Senate Returns To Work No Closer To A Health Care Deal
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.