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Mitch McConnell should save his legacy by crafting a bipartisan health care fix

Tom Williams/CQ Roll Call/Getty

Mitch McConnell’s careful plans have been thrown awry. Four Republican senators have now publicly proclaimed they won’t even support a vote to begin debate on his health bill, effectively killing the measure in its current form. It’s too early to declare Obamacare repeal dead for sure, but it’s clear McConnell has to return to the drawing board for the time being.

He should take this as an opportunity.

As I argued in a feature on McConnell published Monday, the heavy-handed, secretive tactics he was using to try pass the bill — skipping committees, writing the bill behind closed doors, ignoring its dramatic unpopularity, not even trying to reach out to Democrats, and trying to quickly ram a vote through on a party-line basis — were doing grave damage to the Senate, and to McConnell’s legacy.

This isn’t just a concern about tactics. The reason McConnell chose those tactics is revealing. It’s because his underlying bill was so unpopular and controversial that a more open process would surely have doomed it. He wanted to win a once-in-a-generation partisan accomplishment by slashing hundreds of billions of dollars in government spending on health care, and he thought stealth and speed provided him his best chance of success.

But all this looked remarkably hypocritical — indeed, it flatly contradicted McConnell’s previously stated beliefs on both how the Senate should be run and how good and durable legislation can be crafted.

So now McConnell should return to his previously stated values, put aside the politically polarizing issues of Medicaid cuts and tax cuts, and deal with Democrats on a bipartisan compromise to actually fix Obamacare’s real problems.

McConnell has argued that the Senate is the country’s best institution at crafting bipartisan consensus

The Senate, McConnell argued in a major 2014 speech, should not be used as “an assembly line for one party's partisan legislative agenda.” If used that way — as he believed it was used to pass Obamacare in the first place — then the consequence would be “instability and strife” rather than “good, stable law.” He continued:

It may very well have been the case that on Obamacare, the will of the country was not to pass the bill at all. That’s what I would have concluded if Republicans couldn’t get a single Democrat vote for legislation of this magnitude. I’d have thought, maybe this isn’t such a great idea. But Democrats plowed forward anyway. They didn’t want to hear it. And the results are clear. It’s a mess.

McConnell’s theory is not one that partisans and passionate activists on either side will love to hear. Still, it’s worth noting that years of political instability and turmoil did in fact follow the passage of Obamacare — just as years more surely would have followed if McConnell passed his own even more unpopular health bill.

But, he said, there was another way. Because the Senate’s supermajority requirement for most legislation made it tremendously difficult to pass new laws on a partisan basis, it had functioned — and should function, he argued — “as a place to build consensus to solve national problems”:

Without a moderating institution like the Senate, today’s majority passes something and tomorrow’s majority repeals it; today’s majority proposes something, tomorrow’s majority opposes it. We see that in the House all the time. But when the Senate is allowed to work the way it was designed to, it arrives at a result that’s acceptable to people all along the political spectrum.

Still minority leader at that point, he finished his speech with a stirring exhortation. “Restoring this institution is the only way we’ll ever solve the challenges we face. That’s the lesson of history and experience. And we would all be wise to heed it.”

McConnell should heed his own advice and craft a bipartisan health fix

According to Politico, McConnell has warned his Republican senators that if they fail to pass his partisan bill, the GOP will lose its leverage and he’ll be forced to work with Chuck Schumer and Democrats on an individual insurance market fix.

Doing so, Schumer has made clear, would mean that Republicans would have to abandon their plans to cut hundreds of millions of dollars out of Medicaid, as well as their efforts (included in previous versions of their bill) to cut taxes in a way that mostly benefits the wealthy.

And that is exactly what McConnell should do.

The Affordable Care Act isn’t “collapsing” everywhere — not even close — but in certain areas, it really is badly troubled, and is in danger of leaving consumers with zero choices on the individual markets. These problems are particularly evident in rural counties in states like Ohio, Tennessee, and Missouri, as Vox’s Sarah Kliff recently wrote. Elsewhere, consumers complain that their premiums and deductibles are too high.

None of the various versions of the GOP House or Senate health bills were serious attempts to actually solve these problems.

Instead, the most important aspects of the bills were permanent, long-term cuts to Medicaid that went far beyond just repealing Obamacare’s expansion of the program or fixing Obamacare’s problems in general. Republicans hoped they could enact major cuts to a program that provides insurance for tens of millions of low-income Americans by cloaking it in the banner of Obamacare repeal.

Meanwhile, as far as the individual markets go, a Congressional Budget Office report concluded that the Senate bill would in fact make them worse in some ways. Deductibles, the nonpartisan scorekeeper predicted, would become so expensive for poorer Americans that “few low-income people would purchase any plan.”

Furthermore, the Senate bill wouldn’t have fixed the problem of insurers pulling out of marketplaces in some areas entirely, according to the CBO. “A small fraction of the population resides in areas in which — because of this legislation, at least for some of the years after 2019 — no insurers would participate in the nongroup market or insurance would be offered only with very high premiums,” the CBO report stated.

These are real problems that Congress should try to fix. Republican senators like Lamar Alexander of Tennessee, the chair of the Health, Education, Labor, and Pensions Committee, have already made clear they want to do this. And on Monday alone, Sens. Jerry Moran (R-KS) and John McCain (R-AZ) issued statements calling on the Senate to start over with an open process.

What McConnell is doing instead, so far

McConnell isn’t yet taking this path — instead, he’s announced that he’ll ditch his own replacement, and that the text he intends Republicans to work from is the repeal-only bill they passed in 2015.

This is a bill that provides no replacement for Obamacare at all, and sets repeal to take effect in two years. (It also avoids repealing many insurance market regulations the Affordable Care Act put in place, to abide by Senate budget reconciliation rules.)

The way this would work, procedurally, is that first he’d call a vote to bring up the House-passed health bill for consideration. Then he’d call a vote on substituting its text with the repeal-only bill. And then reconciliation’s special vote-a-rama process would begin, with all sorts of amendments being proposed and voted on. What comes out at the other end of that process, nobody knows.

It’s tough to say what the notoriously hard-to-read majority leader is thinking. Is McConnell hoping his senators (nearly all of whom supported this repeal-only bill in 2015) will now put their qualms aside and decide to open debate anyway rather than kill Obamacare repeal for good?

Or has he perhaps already calculated that repeal-only doesn’t have the votes and that he has to kill the partisan health effort so he can move on to tax reform — and a bipartisan health fix? (This would be the “show me a body” strategy my colleague Dylan Scott theorized about last month.)

We don’t know yet, and this drama isn’t yet over. But should McConnell wish to repair his damaged legacy and be responsible for a legislative achievement that actually lasts, there’s one obvious path: a deal with Democrats.

Read more on McConnell in my feature profile of him, published Monday.