Chaos was the theme of the week, as Senate Republicans tried and failed to pass two health care bills only to coalesce around the strategy of passing a third bill that they all agree is bad — only to have that bill fail too. Meanwhile, the White House was almost entirely disengaged from this critical legislative process in part because the executive branch was tied up in internecine feuding that ended with the surprise announcement of a new White House Chief of Staff.
Things got so bad by the end of the week that completely inconsequential feuding involving the White House communications director overshadowed extremely consequential feuding between the president and the attorney general, and a total breakdown of communications between the military and the commander in chief.
Here’s what you need to know.
The Senate rejected three versions of ACA repeal
After an extraordinarily confusing week of votes, speeches, and amendments, Senate GOP leaders tried and failed to secure majority support for three different flavors of Affordable Care Act repeal — seemingly exhausting all their options.
- The Better Care Reconciliation Act: The BCRA, the Senate leadership’s original plan, would have replaced the ACA’s subsidized exchanges with a structurally similar but less financially generous system and then paired that new system with enormous Medicaid cuts that went far beyond simply repealing the ACA Medicaid expansion. That got 43 votes, drawing opposition from Susan Collins (ME), Tom Cotton (AR), Bob Corker (TN), Lindsey Graham (SC), Dean Heller (NV), Mike Lee (UT), Jerry Moran (KS), Lisa Murkowski (AK), and Rand Paul (KY).
- The Obamacare Repeal Reconciliation Act: The ORRA, which passed the Senate in 2015, simply undid as much of the ACA as was possible to undo through the 50-vote reconciliation process, leaving no replacement at all. That meant rolling back Medicaid expansion and eliminating exchange subsidies and taxes, with no further changes to programs and a huge increase in the number of uninsured. That got 45 votes, drawing opposition from Shelley Moore Capito (WV), Collins, Heller, Murkowski, John McCain (AZ), Rob Portman (OH), and Lamar Alexander (TN).
- The Health Care Freedom Act: Last and, honestly, least was the HCFA — so-called “skinny” repeal — that leadership slapped together at the last minute. The idea here was to undo Obamacare’s unpopular mandate, thus blowing up the exchanges while offering no alternative, but leaving Medicaid in place. Nobody really thought this was a good idea, but leadership tried to sell members on the idea that they should vote for it in order to pass the hot potato back to the House of Representatives. Many GOP senators who voted for it claimed to do so only after receiving reassurances from Paul Ryan that the House wouldn’t pass the bill. In the end, McCain joined Murkowski and Collins to kill this idea.
Republicans are running out of options
The skinny bill's failure leaves Republicans with a dwindling set of options. Technically, that legislation only fell one vote short of passing. But many of the senators who voted yes on it claimed to be doing so only in order to move the process forward, so now that the process has derailed, there’s little reason to see it as an especially promising starting point for a reboot. Here are three options going forward:
- Option 1: The president and party leaders could lean on the mercurial McCain to switch his vote, back skinny repeal, and kick things over to the House, which will either start a conference committee process to write a new bill (but what bill?) or else simply pass the skinny repeal bill. McCain seemed willing to do this for most of Thursday evening, only to flip late at night, so maybe he’ll flip back.
- Option 2: Republicans could try to hash out another, more popular bill along the lines of the BCRA and ORRA. Of the two, the BCRA was more moderate on its treatment of the exchanges and the ORRA less extreme in its treatment of Medicaid. Perhaps combining those two features could get more votes? But both of these strategies center on the inherently unpopular task of delivering worse health insurance to most people.
- Option 3: Republicans could forget about what the furthest-right members of their caucus want, and work with Democrats on a bipartisan set of fixes aimed at stabilizing the exchanges. To do this, the GOP would need to give up on the idea of giant tax cuts or huge Medicaid cuts, but “skinny” repeal does that already. Yet virtually nobody on the Republican side, with the exception of Susan Collins, seems to be advocating for this approach.
Trump named a new Chief of Staff
Reince Priebus, Trump’s White House Chief of Staff, had never been a favorite of the president’s, close to him personally, or empowered to do the job in a traditional way. But Trump mused about firing him so many times over the past six months that when he started musing again this week it didn’t necessarily seem to mean anything. But it turns out he was serious — Friday afternoon Trump announced that Priebus was out, and John Kelly, a retired general and current Secretary of Homeland Security, was in.
