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McConnell should let the Senate try to craft a bipartisan health bill

What if — stay with me here — the Senate actually did its job on health care?

Senate Democrats Pass 'Nuclear Option' On Filibuster Rules
Sen. Lamar Alexander looks on as Senate Minority Leader Mitch McConnell speaks during a news conference on Capitol Hill, November 21, 2013 in Washington, DC.
Photo by Drew Angerer/Getty Images

With his health care bill teetering on the edge of defeat — “it's probably going to be dead,” said Sen. John McCain on Sunday — Senate Majority Leader Mitch McConnell is trying to scare recalcitrant Republicans by threatening that if they don’t vote for his bill, he might work with (gasp!) Democrats.

“If my side is unable to agree on an adequate replacement, then some kind of action with regard to the private health insurance market must occur,” McConnell said on Thursday.

The previous week he had framed the threat even more directly. "Either Republicans will agree and change the status quo or the markets will continue to collapse and we'll have to sit down with Senator Schumer," McConnell warned.

There are three things worth saying about this.

Point one: This is the opposite of how legislative efforts are typically constructed. Usually you try for a bipartisan outcome first and resign yourself to a partisan outcome only if that fails. McConnell has reversed this structure. A partisan bill is his preferred result, and a bipartisan process is his threatened fallback. Welcome to American politics in 2017.

Point two: The oft-given justification for McConnell’s no-Democrats-allowed approach to his health bill is that the Democrats would refuse, under any circumstances, to work with the GOP on this bill. And there’s a way in which that’s true — so long as Republicans insist on building their health reform process around tax cuts for the wealthy paid for by gutting Medicaid spending on the poor, they won’t find Democratic support. But as McConnell admits here, Democrats are willing to work with Republicans if the actual aims are — as Republicans often say — strengthening insurance markets and bringing down premiums and deductibles.

“It’s encouraging that Sen. McConnell today acknowledged that the issues with the exchanges are fixable," Schumer said in reply to McConnell’s comments. "Democrats are eager to work with Republicans to stabilize the markets and improve the law."

Point three: McConnell keeps warning that the only alternative to his bill and his process is a bilateral negotiation with Schumer. This is not true. The alternative to his bill and his process is the way the Senate is actually supposed to work.

The committees that would normally write a health care bill are the Finance Committee and the Health, Education, Labor, and Pensions Committee. Both are, at the moment, well-staffed to take on this task. The Finance Committee is chaired by Sen. Orrin Hatch — a Utah conservative known, at least in the past, for working across the aisle — and the top Democrat is Oregon’s Ron Wyden, author of the bipartisan Healthy Americans Act and co-author of a health care proposal with House Speaker Paul Ryan.

The HELP Committee is chaired by Tennessee’s Lamar Alexander. This is fortuitous. Alexander is one of McConnell’s closest friends and widely considered one of the Senate’s most capable legislators. When I ask Democratic senators which Republicans they like working with most, he is nearly always mentioned. The ranking Democrat on the HELP committee is Washington’s Patty Murray, a member of the Democratic Senate leadership and the author of a successful budget compromise with House Speaker Ryan. Alexander and Murray are good at working together, too — they defied expectations and managed to reform No Child Left Behind on a bipartisan basis in 2015, and pass the 21st Century Cures Act in 2016.

Could Hatch and Wyden and Alexander and Murray work out a deal? I honestly have no idea. Republicans haven’t tried to endear themselves to Democrats amid this process, and the fact that they don’t know what they want to achieve on health care makes it hard to know what the space for bargaining is. But an actual committee process would be one way to find out.

Nor would Senate Democrats simply refuse to work with Republicans on health care in the hopes of killing Trumpcare altogether. No matter how embattled McConnell’s bill looks, Democrats remain afraid that, as happened with the House’s American Health Care Act, Republicans will pass a bad bill simply because none of them want to be blamed for killing it. Fear can be a powerful motivator for compromise.

A number of Senate Republicans have already called for the health bill to be returned to a traditional committee process. Kansas’s Jerry Moran says he wants Democrats brought back into the discussion so the two sides can “figure out where there are 60 votes to pass something.” McCain made a similar argument on Face the Nation. “Introduce a bill. Say to the Democrats, here's a bill. It doesn't mean that they control it. It means they can have amendments considered. And even when they lose, then they're part of the process. That's what democracy is supposed to be all about.”

The other upside of returning to a normal committee process is it would allow the bill to be written without the handicap of budget reconciliation — which means the insurance regulations, delivery-system reforms, and much else would be dramatically easier to address.

The collapse of McConnell’s health care bill would not leave him without options. He could, if he chose, do what he should have done in the first place and turn this issue over to the committees that are supposed to work on it, and see if there’s space for a bipartisan bill. Call it the Make the Senate Great Again plan.