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Senate Returns To Work No Closer To A Health Care Deal

congress-healthcare

The Senate returns to work today after a week-long recess with the leadership apparently determined to make a push to make progress on getting its version of a healthcare bill to the floor and passed, but things aren’t looking good at all:

Senate Republicans appear miles away from their long-sought repeal of Obamacare, returning to Washington on Monday with just a few weeks to put the pieces back together before they could be forced to abandon their partisan attempts at a health care overhaul altogether.

Over the July 4 recess, conservative demands hardened and surprising opposition to the Senate GOP’s first stab revealed itself in red states like North Dakota and Kansas. Republicans sniped over the merits of deregulating the health insurance industry and GOP senators began floating exit strategies in case they can’t agree on legislation, ranging from working with Democrats to amend Obamacare to simply repealing the law and figuring out how to replace it later.

Senate Majority Leader Mitch McConnell isn’t giving up yet, and his staff and allies toiled over the break to fashion a compromise that can get 50 of the Senate GOP’s 52 senators on board. The calculating Kentucky Republican could still find a deal that unites his fractious party. But McConnell and his whip, John Cornyn of Texas, are facing the party’s toughest legislative task since taking the majority in 2014.

At best, the repeal effort stayed stuck in neutral over the past nine days, several Republicans familiar with the ongoing negotiations said. At worst, the bill McConnell unveiled before the recess has little chance of being saved.

“My view is it’s probably going to be dead,” Sen. John McCain (R-Ariz.) said on “Face the Nation” on Sunday. “I fear that it’s going to fail.”

White House chief of staff Reince Priebus said on “Fox News Sunday” that such a result would be unacceptable. The rest of President Donald Trump’s agenda is already moving glacially through Congress. If the GOP’s six-month effort on health care is scuttled ahead of the August recess, the party risks coming up empty-handed during what is typically the most fertile period of legislating in a president’s first term.

“The president expects them to get this done. The president expects the Senate to fulfill the promises it made to the American people,” Priebus said.

The president also addressed the subject Sunday in a tweet: “For years, even as a ‘civilian,’ I listened as Republicans pushed the Repeal and Replace of ObamaCare. Now they finally have their chance!”

This week, McConnell is expected to receive critical guidance from the Congressional Budget Office on whether a flurry of tweaks made in June will improve on initial estimates that the bill would result in 22 million fewer people with insurance. The nonpartisan office is also considering whether premiums can be reduced further.

McConnell’s initial proposal was broadly similar to a version that passed the House in May, and it would repeal most of the taxes created by the 2010 Obamacare law and scale back subsidies that help people buy insurance. It also would make major cuts to the Medicaid program, which covers low-income families and people with disabilities, and allow insurance companies to charge older people more for coverage.

After that bill failed to get enough support among Senate Republicans, the GOP asked the CBO to weigh proposals that would leave in place Obamacare’s taxes on Medicare and wealthy individuals, allocate more money for low-income people’s insurance, allow pre-tax money to pay for premiums and supply $45 billion to fight opioid funding, according to senators and aides.

Republicans will also learn the impact of a proposal from Sens. Mike Lee and Ted Cruz to drag the bill further to the right by eviscerating Obamacare’s insurance regulations.

As you may recall, when we last checked in with the Senate McConnell and the GOP leadership had decided to cancel plans to hold a vote on the bill before the July 4th break when it became clear that there was simply no way the bill could pass due to opposition from both conservative and moderate Republican Senators. That decision came on the heels of a report from the Congressional Budget Office that estimated that some 22 million people would lose coverage under the Senate plan, only slightly less than the two versions of the plan passed by the House of Representatives that the CBO had previously evaluated. At the time it was decided to cancel the vote, the hope was that Republicans working behind closed doors would be able to come up with a revised plan that could be scored by the CBO during the recess and be ready for consideration with the Senate return. However, negotiators were unable to accomplish that goal and, as noted above, instead submitted a number of proposed changes to the original bill without any indication that any of them have much support from the GOP Caucus as a whole. Additionally, Texas Senator Ted Cruz has come up with a proposal of his own that would permit insurance companies to offer policies that don’t comply with the law’s minimum coverage requirements, a proposal designed largely to appeal to the conservatives who have said that the Senate bill doesn’t go far enough. All of these proposed amendments have been submitted to the CBO for scoring, and we should get the CBO’s response sometime this week.

