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The Senate health care bill, in its current form, is dead.
The Senate health care debate is not over.
Sound familiar?
Senate Majority Leader Mitch McConnell (R-KY) hastily called off a planned Thursday vote on health care on Tuesday afternoon, as it became clear he did not have enough support to pass the measure.
It is clear, however, that McConnell and his fellow Republican senators view this delayed vote as a temporary obstacle, not a death knell for Obamacare repeal. Senate leadership has reportedly set a Friday deadline for a new draft of the bill. The Congressional Budget Office could score it next week, setting up a mid-July vote.
In thinking about what happens next in the Senate vote, I find it instructive to look at the House’s health care process. House Republicans failed to rally enough votes around the American Health Care Act during their first attempt at a vote, in March. But two months later, with some relatively minor changes, House Speaker Paul Ryan was able to get his caucus on board.
The House process demonstrated that the desire to repeal the Affordable Care Act is strong and motivating to Republican legislators. Nobody wanted to be the one member of Congress standing in the way of delivering on a campaign promise the party has made for the better part of a decade.
“I definitely don't like everything,” one Republican member of Congress, who requested anonymity to speak openly, told me recently. “I'm probably going to support it. It's going to be really hard to explain to your Republican constituents who elected you that you couldn't support the thing you've been campaigning on.”
It’s hard to vote for a bill one week after its introduction. It’s easier to vote for that bill after you’ve had a few months to take in the policies, lobby for a few tweaks to the language, and have your arm seriously twisted by the White House and Senate leadership.
All of which adds up to: A canceled vote today doesn’t say much about the Senate’s longer-term Obamacare repeal prospects.
What the House Obamacare repeal process taught us: Republicans really want to deliver a law
On March 24, around 4 pm, House Speaker Paul Ryan stepped in front of dozens of reporters and declared “Obamacare is the law of the land. … We’re going to be living with Obamacare for the foreseeable future.”
I watched the press conference in the Asheville airport, on my way back to Washington after my honeymoon. I expected that my one-week trip had meant I missed the health care debate entirely. After all, Ryan said the law would remain standing.
Boy, was I wrong. What Ryan didn’t control was the rank-and-file membership’s desire to pass an Obamacare repeal bill. Policy qualms about the House bill gave way to political hopes.
Conservative members began to whittle down their demands to two (admittedly big) things, and worked those into the bill. Moderate members were ultimately swayed with small amounts of money to help Americans with preexisting conditions. News coverage died down a little bit, helping the House operate with slightly less public focus.
On May 4 — exactly 45 days after that Ryan press conference — the House passed the American Health Care Act. There was a second press conference, this one in the White House Rose Garden, to celebrate the occasion.
The lessons I took from the House debate were threefold.
First, Republican legislators are really motivated to deliver on the big-picture goal of Obamacare repeal even if it doesn’t tackle the issues they purport to have with the health law. Case in point: Republicans have lamented the Affordable Care Act’s too-high deductibles as unaffordable. They passed a bill that would raise deductibles. The key thing seemed to be passing something called Obamacare repeal even if it didn’t address the specific problems legislators had raised about the law.
Second, Republican legislators are not deterred by a lack of outside validators. We saw groups ranging from the American Medical Association to the American Hospital Association oppose the House health care bill. Conservative academics who are no fans of Obamacare joined the pile-on, too. Still, Republicans pressed forward undeterred. The conventional wisdom that a health bill needs widespread buy-in to move forward in Washington was seriously undercut.
Third, coming around to this point of view does take time. It took Republicans in the House a month and a half to wrap their minds around a major piece of legislation, make some changes, and decide to pass it. Part of this was about making substantive policy changes, but part of it also seemed to be having a few weeks to think about the alternative to this bill — which was likely passing no Obamacare repeal bill at all. Many members decided that simply wasn’t an option.
The Senate is pressing forward on a new version of its health care bill
It’s clear that the Senate bill doesn’t have enough support to move forward at this point — but also clear that many of those opposed are eager to keep working on the issue.
“In the days and weeks ahead, I’m committed to continue talking with my colleagues about how we can fix the serious problems in our health care system while protecting Ohio’s most vulnerable citizens,” Sen. Rob Portman said in a statement, speaking to the opioid crisis funding in the Senate bill.
The dynamics in the House were, of course, a bit different. Significantly, the House had the safety blanket of knowing whatever they passed wasn’t the final word — it would just bounce the issue over to the Senate. Senators don’t have that luxury; they can reasonably expect that some semblance of what they pass would become law.
Still, the desire to repeal the Affordable Care Act is incredibly strong. It’s strong enough that McConnell isn’t calling it quits now that he can’t get his caucus together for a planned vote this week. The coming weeks will test how strong that desire is, and how far it can move their repeal bill.
