Republicans are celebrating their success at voting to bring the health care bill to the floor Tuesday, but none of the problems that have stalled their effort to repeal and replace Obamacare has really been solved.
Sen. Mitch McConnell passed the test of whether he could be as effective pushing forward legislation as he has been at obstructing bills. But the battle is far from done. The senator still needs to get legislation through the Senate and the conference committee that will pass both chambers. The legislation will have to survive the scrutiny of the parliamentarian if it is to qualify for passage through the budget reconciliation process, which only requires 50, rather than 60 votes, to pass.
The bones of the legislation remain highly problematic and deeply unpopular with broad swaths of the public. Even in red states, many citizens and health care providers are trembling as they think about what conditions will be like if some version of Trumpcare becomes the law. They fear what their future will look like if millions have lost their health care.
The vote on this legislation could be one of those historic moments in Congress when legislators face a moral test of conscience. Rather than allowing legislative debate to continue, as Sen. John McCain stressed in his speech, they would be voting on whether to take away health care coverage, unless the legislation changes radically during the floor debate. The political and moral risks that Republicans face from supporting the existing legislation are immense.
President Trump, notwithstanding his televised appeal, has been nothing but trouble for the GOP, constantly undermining Republican confidence in the ability of the White House to deliver and protect legislators, while failing to focus on selling this bill for more than a few hours. McConnell has also been unable to craft a piece of legislation that commands broad support within his own party, let alone among moderate Democrats. This is why most Republicans were voting yes to bring the bill to the floor without knowing what they will ultimately be voting on, a stunning display of the broken state of our congressional process.
What happened and how did Senate Republicans turn the dire situation from last week into a moment of victory? How did McConnell obtain the votes he needed for a bill that is less popular than any major piece of legislation in several decades?
For both parties, there are lessons to be learned in the reasons for the momentary success in the Senate. They can be summed up as the Four P’s:
Pork: It turns out that tea party Republicans in both chambers are showing they are actually comfortable doling out what they would ordinarily call pork. In the initial revision of the bill, McConnell used portions of the revenues that came from removing the tax cuts on the wealthy to win over the support of reluctant senators with specific provisions benefiting their states at the same time he made the actual bill more conservative to placate Sen. Ted Cruz. Numerous reports suggest this is the game plan when the new version of the legislation reaches the floor. McConnell will allow many amendments, using the projected savings as a piggy bank through which to buy support through all sorts of spending.
Partisanship: Throughout the days that senators such as Susan Collins and Rob Portman, Lisa Murkowski and Dean Heller were proclaiming their independence or moderation, pundits were wondering whether in the end they would fold. This is what happens in our era of intense partisanship. Independent thinking is not common and legislators will usually cave to the leaders of their party. We have seen this happen many times before with so-called Republican “moderates” who end up siding with their party on legislation they privately or publicly deemed to be unreasonable, whether that be on immigration reform or climate change. When push comes to shove, and when it is time to vote, Republicans usually come back to the fold.
Persistence: McConnell, who likes to talk about playing the “long game,” has shown he can remain committed to a goal while Democrats fell asleep at the wheel. Even with his first two stinging defeats, McConnell kept moving forward like the congressional Energizer Bunny. He dusted himself off after the previous defeat and instantly announced he would try again. Pundits speculated about whether he had a secret plan. His plan was to just keep trying.
Meanwhile Democrats lost their focus. At each moment the Senate was poised to vote in the past, the Democrats have been incredibly successful, not only at staying united, but at publicizing and promoting the devastating effects the Republican legislation would have for tens of millions of Americans who will lose their coverage. Grass-roots activists have been unyielding in raising concerns about what the different versions of the bill would do, and letting legislators as well as state officials know there would be political consequences to their support.
Over the last few days, the Democrats seemed lost in the haze of President Trump’s chaos. They understandably turned to other issues, from the Russia scandal to their own new economic platform, without continuing to pound the drum in the states and in the media about what this legislation would do. During these days of silence, Republicans pounced and moved toward a vote, obviously convincing enough Senate doubters that they could take the risk of bringing this to the floor.
As Paul Krugman warned in The New York Times, “We mustn’t let this mother of all scandals take up all our mental bandwidth: Health care for millions is also on the line.” If this bill moves to passage in the form that was being considered last week, or in the form passed by the House, Democratic leader Sen. Chuck Schumer, his colleagues, and their interest group allies will spend a lot of time thinking about the way they spent their energy over the weekend.
Polluted process: Legislating is always ugly. That is the reason for the familiar joke that legislation is like sausage: You never want to see how the final product is made. This time, the process was as ugly as it gets. Not only did McConnell employ a throwback to the kind of secrecy that was familiar in the era before Watergate, when closed congressional rooms were the norm, but he persuaded legislators to move forward without having a bill they could even discuss. Besides Democrats being left out of the deliberations, so, too, were most Republicans.
The procedural vote Tuesday was a vote for blind party loyalty, not deliberation and not sound public policy. McConnell persuaded most of his colleagues to keep moving along despite his not having a concrete plan to debate. The GOP is talking about using the reconciliation process, which prohibits the filibuster, to dismantle one of the biggest social programs we have, a decision that will have huge ripple effects throughout society, without knowing what will come next.
The four P’s were enough to succeed on Tuesday’s procedural vote. Now the question is whether these tactics are sufficient to move legislation through the Senate and then conference committee, or whether the underlying flaws that have stifled progress on this measure since January are still strong enough that they bring this effort to an end. Opponents of the legislation are still in a strong position to block this bill, or to force McConnell into replacing the House version with something much narrower and which has far less dramatic consequences on the population. Still, Democrats might want to take notice of what went wrong.