As things stand, though, the road ahead for the Senate GOP’s plan doesn’t look good, and it will take some deft political maneuvering from McConnell and the rest of the leadership to get a bill passed before the Congressional recess at the end of the month. As things stand right now, the odds appear to be against them. The New York Times notes, for example, that support for the plan seems to have eroded over the week-long break in no small part because many Senators who returned home found vehement opposition to a bill that is quite literally the most unpopular piece of legislation in the past thirty years.  Given that, it’s likely going to prove difficult for Senators who came out in opposition to the bill before leaving town for the break to change their position unless the Senate makes significant changes to the bill. Given the fact that the objections to the bill range from conservatives who say it doesn’t go far enough to moderates who say it goes too far, especially when it comes to the changes for popular provisions such as the bar on denying coverage for pre-existing conditions and expanded Medicaid coverage, the odds that the GOP will be successful seem pretty low.

All of this places the Republicans on Capitol Hill in quite a difficult position. For seven years, they ran on the idea of repealing the Affordable Care Act, and the promise that they would do so was a prominent part of their fundraising appeals to the Republican base and the fundraising appeals of the various “grassroots” organization that made up the Tea Party movement. From 2011 through the end of 2013, House Republicans held votes to repeal the PPACA in whole or in part that they knew were not serious because they would never even get to a vote in the Democratic-controlled Senate. At no point during this period did they put forward any serious proposal to replace the PPACA with some alternative plan. In 2013, they went along with Ted Cruz’s idiotic idea to force a government shutdown they knew they could not win to allegedly “stop” the implementation of the PPACA that went forward in November of that year. After gaining control of the Senate in the 2014 midterms,  again without a replacement, because they knew the President would veto it and they would not have the votes to override that veto. Now that they are in charge, they come up with two very bad plans that, again, accomplish nothing of substance other than cutting taxes for the rich while leaving millions of Americans without health care coverage that they’ve come to rely upon. Now, they find themselves no closer to repealing and replacing the PPACA than they’ve ever been, and the prospect that failure on this agenda item will have an impact on what Congress is able to accomplish for the rest of the year. Perhaps things would be different if they’d spent at least some part of the past seven years coming up with a viable alternative to the PPACA, or a way to fix it that addresses the problems with the bill. The fact that they didn’t is the main reason that they appear to be headed to failure.

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About Doug Mataconis
Doug holds a B.A. in Political Science from Rutgers University and J.D. from George Mason University School of Law. He joined the staff of OTB in May, 2010 and also writes at Below The Beltway. Follow Doug on Twitter | Facebook

Comments

  1. Argon says:

    “My view is it’s probably going to be dead,” Sen. John McCain (R-Ariz.) said on “Face the Nation” on Sunday. “I fear that it’s going to fail.”

    Yeah, but guess which way McCain would vote. Senator ‘Maverick’.

    Like or Dislike: Thumb up 13 Thumb down 0

  2. OzarkHillbilly says:

    Senate Returns To Work No Closer To A Health Care Tax Cut for the Wealthy Deal

    Fixed that for you Doug, you’ll get my bill in the mail.

    Like or Dislike: Thumb up 7 Thumb down 0

  3. michael reynolds says:

    Of course Republicans can’t do anything on health care, they never intended to. Their motives run like this:

    1) Greed. The 1% want tax cuts.
    2) Ideology. This mostly applies to Rand Paul.
    3) Racist spite. The motive of Republican voters and most of Congress.

    What they really want is not better health care, they want that damn ni**er’s name off health care. That’s what this is about, and that’s why after seven years they’ve got nothing.

    Highly-rated. Helpful or Unhelpful: Thumb up 17 Thumb down 0

  4. OzarkHillbilly says:

    “The president expects them to get this done. The president expects the Senate to fulfill the promises it made to the American people,” Priebus said.

    I don’t remember any Republicans promising an increase in the # of uninsured by as much as 309% (in WV).

    I don’t remember any Republicans promising to cause the amount I pay for insurance to go up while making it possible for insurance companies to cover less and less.

    I don’t remember any Republicans promising to cause medical bankruptcies to skyrocket by bringing back annual and lifetime limits on what insurance companies will pay out.

