to push amendments (on, say, Medicaid) that kill conservative support for the bill without gaining it any Democratic votes.
But not only are the problems with this strategy both large and obvious, but the Senate Republican leader is also a veteran legislator and probably the most impressive political tactician of the 21st century. Nobody believes he can’t see the flaws with his stated approach, which raises the question of what exactly he’s really up to. Here are the four leading theories circulating in Washington about what’s going on in the body that, ultimately, will do more to make or break Affordable Care Act repeal than even Friday afternoon’s dramatic vote.
It’s a mercy killing
Jonathan Chait’s theory is that McConnell is rushing the vote because he knows he will lose and he simply wants the whole thing over and done with as soon as possible. If Murkowski, Collins, and one or two others kill the bill from the left while Paul and one or two others kill it from the right, then everyone will have made their point and the party can simply move on to other things. It’s true that this will complicate House Republican plans for comprehensive tax reform, but the House GOP blueprint for comprehensive tax reform also appears to be dead on arrival in the Senate, where opposition from oil refiners, Walmart, and others simply makes it impossible to pass.
On this view, McConnell thinks Ryan is drawing dead in the Senate and has been from the beginning on both of his main legislative priorities. The goal, then, is simply to demonstrate as quickly as possible that this isn’t going to work, rather than generating a series of long, drawn-out struggles that poison the political atmosphere.
Then with the bill dead, the Senate can focus on things like confirming Neil Gorsuch, confirming Trump’s sub-Cabinet nominees, and passing some kind of tax cut.
There’s a secret plan
A diametrically opposed theory, which I’ve heard from several Capitol Hill Democrats, is that McConnell is moving boldly ahead because he knows he has the votes to pass an Obamacare repeal bill. Not the exact Obamacare repeal bill the House is currently talking about, but a somewhat more moderate version that would lead to less coverage loss.
On this theory, the text — or at least a solid outline — exists somewhere, and has been more or less agreed to by a critical mass of members. Then when that’s done, party leaders will return to the House and furiously twist the arms of conservative Republicans there to pass the bill.
MoveOn’s Washington director, Ben Wikler, is also warning his group’s members of this plan.
The widespread currency this notion has in Washington liberal circles is a testament to the level of respect Democrats have come to amass for McConnell as a shrewd political strategist. Faced with behavior that does not seem to make sense, many Washington Democrats believe there must be a clever secret plan at work. Yet the idea that a legislative initiative of this magnitude could be successfully kept under wraps somewhat strains credulity.
There is no plan
A third option is that things are exactly as they seem: There are 52 GOP senators who sincerely want to overhaul the Affordable Care Act but do not yet have a specific piece of legislation that 50 of them can agree to, and they simply think that moving very, very fast is the best way to build some kind of consensus.
That would fly in the face of decades of conventional wisdom on Capitol Hill about how you move a contentious bill.
But it would essentially emulate the strategy that Republican leaders in the House used. Rather than use the committee process as a forum for improving the legislative text and reaching consensus, Republicans have deployed a frenetic pace to maintain a constant high-pressure atmosphere that casts any kind of doubts and quibbles as an effort to derail the entire process. Since almost nobody wants to be the person who killed Obamacare repeal, constant deadlines serve to suppress doubts.
Perhaps Republicans really do think replaying those high-speed tactics — except even faster — is the best way to build consensus in the Senate.
McConnell is just lying
A fourth possibility — the one that seems most in keeping with the behavior of Senate members — is that McConnell’s talk of an expedited schedule is basically just a lie.
Back on February 6, Orrin Hatch (R-UT) the chair of the Senate Finance Committee, delivered a floor speech dedicated to pushing back on media coverage that portrayed the GOP caucus as hopelessly divided. He said that “the fact that there are some relatively minor differences of opinion shouldn’t be all that noteworthy,” given the inherent scale and complexity of the issues involved. But, he added, “the purpose of the legislative process — particularly the process we use here in the Senate — is to allow differences to be aired and worked through so that, at the end of the process, consensus can be reached.”
It was true, he conceded, that senators hadn’t yet reached consensus on all the details, but “differing views on some issues at the beginning of the process are to be expected, and once again, they are hardly noteworthy.”
Five days later, Burgess Everett and Jennifer Haberkorn reported for Politico that Lamar Alexander, chair of the Senate Health Committee, “is preaching patience as much of the GOP demands quick action,” saying, like Hatch, that to get repeal done would require a deliberative process.
This kind of talk vanished rather quickly as the House moved into overdrive, but the key players never disavowed it. McConnell’s talk of fast-track repeal may be essentially a bluff to encourage wavering House members to not ask too many questions about why they are being pressured to act fast when the Senate still has a lengthy process in its future.
The Senate is the key
Whatever the truth of the matter, despite today's drama in the House of Representatives it's the Senate that holds the key to the future of American health care policy.
Even if repeal passes the House today, it can't become law without the Senate’s say-so. And even if repeal fails today and the Trump administration decides to break off talks, the issue will remain alive in the Senate, and any progress toward repeal there would surely revive Senate interest.
McConnell is a much lower-key figure than Ryan or Trump, and someone who does far less to court either positive or negative media attention. But the Senate is traditionally where legislative agendas live or die, and 2017 is no different on that score. Whether Obamacare repeal ultimately happens hinges much more on whether the GOP’s shrewd leader does or does not have a plan here than on what plays out today under the bright lights in the House.