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Republicans are continuing to play a blame game for the failure of Obamacare repeal, and more and more of it is falling on Senate Majority Leader Mitch McConnell.
Today, a group of conservative activists — including former Virginia Attorney General Ken Cuccinelli and longtime partly gadfly Richard Viguerie — called onMcConnell and his entire leadership team to step down and reserved their greatest ire for the leader himself.
After listing myriad sins, the activists wrote that McConnell's "greatest betrayal" was his "failure to repeal Obamacare, the single most devastating piece of legislation against freedom ever crafted." They continue: “President Trump and the House of Representatives have done their part. You sank it all.”
To an extent, the activists' critique is oversimplified and self-serving. They're trying to scapegoat McConnell, whom they already dislike and have clashed with over conservative primary candidates, for repeal's failure.
Still, they're not entirely off the mark. The Senate is of course where the effort derailed. McConnell was supposed to solve the Rubik's cube and come up with a workable legislative compromise, and he obviously failed to achieve that.
Yet that raises a question that's much tougher to answer: What, specifically, could McConnell have done differently that could have gotten repeal into law?
1) Could he have gotten that one extra vote in July? It's possible to fantasize about arm-twisting or incredible persuasion that could have gotten one more vote for the "skinny repeal" bill back in July, from Susan Collins, Lisa Murkowski, or John McCain. (It's quite tough, though, given those senators' experience, popularity in their states, and histories of independence.)
But we should also remember that even that bill only came so close to passage because Republicans were promising their own members it wouldn't actually become law. They were in fact quite a bit further away from agreeing on a fuller repeal. So getting that one more vote wouldn't have been the end of the story.
2) Should he have been tougher on holdouts? There's also a strain of thinking, including from President Trump, that McConnell should have punished GOP senators who wouldn't play ball. "That should have been very easy to handle, whether it’s through the fact that you take away a committee chairmanship or do whatever you have to do,” Trump said in August.
Yet that seems like a brilliant way to permanently poison relationships and lose votes for tax reform. And it's worth remembering that when the Trump administration tried these "crude threats" tactics against Lisa Murkowski, they only backfired.
3) Should he have run a more open process? Finally, there are a bunch of gripes about McConnell's process, which involved skipping committees, writing a bill in secret, and trying to quickly ram it through the Senate. It indeed looked ugly, and McCain cited it in explaining his "no" vote.
But McConnell embraced this process for a reason: What Republicans wanted to do with health care was extremely unpopular. Throughout this process, all of the bills Republicans have put forward have polled horrendously. So it's not unreasonable, then, that McConnell thought "stealth and speed" was his best and only real chance of success.
And really, this is at the core of what happened here — the health care ideas Republicans presented during Obamacare repeal were extremely unpopular. They'd put off the hard work of designing a realistic replacement for the law for years. They'd promised to lower premiums and deductibles but seemed more interested instead in slashing government spending on health care.
So as the GOP grapples with the question of why they can't pass repeal, they really need to grapple with their failure to put together a plan that could withstand public scrutiny. McConnell's tactical failures are just a minor part of this larger issue.
Chart of the Day
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ACA Navigators say they're likely to lay off staff. My colleague Dylan Scott has a great new piece on all the ways the Trump is administration is sabotaging Obamacare, which you should read here. Here's some new data from the Kaiser Family Foundation laying out just how that's happening and showing how states' Navigator programs (which are charged with helping sign people up on the marketplaces) are responding to big funding cutbacks.
Kliff’s Notes
With research help from Caitlin Davis
Today's top news
- “In New Test for Obamacare, Iowa Seeks to Abandon Marketplace”: “If approved by the federal Centers for Medicare and Medicaid Services, it would allow the state to jettison some of Obamacare’s main features next year — its federally run insurance marketplace, its system for providing subsidies, its focus on helping poorer people afford insurance and medical care — and could open the door for other states to do the same.” —Abby Goodnough, New York Times
- “Senate Democrats ask Trump administration to renew gun research at NIH”: “Senate Democrats are asking the National Institutes of Health to resume conducting research on gun violence after funding lapsed early this year.” —Kimberly Leonard, Washington Examiner
- “ACLU, Planned Parenthood sue Missouri over new abortion law”: “The groups argue a recently passed law 'severely restricts access to safe, legal abortion' by requiring the same physician performing an abortion to be the one giving state-mandated information to a patient 72 hours before the procedure.” —Jessie Hellmann, the Hill
Analysis and longer reads
- “Trump May Do the Harm to Insurers That Congress Couldn't": “Despite seven years of alleged prep work and more than seven months of high-pressure effort, destroying the Affordable Care Act was beyond Congress this year. But President Donald Trump might manage it anyway, with an executive order he could sign this week.” —Max Nisen, Bloomberg
- “Weakening the Affordable Care Act will boost hospitals’ financial burden”: “Whenever possible, hospitals attempt to shift the costs associated with free care and bad debt onto other payers, like commercial insurers. Like pressing on one side of a balloon only to see another side bulge out, shifting the costs of uncompensated care eventually results in higher premiums for everyone else.” —Joel S. Weissman, Marc A. Cohen, and Amanda Reich, STAT
- “Anthem stops covering non-emergency medical conditions treated in the ER in three states”: “Anthem is no longer paying for non-emergency medical conditions treated in the emergency room in three states. The policy was rolled out in Georgia and Missouri this summer and has been in place in Kentucky since 2015, according to Anthem.” —Susan Morse, Healthcare Finance
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