    I don’t remember any Republicans promising to shift the cost of copays, deductibles and coinsurance from employers to employees.

    I don’t remember any Republicans promising to create a loss of 1.45 million U.S. jobs by 2026.

    I do remember them saying they would repeal the ACA but… Oooopps, that’s the same thing. Maybe somebody should have told people what Republicans were actually going to do? Wait a minute, I seem to recall a woman saying as much.

    Now what was her name?

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  5. gVOR08 says:

    I hope it’s dead, but this sure sounds a lot like the kabuki in the House just before they passed their POS bill. I’m seeing gop senators saying they don’t like the bill. I’m also hearing a lot of qualifiers like “the current bill” and no commitments to vote against this bill or one like it.

    Remember that their plan to pass additional tax cuts under reconciliation depends on passing this or something like it. They’re not walking away from it.

    Like or Dislike: Thumb up 10 Thumb down 0

  6. ptfe says:

    @OzarkHillbilly: “Oooopps, that’s the same thing.”

    Let’s be fair: their replacement plan is actually the issue. A straight-up repeal would probably be better than what they’ve proposed.

    Like or Dislike: Thumb up 0 Thumb down 0

  7. MarkedMan says:

    Republican congress critters always end up doing what they are told. Their “moderation” is only in the abstract.

    Like or Dislike: Thumb up 4 Thumb down 0

  8. MarkedMan says:

    @michael reynolds:

    they want that damn ni**er’s name off health care.

    Read more: http://www.outsidethebeltway.com/senate-returns-to-work-no-closer-to-a-health-care-deal/#ixzz4mSQ7JjTT

    I think it’s a little bit more complicated than this, and in a way that is important. A lot of Republican voters, and no small number of independents and Dems, resent such programs because they feel that most of the people on them are freeloaders. And yes, quite often they believe it includes most brown people. But they also know it includes their no good brother, and the tattooed twenty-somethings at cousin Edna’s wedding who were talking about how to scam disability, and the neighbor who’s been on Workman’s comp for a year but is seen riding a jet ski. A lot of these Republican voters don’t actually know any brown people but they do know a bunch of whites that seem to be scamming.

    Dems could make major inroads if instead of immediately crying “racist!” They said “you’re right! Nothing pisses me off more than someone scamming programs that are meant only for people who really need them. We better make darn sure we find those slackers and kick them off.”

    Like or Dislike: Thumb up 12 Thumb down 1

  9. Daryl's other brother Darryl says:

    Banana Republicans now think that Colleges and Universities are bad for the US.
    http://www.people-press.org/2017/07/10/sharp-partisan-divisions-in-views-of-national-institutions/
    Welcome to Trumpistan.

    Like or Dislike: Thumb up 5 Thumb down 0

  10. al-Alameda says:

    @Argon:

    Yeah, but guess which way McCain would vote.
    Senator ‘Maverick’.

    Let’s go wayyyy back, to the confirmation hearings for Betsy DeVos, shall we?

    There should have been more than 2 Republican senators willing to turn Trump down on this appointment, yet only Murkowski and Collins had the nerve to vote “no.” Pence was the tie breaker, and here we are with a Secretary of Education who is as hostile to public education has you can be without drooling uncontrollably as she speaks.

    What happened to ‘mavericks’ like McCain and Graham? Yeah …. long gone.

    Like or Dislike: Thumb up 7 Thumb down 0

  11. michael reynolds says:

    @MarkedMan:
    I am always prepared to spread a little bullshit for political advantage, but in this place I prefer the straight truth.

    No, Republicans do not think Obamacare is about their layabout cousin. They favor opioid money to treat their layabout cousin. They favor allowing their layabout cousin to buy health insurance despite his pre-existing condition. They even want birth control so that layabout doesn’t breed.

    In poll after poll, they like all the major elements of Obamacare except for one thing: Obama. That’s why the approval numbers change when you call it the AHCA rather than Obamacare. If it were Romneycare (and it basically is) they’d love it. A white president offering the same plan would be welcomed.

    Nothing about opposition to Obamacare is rational. It has nothing to do with improving coverage. Yet, despite their plan polling in the teens, Republicans are desperate to pass their asinine replacement. They are positively frenzied. Why? To get that ni**er’s name off it. Offer the identical plan but call it the Robert E. Lee Care Plan and they’d love it.

