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"Stealth and speed": Senate Republicans’ health care strategy is a massive political gamble

These tactics may have short-term benefits, but they’re enormously risky in the long term.

Alex Wong / Getty
Andrew Prokop is a senior politics correspondent at Vox, covering the White House, elections, and political scandals and investigations. He’s worked at Vox since the site’s launch in 2014, and before that, he worked as a research assistant at the New Yorker’s Washington, DC, bureau.

Senate Republicans have not yet finalized, released, publicly debated, or held any hearings on their Obamacare repeal bill.

Yet they’re planning a vote on it next week.

Make no mistake, this is an intentional strategy. Majority Leader Mitch McConnell has calculated that Republicans’ best and probably only shot of repealing Obamacare is with a legislative strategy that combines stealth and speed.

First, there’s the stealth — McConnell’s staff has been crafting the Senate’s version of the American Health Care Act in secret, after weeks of private consultations and negotiation with several other Republican senators.

Then will come the speed — McConnell plans to bypass the committee process, bring the bill to the Senate floor, and hold a final up-or-down vote on it within days of its unveiling. Which means there will be remarkably little public deliberation or debate over that bill’s actual contents.

It’s a stunning process, and one remarkably different from the passage of Obamacare itself, which took many months and went through multiple committees. This bill would implement massive changes to a sector that makes up one-sixth of the US economy and if signed into law, it will greatly impact tens of millions of Americans.

And the tactics of speed and stealth may just be successful. Though it’s difficult to sift through the reporting on where a secret bill stands, it’s quite possible that the Senate GOP doesn’t want to be left holding the health care hot potato. After campaigning on repealing and replacing Obamacare for the better part of a decade, they may feel like they have to pass something.

But in acting hastily to solve a short-term political problem, the GOP will be taking immense risks with their long-term political fortunes if this already loathed policy that will likely hurt millions of Americans ever goes into effect.

Reconstructing the Republican decision to use stealth and speed

McConnell’s reasons for using stealth and speed are simple — these tactics maximize his chances of getting a health bill through, and even if the effort ends up failing, it gets health care out of the way so Republicans can move on to a tax bill. Here’s why.

  • Republicans control only 52 Senate seats, meaning they can’t beat a filibuster and advance any ordinary bill without substantial Democratic help. And GOP leaders calculated (probably accurately) that few Democrats would ever support something sold as a repeal of Obamacare.
  • Therefore, to pass the sweeping partisan health care and tax bills they want, McConnell and Paul Ryan decided they’d rely on the special budget reconciliation process, which requires only a majority vote and therefore can be done on party lines.
  • But the complex Senate rules on budget reconciliation essentially mean that they can’t do a health bill and a tax bill simultaneously — they need to do one first.
  • And they decided they’d do health reform first, for a variety of reasons I’ve explored at greater length elsewhere. (For one, they envisioned the health bill as a “repeal and delay” policy that would punt the hard decisions over replacing Obamacare until later, only abandoning that after backlash among members.)

So GOP leaders put health care first on the agenda, and planned to do it fast, along party lines. And then McConnell had to decide how, exactly, the Senate would go about crafting its bill — would he use the Senate’s traditional committee process, or bypass it?

It was back in February that I first heard, while interviewing a Senate Democratic staffer, that there was a rumor going around that McConnell wanted to skip the traditional committee process, instead bringing some modified version of whatever got through the House directly to the Senate floor.

You can see how this decision makes political sense. The committee process for Obamacare took many arduous months, which would have conflicted with the GOP’s desire for speed. That process itself was motivated in part by Democrats’ hopes of attracting Republican support for the bill, something the GOP has already ruled out this time around.

Furthermore, the GOP’s small margins, combined with the particular makeup of the two relevant committees, called into question whether they could even pass anything out of committee — for instance, the votes of Sens. Rand Paul and Susan Collins would both be necessary to pass a partisan bill out of the Senate Health, Education, Labor, and Pensions Committee.

So McConnell decided at some point that the Obamacare repeal bill would skip the committee process. Furthermore, he decided that rather than start work on a unique Senate proposal (as Democrats did in 2009), he’d wait and see what happened in the House of Representatives. When the House bill failed in March, this decision looked clever — McConnell had avoided tarnishing any of his members with a divisive and unpopular proposal. (In fact, many of them loudly criticized the House bill.)

But when the House took up its bill again and successfully passed an amended version in May, the pressure was all of a sudden on McConnell to deliver something, or be responsible for the failure of Republicans’ top partisan priority. And remember, the clock is still ticking, because the GOP wants to move on to tax reform.

So McConnell has spent the month and a half since trying to craft a proposal behind closed doors — first through a group of 13 Republican senators holding talks, and then through the even more opaque leadership-led process happening now. (Even Sen. Mike Lee (R-UT), a member of the 13-member working group, said this week that he didn’t know what was going on.)

