Senate Republicans are pushing desperately this week to find a health care plan they can coalesce around — but hopes are fading, even among lawmakers.
Instead, observers in Washington think the Senate is preparing to take a failed vote that would bring a seven-year quest to repeal and replace Obamacare to a spectacular but definitive end.
It’s the “show them a body” strategy.
“I think the destination is already set. But what’s the path?” one Republican health care lobbyist, who asked for anonymity to speak candidly, told me. “They have to be able to show the electorate a body, to say that they tried and failed.”
That’s not Republicans’ preference, of course. Senators have been talking for a month and are reviewing more detailed policy options this week, as the pressure mounts for them to find a plan that can win support from 50 of the 52 Senate Republicans — which would still allow Vice President Mike Pence to be the tie-breaking vote. After House Republicans found a way to pass a bill, senators don’t want to be the ones responsible for failing to undo Obamacare.
Republicans have campaigned for years on repealing the law that they’ve derided as a government takeover of health care. Their base expects it and President Donald Trump is pushing hard to get a policy win after a tumultuous first few months in office. But now, with the time coming to make the tough policy decisions to enact their own vision for US health care, Senate Republicans are struggling to unite around a plan.
It’s a real possibility that they will come up short. The question then becomes: How do we get out of this?
The policy divisions are real — and they’re running out of time
Senate Majority Leader Mitch McConnell, known for choosing his words carefully, told Reuters he didn’t see the path to a majority yet. If it came to it, Republican lobbyists think McConnell and his lieutenants would opt for bringing up a bill they know won’t pass.
“I keep hearing that McConnell desperately wants to pivot and has to find his way out. He doesn’t want to arrive after Labor Day, with the only things to have happened are Russia and a really unpopular health bill,” another GOP lobbyist, who used to work in the Senate, told me.
Some senators have reflected those doubts, even saying openly that they doubt the upper chamber can unite around any comprehensive health care legislation this year.
"It's unlikely that we will get a health care deal,” Sen. Richard Burr (R-NC) said last week, while the Senate was back home for Memorial Day. “I don’t see a comprehensive health care plan this year."
The mood hadn’t improved when senators returned to Washington on Monday.
"I just don't think we can put it together among ourselves,” Sen. Lindsey Graham told Bloomberg.
The policy divisions within the Republican conference are significant. The House bill they’re taking up is estimated to lead to 23 million fewer Americans having insurance, overhauls Medicaid, and could unwind Obamacare’s protections for people with preexisting medical conditions. Senate Republicans remain divided on those Medicaid cuts, insurance reforms, and more.
A failed vote is the only way to unambiguously bring an end to the Obamacare repeal quest if they conclude they can’t actually succeed. Otherwise, they would likely face persistent pressure from Trump to find a compromise, which would risk bogging down the rest of their legislative agenda.
There would be little time for a tax overhaul or an infrastructure plan if the health care debate pushes late into the year.
A definitive “No” vote on repeal would also allow Republicans to turn to some smaller policy changes that would stabilize Obamacare’s markets, a course that some Senate Republicans are already urging.
Republicans only need 50 votes — but can they get there?
In what would be an ironic twist, the GOP’s decision to use a legislative shortcut that requires only 50 votes to advance their health care bill makes this “show them a body” strategy a little more painful.
That will likely require putting Republicans on the record opposing Obamacare repeal. But if Senate leaders want to move on to tax reform, which many consider more comfortable terrain than a bill that would lead to millions of Americans losing their health coverage, that might be the price they have to pay.
Under the normal legislative procedure, the bill would need to clear a 60-vote threshold before it could advance. In that scenario, Democrats would unite against the bill and it would fall short; Senate Republicans could in turn pin the blame for blocking Obamacare repeal on the minority.
“How do you do it in a way that you allow Democrats to kill it?” the second GOP lobbyist said. “If you couldn’t find a way to blame it on the Democrats, you have an obvious problem.”
But the Senate is moving its bill under “budget reconciliation.” The advantage is that advancing a bill would require only 50 votes, preventing a Democratic filibuster. But that only helps if you actually have the votes. If Senate Republicans decide they can’t get 50 votes, then the only way to definitively resolve the health care debate (other than announcing the impasse and hoping it will be left at that) might be to put the bill on the floor and force their own members to block it.
If the Senate doesn’t have a vote, they would likely face continued pressure from President Trump and outside conservatives to keep working on a plan and find some kind of compromise.
When the House initially fell short in late March, its leaders said the repeal pursuit was over. But the White House kept pressing lawmakers for a solution and, eventually, some inelegant policy fixes were found to send the bill to the Senate.
“We’re going to have a vote one way or the other”
The “show them a body” scenario could help explain why Senate Republicans are pushing ahead to draft a plan, with the goal of voting on it before the end of June, despite these unanswered policy questions. They are reportedly hoping to send legislation to the Congressional Budget Office by the end of the week for an official cost-and-coverage analysis.
Pressing ahead both puts members under pressure to support whatever bill the Senate drafts and also speeds up the end of a repeal effort that has bedeviled Republicans since they took full control of Washington in January.
"We're going to have a vote one way or the other,” Sen. John Thune (R-SD), the No. 3 Republican, told Politico.
McConnell is a deft political operator; leaving the matter unresolved and inviting continued pressure is the least appealing option. If he concludes his caucus won’t unite around a plan, forcing his own members to vote down Obamacare repeal might be his only choice.
“They’re gonna have a vote, I believe that,” a third health care lobbyist said. “I don’t know if it’s gonna pass or fail. If it fails, they just move on. If it passes, hooray.”