    I understand we may at times have to pretend that these people aren’t just nasty, small-minded people, but in reality that’s what they are. They are tribalist whites panicky over their perceived loss of status to blacks and immigrants and gays. That’s what the post-election analysis shows clearly.

    Like or Dislike: Thumb up 11 Thumb down 0

  12. ptfe says:

    @MarkedMan: “Lord, make me worthy to receive this doctor’s healing touch! If I be found wanting, remove my unemployed millenial name from the insurance rolls and smite me now!”

    I’m unimpressed that you assume health care is something we should means test.

    Health care needs to be considered a right in this country. While we may not be compensated identically for our chosen professions, our fundamental human value does not depend on owning a home or being able to buy steak for every second meal or having the means to pay thousands of dollars to a third party just to survive common human ailments.

    Your plan is just another way of saying “undesireables need not apply”, letting the wealthy make judgments on the poor and the white nationalists on everyone else.

    No, Democrats should do exactly the opposite of that.

    Like or Dislike: Thumb up 4 Thumb down 0

  13. MarkedMan says:

    @ptfe: Personally, I’m a universal health care person from way back. I don’t think it should be means tested. Obamacare (which I think is a fantastic program and have been speaking in favor of for years) is not universal health care and it is means tested. That’s not my preference, that’s just the fact. People with less income get bigger subsidies. People past a certain threshold get none. Such a system naturally creates some resentment and, more significantly, makes it easier for politicians and wealthy businessmen to generate even more resentment through phony or twisted representations. It’s why Republicans are constantly proposing to means test social security – they know it is the camel’s nose under the tent that will start to erode support.

    @michael reynolds: You and I may disagree on how many of the Trump voters or leaners are truly small minded and bigoted. (Or we may not. In the past few years of going back and forth with you on this site I’m pretty sure we could each argue either side of this one.) But for the sake of argument I’ll concede that every single one of them are dyed in the wool bigots. My point still stands – Dems could gain a lot by addressing their concern about being taken advantage of. Even a bigot might see the potential benefits for themselves but that motivation of not letting someone cheat you or play you for a fool is a very powerful one. Alleviating it as much as possible might win over a few voters who, once they get that out their mind, might be willing to put their own self interest forward.

    Like or Dislike: Thumb up 4 Thumb down 0

  14. Kylopod says:

    @michael reynolds:

    If it were Romneycare (and it basically is) they’d love it. A white president offering the same plan would be welcomed.

    Sorry, but I’m going to have to disagree here.

    If a white Republican had offered the same plan, they’d love it. But a white Democrat? We don’t even have to speculate about that: we saw how Republicans reacted to “Hillarycare” in the 1990s, and it’s not hard to imagine how they’d have reacted if it had passed.

    Would the hysteria have been to the same degree as with Obamacare? Maybe, maybe not. But there’s no question they’d have launched a hysterical crusade against it–which, in fact, they did.

    I’ve been discussing this with people for years–how much of the opposition to Obama is racially motivated–and I tend to come out somewhere in the middle. There’s no doubt in my mind that a lot of the anti-Obama rhetoric has a racial edge to it that even anti-Clinton hysteria never had. (I made the case here.) But you can’t just ignore the role of partisanship: that and racial attitudes are intertwined on the right in one big bundle. It’s possible that if a white Democrat (even a white male Democrat, if you like) had passed an identical health care law, the right-wing crusade against it wouldn’t have been quite as vitriolic or extreme as with Obamacare. But I’m sorry, you have to be blind to think Republicans would have embraced it.

    Like or Dislike: Thumb up 5 Thumb down 0

  15. michael reynolds says:

    @Kylopod: @MarkedMan:

    I would agree that GOP voters would (and did) oppose health care plans by white Democrats – seven years ago when we were initially discussing all this. But this isn’t 7 years ago, this is years into Obamacare, and the polls show that every major element of same is popular even with Republicans – so long as you don’t use the dreaded ‘O’ word. People are actually on Obamacare, and want to keep everything it gives them, nevertheless become rabid when asked about Obamacare. Is that rabidity, that desperate edge, even to the point of cutting off nose to spite face simply partisanship?

    No. Conservatives hated social security – came around. Hated Medicare – came around. Hated S-CHIp – came around. Hated Medicare and came around. . . except in hard right states.

