Senate Majority Leader Mitch McConnell is done herding cats on his party’s catastrophic “repeal and replace” health-care bill, ending for now the GOP’s seven-year quest to unravel Barack Obama’s signature achievement, the Affordable Care Act, which Republicans have likened to a deadly plague or an Earth-killing meteorite.
It now looks like McConnell’s short-term goal is to teach a tuned-out president that griping from the sidelines about legislation he hasn’t shown much interest in comes with a steep price. But more important, he will succeed in delivering a “dead body” to the Republican base so he can say he did his best and move on to his true passion, cutting taxes on the wealthy.
Here’s the tell: After Republican Senators Jerry Moran of Kansas and Mike Lee of Utah became the third and fourth vote against moving to take up the Better Care Reconciliation Act, McConnell announced that he would bring to the floor for a vote the same repeal bill that the GOP-led Congress passed in 2015.
But that bill, passed when an Obama veto was guaranteed, isn’t a serious piece of legislation. It was a shambolic hunk of red meat for the GOP base. Designed to conform to Senate reconciliation rules that allow passage with a simple majority, it killed all of the ACA’s taxes and subsidies but left its market reforms intact. The repeal-only plan kept the dreaded individual mandate in place, but assured that it would never be enforced. If it were ever enacted into law, the plan would destroy the insurance market and hurt tens of millions of people. Insurers wouldn’t be able to charge older people significantly more than younger people, or deny coverage for those with pre-existing conditions, but all of the mechanisms that make those popular provisions possible would be gone, leading to a rapid death-spiral.
The Congressional Budget Office found that the year after its enactment, 18 million people would lose coverage and premiums would increase by an average of 20 percent more than they would under the current law. Within ten years, compared with the ACA, 32 million would lose coverage and premiums would double.
McConnell’s plan is to delay the bill’s implementation for two years, to give his caucus time to come up with a replacement, but nobody believes the passage of time will make it any easier to come to an agreement.
McConnell had alternatives, at least in theory. If he were serious about pursuing a “clean repeal,” conservative think tanks have come up with various theories about how the ACA could be torn up from the roots through reconciliation. If he were hesitant to kill the filibuster for legislation, he could bring a full repeal bill to the floor and simply overrule the Senate parliamentarian’s judgment about what does and doesn’t qualify under the rules of reconciliation. By holding a vote on an impossible piece of legislation, McConnell can extricate his party from the corner they’ve painted themselves into.
While the ACA has some real problems, Republican rhetoric about its ills and the party’s denial of its very real benefits have been totally divorced from any objective reality. Their opposition has made the law more popular, as people contemplate the status quo ante, when insurers were free to engage in egregious abuses and 79 million Americans, more than one in four, were either uninsured or underinsured.
They’re ideologically incapable of replacing it with anything that wouldn’t strip coverage from millions of Americans, resulting in an untold number of unnecessary deaths, because it takes real dollars, not slogans like “freedom,” “choice,” or “patient-centered care,” to cover people who can’t afford health insurance. Their base is howling with fury about their inability to deliver on their promises now that they own the entire government, and everyone else is rightly incensed about the damage they’d do if they did deliver. You can’t blame McConnell for wanting to bring this slow-moving disaster to some kind of conclusion, at least for the next year.
While this outcome reflects some serious ideological disunity in the Republican caucus, there is no doubt that it’s a significant victory for the anti-Trump resistance. The legislative process may have unfolded behind closed doors, but it wasn’t entirely out of earshot of the constant din of protests, both in Washington and back in lawmakers’ home states. Activists were not only in Republicans’ faces throughout, they helped keep the Democratic caucus unified. Just one quisling—a Joe Manchin or a Heidi Heitkamp—would have changed the dynamic in a big way.
But celebrations are premature. McConnell’s quest to strip health insurance from millions is a zombie that will never die while the Republicans are in power. And if the midterms don’t go very well for Democrats, the GOP may have a larger Senate majority in 2019, in which case obliterating the ACA once and for all will be an easier lift.