- Generals are Trump’s go-to: Trump does not have much respect for politicians and less for government bureaucrats, so he doesn’t like appointing people who have experience working in government. That’s a problem because he needs people to help him run the government. The main exception to this is generals, who he has tapped for several cabinet posts and who have the virtue of knowing something about public sector management and how the federal government works.
- A military Chief of Staff is unusual: That said, the pick of a military man for the Chief of Staff role is highly unusual. It was last attempted in the final chaotic months of the Nixon administration, when many of Nixon’s key aides had already resigned under pressure and General Alexander Haig served as Chief of Staff. Haig successfully kept the government running and managed the transition of power to Gerald Ford, but under the circumstances his ability to run a conventional policy-oriented White House was not really put to the text.
- Trump really likes the immigration issue: Whether you agree with the policy direction or not, one thing you can say for sure about DHS under Kelly is it has accomplished what Trump set out to accomplish. Immigration enforcement has become harsher, Central Americans appear to have become more reluctant to seek refuge in the United States, long-time undocumented residents have become more fearful, and things are more-or-less going according to plan. With the GOP legislative agenda in disarray, Trump is returning to the rhetorical tropes of anti-immigrant fear that won him the GOP nomination and empowering a competent ex-general who’s helped him translate those fears into policy.
Trump kind of banned transgender military service
In a Wednesday morning tweetstorm coinciding with the 69th anniversary of Harry Truman’s order desegregating the military, Trump announced a new policy barring transgender people from serving in the American military. Democrats immediately moved to block the order, and the unified generals who run the military said they hadn’t been consulted on the tweets and had no plans to actually do anything until they received clearer orders from the White House.
- Trump may have been confused: One theory about what happened is that Trump was trying to wade into a different debate, in which House conservatives are pushing a defense appropriations bill that would bar the military from paying for gender reassignment surgery. That's an important issue for transgender service members but a considerably narrower one than a complete ban — a difference Trump would appreciate if he understood this or any other policy area.
- Political blowback: White House officials swiftly moved to make the case that this was a stroke of political genius that would wrongfoot Democrat incumbents up for reelection in 2018. The immediate politics, however, went the other way, with Republicans such as Orrin Hatch (R-UT), Joni Ernst (R-IA), and Thom Tillis (R-SC) coming out against Trump.
- What’s next? Transgender service members are now in limbo, told by their commander in chief that they are unwelcome but not actually barred from serving until someone tells the top brass what the new rule is supposed to be. The White House, meanwhile, has provided no clear timetable for promulgating a real order or given any sense of what kind of process might lead to such an order.
Trump feuded with his attorney general
Having told the New York Times last week that he wouldn’t have picked Jeff Sessions to serve as attorney general had he known he would recuse himself from the Russia inquiry, Trump stepped up this criticism this week. In a Monday tweet, he referred to Sessions as “embattled.” On Tuesday he said Sessions “has taken a VERY weak position on Hillary Clinton crimes,” and by Wednesday he was slamming the AG for failing to fire the deputy director of the FBI. But Sessions aides tell journalists he’s not quitting, and Republican senators seem to have his back.
- What’s going on: Trump’s basic complaints aren’t about policy or personality; they are about Trump. Trump thinks Sessions should have gone to extreme lengths to protect him from the Russia inquiry, rather than following DOJ procedure and letting it be handled by less political people. Sessions is a true believer in an ideological position Trump has inhabited for the past few years, and Trump is a guy who believes above all else in Donald Trump.
- Many GOP senators are backing Sessions: Sen. Lindsey Graham (R-SC) threatened “holy hell to pay” if Trump fires Sessions, and Sen. Chuck Grassley (R-IA), who chairs the Judiciary Committee, suggested it might not be possible to confirm a new attorney general if Sessions were fired, so Trump would be stuck with Rod Rosenstein (who was the one who hired special counsel Robert Mueller to oversee the Russia investigation in the first place). Sessions was a senator for years, and senators like defending their colleagues.
- There are limits to what Trump can do: The whole episode is significant because it looks like for the first time, we found a line that congressional Republicans are not going to let Trump cross. Since liberals basically all hate Sessions, it’s not a line they’re very excited about. But it is a line.