    As mentioned, race and partisanship are intertwined in this country, and particularly so in the Southern Strategy legacy states. In Alabama the Democrats quickly became the black party, and Republicans the white party. So we have a bit of a chicken and egg problem there: which came first, the racism, or the Republicanism. Clearly the racism preceded the party ID. And that has not changed, if anything it is ever more clear that in the minds of conservatives it is black/brown/gay vs. white/Christian/old.

    So we have today a GOP that is the fruit of the Southern Strategy tree, a party where the SS legacies have taken over the party. It is not possible to disambiguate race from Republican party ID, and given that logically and historically race preceded party ID, it is reasonable to cite racism as one of the core motivations of Republicans.

    From very different roots the GOP morphed to exploit southern racism, brought that into rightwing media imagining it was a force that could be controlled, and in 2016 lost control entirely to what was once an extremist fringe. The argument that this is primarily tribal or partisan fails IMO, because we are talking distinctions without real difference. No part of modern Republicanism can be separated out from the racism and bigotry that provided the essential building blocks of GOP electoral success.

    Like or Dislike: Thumb up 2 Thumb down 0

  16. michael reynolds says:

    @Kylopod: @MarkedMan:
    By the way, I agree completely that we’ll have to do a bit of light pandering to these cretins, but that doesn’t change who they are.

    Like or Dislike: Thumb up 1 Thumb down 0

  17. michael reynolds says:

    Another way to come at this is to consider humans as a neural net fed various foundational images and concepts. Those core images are the fuel for what follows. Early Google Deep Dream was all about dogs, eyeballs and pagodas and no matter what else you gave it, it ‘found’ dogs, eyeballs and pagodas.

    That’s the way we all work unless we are very devoted to curating what’s in our brains and regularly re-examine presuppositions. This is why it’s so hard to change minds – people have spent lives uncritically piling assumption on assumption, have spent no time at all questioning those assumptions, and as a result are now strongly, even fanatically convinced of things which are demonstrably false.

    Like or Dislike: Thumb up 3 Thumb down 0

  18. Kylopod says:

    @michael reynolds:

    Is that rabidity, that desperate edge, even to the point of cutting off nose to spite face simply partisanship?

    No. Conservatives hated social security – came around. Hated Medicare – came around.

    But you can’t apply the same partisan models to the past, because the partisan divide was simply different. To some extent the right did launch a maniacal crusade against the social programs of FDR and LBJ (and to some extent, they never stopped), but it never fell strictly on party lines because the parties were a lot less ideologically unified than today. Back then there were genuine liberal Republicans and genuine conservative, even ultraconservative, Democrats. When Medicare was passed, half of the Republicans in the House voted for it. That sort of result is simply impossible to imagine with today’s GOP, regardless of the race of the sitting president.

    Besides, these discussions about the role of racism in opposition to Obama’s policies tend to distract from the most fundamental way in which racism has long played a role in shaping American conservative thought on the social safety net. As I mentioned the other day, when Social Security was first passed it excluded agricultural and domestic workers who included the majority of the black work force at the time. That was the price FDR paid for getting the Dixiecrats on board with the law. But when Truman proposed universal health care in the ’40s, that same group balked because they feared it might interfere with their beloved Jim Crow.

    Nowadays, SS and Medicare remain popular even among Republican voters, but many of those same voters routinely disparage people on welfare or food stamps. Indeed, I’ve personally known Republicans who are on welfare or food stamps who are still convinced most people on those programs are getting undeserved “free stuff” from the government.

    The social safety net in this country has always been heavily racialized, regardless of who was president.

    Like or Dislike: Thumb up 2 Thumb down 0

  19. Moosebreath says:

    @michael reynolds:

    “Conservatives hated social security – came around. Hated Medicare – came around. Hated S-CHIp – came around.”

    The first 2 took more than 7 years. A significant portion of the Republican Party was still hoping to kill Social Security when Eisenhower was elected, 15 years later.

    Like or Dislike: Thumb up 3 Thumb down 0

  20. michael reynolds says:

    @Kylopod:

    The social safety net in this country has always been heavily racialized, regardless of who was president.

    I agree. I just think the black president’s name on health care added a level of intensity and fervor. Racism is the pre-existing condition that makes lots of these people vulnerable to being fed nonsense. If you are convinced that the other party doesn’t just represent competing ideas, but a competing race, even an enemy race, you get the sort of fanaticism that drives the GOP.