All this is in service of a speedy vote planned for next week. This new push for speed appears to be in part because McConnell thinks it maximizes his chances of success. The unexpectedly successful House revival of the health bill — a deal was struck and the bill was brought up and passed before the news cycle or liberal activists truly reckoned with it, and before the Congressional Budget Office had even scored the new version — emphasized that stealth and speed were both crucial.

These tactics are also motivated, though, by that ticking clock and McConnell’s desire to move on to tax reform. My colleague Dylan Scott has written about the “show them a body” theory — in essence, the idea that McConnell would be perfectly okay with health reform failing on the Senate floor, so long as it’s definitively wrapped up soon. McConnell’s worst-case scenario, in this line of thinking, is not that the health bill fails, but that the health debate stretches on for months and prevents the Senate from taking up tax reform.

Whatever the truth, the stealth and speed tactics have been highly effective at minimizing media coverage of the unpopular Republican health bill, which has been absent from evening newscasts and newspaper front pages for months now. And this could well have the effect of deflating opposition from activists and constituents, who aren’t getting the message from the media that a vote on this thing is imminent.

What’s different — and not different — about what Republicans are doing here, process-wise

Now, it should be noted that secrecy itself is nothing new to Congress. The process of writing a bill generally is done in private. And in practically every contentious legislative matter, there’s a point when negotiations move behind closed doors and deals are cut among the relevant players.

That was true for what became the Affordable Care Act in 2009. And yet the policies at issue there were debated and modified over months in several different committees. The closed-door discussions were to nail down variations of policies that had already been extensively debated in public.

“The Affordable Care Act was far more publicly vetted with untold numbers of experts working on this issue,” says Sarah Binder, a political science professor at George Washington University and a senior fellow at the Brookings Institution.

It’s also worth noting that the particular tactical sequence of bypassing the committee process, having leadership or other key members of Congress craft a deal in secret, and bringing the results quickly to the floor is something that’s been increasingly common in recent years. This has been the process used in most of Congress’s last-minute government funding deals, bills to raise the debt ceiling, and even the permanent “doc fix” legislation.

“Congress has been moving to more centralized, leadership-led, behind-the-scenes process for a long time,” says James Curry, a professor of political science at the University of Utah and author of the book Legislating in the Dark.

But there are several enormous differences. For one, most of those behind-the-scenes deals have been at least somewhat bipartisan. “The bigger problem with Obamacare repeal is not the process; it’s that Republicans want to do something that the other party is 100 percent vehemently opposed to,” says Curry.

Second, health reform is an incredibly complex topic that will greatly affect millions of Americans’ lives in very serious and personal ways. According to Congressional Budget Office estimates, if the House heath bill is enacted, it will lead to more than 20 million fewer Americans having health insurance by 2026. Lives are at stake. This is dramatically different from, say, bills that perpetuate or even modify the government funding status quo.

Binder laid out these and other differences at the Washington Post recently, arguing that “the GOP’s extreme secrecy in hammering out a health-care deal strikes me as different in both degree and kind from past practice.”

The enormous long-term risks Republicans are taking

Overall, it’s clear why the combination of stealth and speed serves Mitch McConnell and Republicans’ short-term political interests here.

And yet one has to wonder whether he’s missing the forest for the trees.

The Senate process is still shrouded in such secrecy that we have little idea what the bill Republicans are preparing will actually look like. However, it’s clear enough that actually enacting anything like the House of Representatives bill would be an enormously risky move — both for millions of Americans and for the Republican Party’s political future.

Not only would that bill’s hundreds of millions of dollars in Medicaid cuts violate President Trump’s campaign promises, but its policy changes to the individual insurance market would hurt near-seniors with low incomes, among many other groups.

According to an analysis by the Upshot’s Nate Cohn, “the people who stand to lose the most in tax credits under the House Republican health plan tended to support Donald J. Trump over Hillary Clinton in the 2016 election.”

It’s downright bizarre that a political party would deliberately pass a new law that would disproportionately hurt its own voters, but the GOP seems set to do so.

For whatever reason — either the desire to bank some permanent tax cuts for the wealthy or the desire to please a base they think has long demanded Obamacare’s repeal — Republicans are forging ahead, despite this bill’s awful numbers and the strongly negative feedback they receive when it’s brought up.

They should think twice. Democrats forged ahead and passed Obamacare when it was already clear the bill was unpopular, optimistically telling themselves that once they passed the bill, people would like it and calm down about it.

What instead happened was that “Obamacare” became a stand-in for anyone’s woes with the health care system, and a club that every Republican in the country beat Democrats with over the next several years. (That’s before it even went into effect, and also after.)

Republicans seem set to repeat this experiment, only with a bill designed to hurt far more people in far more dramatic ways. That’s an experiment that could end very badly for their party.

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