    Look at GOP issues. Do you think Trump voters want to give rich people a tax cut? Or want less bank regulation? Or care about shutting down the consumer protection bureau? Nah. So what is it that motivates them to support an agenda that has nothing to do with them? Why do they fanatically support the GOP? It’s not the GOP agenda, it’s the fact that the GOP is the White People’s Party – that is their point of identification.

    What GOP position does the base actually support? The elimination of Obamacare. Why?
    Because they want less health care? No, of course not. The partisanship grows from racism. If the GOP were racially mixed, and not the official white people’s party, they would not be desperately trying to deliver a bill that polls at 17% which they know full well will hurt their own voters. Racist spite is the emotional core of this, with the side benefit of cutting taxes for wealthy people.

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  21. Kylopod says:

    @michael reynolds:

    I just think the black president’s name on health care added a level of intensity and fervor.

    No argument there. In fact I’d go further than saying it added a level of intensity and suggest that Obama’s race helped shape the way in which conservatives attacked him. For instance, Limbaugh described the ACA as “reparations.” Would he have said the same thing about legislation from a white president? I doubt it. Of course he did claim the Clintons offed Vince Foster. The point isn’t that his attacks on a black president were necessarily more unhinged than his attacks on a white one. But Obama’s blackness definitely informed the particular nature of the attacks–the form they took.

    When Newt Gingrich described Obama as the “food stamp president,” it was basically an update of Reagan’s welfare queen. The difference is that his comment was directed at the sitting president rather than an anonymous citizen. This time, those undeserving “others” had a co-conspirator in the White House. But the ultimate source of resentment was still the same as it was 30 years earlier. The president’s race was just one element in fueling their rage–a very important element, perhaps, but not a necessary one.

    Do you think Trump voters want to give rich people a tax cut? Or want less bank regulation? Or care about shutting down the consumer protection bureau? Nah. So what is it that motivates them to support an agenda that has nothing to do with them? Why do they fanatically support the GOP? It’s not the GOP agenda, it’s the fact that the GOP is the White People’s Party – that is their point of identification.

    But this situation has existed to some degree since long before anyone ever heard of Barack Obama. In fact it’s decades old. It was a large part of the basis of the character of Archie Bunker. Carroll O’Connor once described the Archie character as follows:

    “I think probably the most stupid of all conservatives and right-wingers are the poor. No conservative government ever did anything for them, in England or in the United States. The Republicans — it’s not the poor man’s party. So Archie…was a dumbbell. He didn’t know why he was conservative…. He thought that they would keep the country racially pure.”

    That about describes the cultural right since the late 1960s. Of course it’s not just about race–it’s also about gender, sexual orientation, nationality, religion–you name it. What most of it boils down to is fear of a changing world and resentment at a world that has already changed. Obama became a perfect symbol of their rage, but they’d have had it even if the Democrat in the White House had been a good ol’ boy–as in fact was the case in the ’90s.

    Like or Dislike: Thumb up 6 Thumb down 0

  22. Facebones says:

    @michael reynolds: Here’s the difference between Democrats (who I think are mostly result oriented) and Republicans (ideology & tax cuts):

    If Donald Trump actually campaigned to get a Canadian style health care system or even just expanded to Medicare for All. (“We are going to fix those failing Obamacare exchanges by giving everyone the same coverage your grandmother gets!) but it had to be called Donald Trump’s Bigly Amazing MAGAcare, Democrats would be fine with that! We care that people have health care, not the name!

    Like or Dislike: Thumb up 1 Thumb down 0

  23. de stijl says:

    @michael reynolds:
    @Kylopod:

    The past is never dead. It’s not even past.

    There is a persistent thought in White America that people from my tribe use government services responsibly, but “those people” are freeloaders.

    The incidence is falling, but it is still there.

    Like or Dislike: Thumb up 0 Thumb down 0

  24. de stijl says:

    The Chinaman is inscrutable.

    Japanese people are nearsighted and commonly wear enormous eyeglasses. Gilligan would not lie.

    Black Americans exploit government programs.

    Muslims are terrorists.

    These are home truths.

    Like or Dislike: Thumb up 0 Thumb down 0